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

Abstract

Background: Infants of diabetic mothers 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. Objectives: To determine the impact of maternal diabetes on neonatal and neurological short-term outcomes following neonatal HIE. Methods: 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 (3588752 vs 3214514 g, *P=0.012). Infants of diabetic mother (IDM) with HIE were ventilated longer (8 days vs. 4 days, **P=0.0047) and had a longer neonatal intensive care unit (NICU) stay (18 days vs. 11 days, *P=0.0483) as well as longer time to reach full oral feed (15 days vs. 7 days, *P=0.0432) compared to neonates of non-diabetic mother. Maternal diabetes was also associated with increased risk of death or abnormal neurological examination at discharge in neonates with HIE (OR 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.

Effect of Maternal Diabetes on Time to Full Oral Feedings in Infant’s Admitted to the Neonatal Intensive Care Unit

“…A study revealed a difference of 7 days in infants born to mothers with and without diabetes if they were treated with neonatal hypothermia . 5 This difference could be due to maternal diabetes but more importantly re ect the effect of HIE on the infants. The current study excluded infants with encephalopathy to avoid this confounding in uence of encephalopathy on oral feeding.…”

“…Multiple studies have also compared the incidence and mode of feeding with the future incidence of diabetes in the infants of mothers with diabetes. Although a retrospective study of term neonates with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) identi ed a 7-day difference in the time to oral feedings in the infants of mothers with and without diabetes, 5 no study to date has evaluated the difference between time to oral feedings in infants born to mothers with and without diabetes who did not have HIE.…”