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Am J Perinatol
DOI: 10.1055/a-2053-7904
Original Article

Exposure to Maternal Diabetes during Pregnancy Is Associated with Aggravated Short-Term Neonatal and Neurological Outcomes following Perinatal Hypoxic–Ischemic Encephalopathy

Nancy Laval 
1   CHU Ste-Justine Research Center, Montréal, QC, Canada
2   Department of Neonatology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
,
Mariane Paquette
1   CHU Ste-Justine Research Center, Montréal, QC, Canada
2   Department of Neonatology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
,
Hamza Talsmat
1   CHU Ste-Justine Research Center, Montréal, QC, Canada
,
Bohdana Marandyuk
1   CHU Ste-Justine Research Center, Montréal, QC, Canada
,
Pia Wintermark
4   Department of Pediatrics, Montréal Children's Hospital, Montréal, QC, Canada
,
Ala Birca
1   CHU Ste-Justine Research Center, Montréal, QC, Canada
3   Division of Neurology, Department of Neurosciences and Paediatrics, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
,
Elana F Pinchefsky
1   CHU Ste-Justine Research Center, Montréal, QC, Canada
3   Division of Neurology, Department of Neurosciences and Paediatrics, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
,
Sophie Tremblay
1   CHU Ste-Justine Research Center, Montréal, QC, Canada
2   Department of Neonatology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
› Author Affiliations Funding None.
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Abstract

Objective Infants of diabetic mothers (IDM) are at higher risk of perinatal morbidities and glycemic instability, but the impact of maternal diabetes on neonatal and neurological short-term outcomes of neonates with hypoxic–ischemic encephalopathy (HIE) remains poorly described. Our objective was to determine the impact of maternal diabetes on neonatal and neurological short-term outcomes following neonatal HIE.

Study Design This was a retrospective single-center study including 102 term neonates with HIE who received therapeutic hypothermia (TH) treatment between 2013 and 2020. Multiple regression analysis was used to assess the relationship between the presence of maternal diabetes and short-term outcomes.

Results Neonates with HIE and maternal diabetes exposure had a significantly lower gestational age at birth (38.6 vs. 39.7 weeks of gestation, p = 0.005) and a significantly higher mean birth weight (3,588 ± 752 vs. 3,214 ± 514 g, p = 0.012). IDM with HIE were ventilated for longer duration (8 vs. 4 days, p = 0.0047) and had a longer neonatal intensive care unit (NICU) stay (18 vs. 11 days, p = 0.0483) as well as took longer time to reach full oral feed (15 vs. 7 days, p = 0.0432) compared with neonates of nondiabetic mother. Maternal diabetes was also associated with an increased risk of death or abnormal neurological examination at discharge in neonates with HIE (odds ratio: 6.41 [1.54–26.32]).

Conclusion In neonates with HIE, maternal diabetes is associated with an increased risk of death or short-term neonatal morbidities, such as longer duration of ventilation, prolonged neonatal stay, greater need for tube feeding, and being discharged with an abnormal neurological examination. Strategies to prevent, reduce, or better control maternal diabetes during pregnancy should be prioritized to minimize complications after perinatal asphyxia.

Key Points

  • Maternal DB is associated with unfavorable outcomes.

  • IDM have longer ventilatory support and tube feeding.

  • IDM have higher risk of abnormal neurological examination.

Keywords

hypoxic–ischemic encephalopathy - maternal diabetes - asphyxia - neonatal outcomes - neurological examinations

Supplementary Material



Publication History

Received: 30 August 2022

Accepted: 24 February 2023

Accepted Manuscript online:
14 March 2023

Article published online:
18 April 2023

© 2023. Thieme. All rights reserved.

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