Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks

Purpose To evaluate if gestational diabetes (GD) exposes neonates delivered after 34 weeks to an increased risk of severe neonatal respiratory failure (NRF). Methods Data from 3,237 women who delivered after 34 weeks with systematic screening for GD were analyzed. Diagnosis of severe NRF required the association of clinical and radiological criteria with a minimum of 24 h of ventilation and admission to neonatal intensive care unit. Results A total of 166 (5.1%) cases of GD were identified. Severe NRF was diagnosed in 7 (4.21%) cases among women with GD as compared to 13 (0.42%) in others (p < 0.001). The rate of severe NRF was also significantly higher in cases of premature delivery (p < 0.001), fetal growth retardation (p < 0.001), and cesarean section (p = 0.005). After adjustment for these variables, GD was identified as an independent risk factor for NRF (AOR 11.55, 95% CI 3.9-33.9, p < 0.001). Two other risk factors were also identified: late preterm delivery (AOR 6.13, 95% CI 1.8-21.2, p = 0.004); and hypotrophy (AOR 9.16, 95% CI 2.7-30.5, p < 0.001). Conclusions GD is an independent risk factor for severe NRF after 34 weeks. Neonates from such pregnancies should be monitored carefully.