A recent study in the BJOG journal highlighted the urgent need to identify and treat early gestational diabetes mellitus (eGDM) to lower the risk of neonatal respiratory distress syndrome (NRDS). The study aimed to look into the factors associated with NRD in eGDM.
Researchers conducted a nested case-control analysis of the TOBOGM trial at seventeen hospitals in different countries. The study included pregnant women with eGDM of less than 20 weeks of gestation.
The study included women with GDM who had completed an OGTT before 20 weeks. Patients were randomized to receive immediate or deferred GDM treatment. Comparison of pregnancies with/without NRD and pregnancies with NRD with /without high-dependency nursery admission, admitted for more than 24 hours, with those with less than 24 hrs was done. For age, ethnicity, education, pre-pregnancy body mass index, and BMI, the comparison was adjusted. More than 4 hours of respiratory support (supplemental oxygen or supported ventilation) postpartum (NRD), respiratory distress syndrome (RDS), which includes supported ventilation and a nursery stay of more than 24 hours, were the primary outcomes.
NRD incidence halved in 99 of 793 infants with NRD when GDM treatment was started early. The association of NRD was found with Caesarean section (2.31, 1.42-3.76), shorter gestation (0.95, 0.93-0.97 days longer), and large for gestational age (LGA) (1.83, 1.09-3.08). A stay of more than 24 hours was associated with higher 1-hour OGTT glucose (1.38, 1.08-1.76 mmol/L). Results also showed that 15 infants had RDS.