Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study

Reem Zeki; Alex Y Wang; Kei Lui; Zhuoyang Li; Jeremy J N Oats; Caroline S E Homer; Elizabeth A Sullivan

doi:10.1136/bmjpo-2017-000224

Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study

BMJ Paediatr Open. 2018 Jan 30;2(1):e000224. doi: 10.1136/bmjpo-2017-000224. eCollection 2018.

Authors

Reem Zeki¹, Alex Y Wang¹, Kei Lui², Zhuoyang Li¹, Jeremy J N Oats³, Caroline S E Homer⁴, Elizabeth A Sullivan¹

Affiliations

¹ Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia.
² School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia.
³ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Faculty of Health, Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia.

Abstract

Objectives: To investigate the association between the mode of birth and adverse neonatal outcomes of macrosomic (birth weight ≥4000 g) and non-macrosomic (birth weight <4000 g) live-born term singletons in vertex presentation (TSV) born to mothers with diabetes (pre-existing and gestational diabetes mellitus (GDM)).

Design: A population-based retrospective cohort study.

Setting: New South Wales, Australia.

Patients: All live-born TSV born to mothers with diabetes from 2002 to 2012.

Intervention: Comparison of neonatal outcomes by mode of birth (prelabour caesarean section (CS) and planned vaginal birth resulted in intrapartum CS, non-instrumental or instrumental vaginal birth).

Main outcome measures: Five-minute Apgar score <7, admission to neonatal intensive care unit (NICU) or special care nursery (SCN) and the need for resuscitation.

Results: Among the 48 882 TSV born to mothers with diabetes, prelabour CS was associated with a significant increase in the rate of admission to NICU/SCN compared with planned vaginal birth.For TSV born to mothers with pre-existing diabetes, compared with non-instrumental vaginal birth, instrumental vaginal birth was associated with increased odds of the need for resuscitation in macrosomic (adjusted ORs (AOR) 2.6; 95% CI (1.2 to 7.5)) and non-macrosomic TSV (AOR 3.3; 95% CI (2.2 to 5.0)).For TSV born to mothers with GDM, intrapartum CS was associated with increased odds of the need for resuscitation compared with non-instrumental vaginal birth in non-macrosomic TSV (AOR 2.3; 95% CI (2.1 to 2.7)). Instrumental vaginal birth was associated with increased likelihood of requiring resuscitation compared with non-instrumental vaginal birth for both macrosomic (AOR 2.3; 95% CI (1.7 to 3.1)) and non-macrosomic (AOR 2.5; 95% CI (2.2 to 2.9)) TSV.

Conclusion: Pregnant women with diabetes, particularly those with suspected fetal macrosomia, need to be aware of the increased likelihood of adverse neonatal outcomes following instrumental vaginal birth and intrapartum CS when planning mode of birth.

Keywords: diabetes; intensive care; outcomes research; resuscitation.