The aim of our study was to investigate the association between GDM and offspring long-term infectious morbidity while employing sibling matched analysis, which can assist in revealing whether maternal intrinsic or environmental factors are involved in the studied association. STUDY DESIGN: A retrospective population-based cohort study was performed including all sibling deliveries occurring between 1991-2014 at a tertiary medical center. Follow up time was up to 18 years. A Kaplan-Meier survival curve was used to compare the cumulative infectious morbidity incidence and a binary regression of generalized estimation equation (GEE) was created to control for confounders. RESULTS: The study included 6282 individuals (3141 sibling pairs): the first born after normoglycemic pregnancy and other following a pregnancy with GDM. Crude rates of total infectious hospitalizations were found to be significantly higher in the GDM group (12.8% vs 10.3%, OR¼1.3: 95% CI 1.1-1.5, p value¼0.002). The survival analysis demonstrated significantly higher cumulative infectionrelated hospitalization rates in the GDM group (log-rank, p! < 0.001; Figure). The GEE model, which adjusted for the following confounders: preterm labor ( < 37), maternal age and gender, showed an increased risk for offspring infectious related hospitalization in the GDM group (adjusted HR ¼ 1.3; 95% CI 1.2-1.6, p value < 0.001; Table ) CONCLUSION: Offspring born following pregnancies complicated with GDM are at an increased risk for infectious morbidity. This association was based on sibling matched analysis which strengthens maternal intrinsic mechanism linking GDM and offspring health.

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Individuals with do-not-resuscitate (DNR) orders may undergo surgery for symptom relief or to treat reversible conditions. Resuscitative procedures, such as intubation, are frequently necessary to deliver anesthesia and sedation safely. Guidelines recommend that each patient's DNR order be reevaluated preoperatively to ascertain the need for modification or temporary suspension. 1,2 Available evidence suggests incomplete implementation of such guidance. [3][4][5][6] We per-formed a retrospective analysis of orders and documentation describing perioperative management of patients' DNR orders at 1 academic health system in the US.

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