Influence of maternal insulin-dependent diabetes mellitus on neonatal morbidity.

OBJECTIVE

To compare the neonatal morbidity rates (corrected for gestational age at delivery and method of delivery) among infants of women with insulin-dependent diabetes mellitus and those of women without diabetes.

DESIGN

Historical cohort analysis.

SETTING

Tertiary care centre.

PATIENTS

All liveborn infants of women with insulin-dependent diabetes mellitus (IDM group) born between Jan. 1, 1980, and Dec. 31, 1989, each matched for gestational age at delivery, method of delivery and year of birth with two newborns of women without diabetes (control group).

MAIN OUTCOME MEASURES

Neonatal respiratory distress, jaundice, hypoglycemia, polycythemia, hypocalcemia, intraventricular hemorrhage, seizure and macrosomia.

RESULTS

There were 230 infants in the IDM group and 460 in the control group. Compared with the control group the IDM group had significantly higher incidence rates of glucose infusion (odds ratio [OR] 5.38), birth weight above the 90th percentile (OR 4.15) and neonatal jaundice (OR 1.94). No significant difference was found in the incidence rate of respiratory distress, polycythemia or hypocalcemia. The maternal serum hemoglobin A (HbA) level was not significantly related to birth weight, and neither the serum HbA level nor the presence of macrosomia was predictive of neonatal morbidity. Nearly 25% of the infants in the IDM group were born before 37 weeks' gestation; 48.2% of these were delivered early because of maternal hypertension.

CONCLUSIONS

Neonatal morbidity in infants of women with diabetes is determined more by gestational age at delivery than by the maternal diabetes. Within the limits obtained in this study the degree of control of the diabetes does not seem to affect neonatal morbidity.