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. 2017 Jul;60(7):1244-1251.
doi: 10.1007/s00125-017-4279-2. Epub 2017 Apr 13.

Risks of asphyxia-related neonatal complications in offspring of mothers with type 1 or type 2 diabetes: the impact of maternal overweight and obesity

Sven Cnattingius  1 , Anna Lindam  1 , Martina Persson  2
Affiliations

Risks of asphyxia-related neonatal complications in offspring of mothers with type 1 or type 2 diabetes: the impact of maternal overweight and obesity

Sven Cnattingius et al. Diabetologia. 2017 Jul.

Abstract

Aims/hypothesis: We aimed to compare the risks of severe asphyxia-related neonatal complications in the offspring of mothers with type 1 or type 2 diabetes, and to assess the impact of maternal overweight/obesity on these risks.

Methods: This was a population-based study of 1,343,751 live-born singleton infants in Sweden between 1997 and 2011, including 5941 and 711 infants of mothers with type 1 and type 2 diabetes, respectively. ORs with 95% CIs were calculated for low Apgar score (0-6) at 5 min after birth, hypoxic ischaemic encephalopathy and neonatal seizures.

Results: The rates of a low Apgar score were 0.9%, 2.6% and 2.1% in the offspring of mothers without diabetes or with type 1 or type 2 diabetes, respectively. After controlling for maternal confounders (including BMI), the risk of a low Apgar score increased in the offspring of mothers with type 1 diabetes (OR 2.67, 95% CI 2.23, 3.20) but not in the offspring of mothers with type 2 diabetes (OR 1.25, 95% CI 0.66, 2.35). The ORs of hypoxic ischaemic encephalopathy or neonatal seizures were increased in the offspring of mothers with type 1 diabetes (OR 3.41, 95% CI 2.58, 4.49) and type 2 diabetes (OR 2.54, 95% CI 1.13, 5.69). Maternal overweight/obesity was a risk factor for asphyxia-related neonatal complications and low Apgar scores in the offspring of mothers with type 1 diabetes and mothers without diabetes.

Conclusions/interpretation: The risks of a low Apgar score and severe asphyxia-related neonatal complications are increased in the offspring of mothers with type 1 or type 2 diabetes. Maternal overweight/obesity is an important contributing factor.

Keywords: Apgar score; Asphyxia; Asphyxia-related neonatal morbidity; Body mass index (BMI); Diabetes type 1; Diabetes type 2; Obesity; Overweight.

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Conflict of interest statement

Data availability

The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. This national cohort study was based on data from the Swedish MBR. According to Swedish law, the authors are not able to share the register data used in this study with other researchers.

Funding

MP was funded by Stockholm City Council (clinical post-doc position). The study was supported by a grant from the Swedish Research Council for Health, Working Life and Welfare (grant No. 2014-0073) and by an unrestricted grant from the Karolinska Institutet (Distinguished Professor Award to SC).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

MP, AL and SC contributed to the concept and design of the study, the analysis or interpretation of data, critical revision of the manuscript for important intellectual content and final approval of the manuscript. In addition, SC was involved in acquisition of the data and administrative, technical or material support, MP was involved in drafting the manuscript and AL was involved in the statistical analysis. SC had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

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