Association of maternal diabetes mellitus with preterm infant outcomes: a systematic review and meta-analysis

Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):271-277. doi: 10.1136/archdischild-2020-320054. Epub 2020 Nov 10.

Abstract

Context: The association between maternal diabetes and outcomes of infants who are born preterm is unclear.

Objective: To perform a systematic review and meta-analysis of clinical studies exploring the association between maternal diabetes and preterm infant outcomes.

Methods: Medline, PubMed and Cumulative Index of Nursing and Allied Health Literature databases were searched without language restriction from 1 January 2000 until 19 August 2019. Studies examining preterm infants <37 weeks gestational age and reporting prespecified outcomes of this review based on maternal diabetes as primary exposure variable were included.

Results: Of 7956 records identified through database searches, 9 studies were included in the study. No significant association was found between maternal diabetes and in-hospital mortality (adjusted RR (aRR) 0.90 (95% CI 0.73 to 1.11); 6 studies; participants=1 191 226; I2=83%). Similarly, no significant association was found between maternal diabetes and bronchopulmonary dysplasia (aRR 1.00 (95% CI 0.92 to 1.07); 4 studies; participants=107 902; I2=0%), intraventricular haemorrhage or cystic periventricular leukomalacia (aRR 0.91 (95% CI 0.80 to 1.03); 3 studies; participants=115 050; I2=0%), necrotising enterocolitis (aRR 1.13 (95% CI 0.90 to 1.42); 5 studies; participants=142 579; I2=56%) and retinopathy of prematurity (ROP) (aRR 1.17 (95% CI 0.85 to 1.61); 5 studies; participants=126 672; I2=84). A sensitivity analysis where low risk of bias studies were included in the meta-analyses showed similar results; however, the heterogeneity was lower for in-hospital mortality and ROP.

Conclusion: Maternal diabetes was not associated with in-hospital mortality and severe neonatal morbidities in preterm infants. Future studies should explore the association between the severity of maternal diabetes with preterm infant outcomes.

Keywords: endocrinology; epidemiology; mortality; neonatology.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Correlation of Data
  • Female
  • Hospital Mortality
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases* / classification
  • Infant, Premature, Diseases* / mortality
  • Pregnancy
  • Pregnancy in Diabetics* / diagnosis
  • Pregnancy in Diabetics* / epidemiology
  • Severity of Illness Index