Respiratory distress syndrome in infants of diabetic mothers in the 1980s: no direct adverse effect of maternal diabetes with modern management

Abstract

The purpose of this study was to test the hypothesis that diabetes in pregnancy in the 1980s no longer represents a direct risk factor for the development of respiratory distress syndrome (RDS) independent of gestational age, race, sex, mode of delivery, and neonatal asphyxia. We pair-matched 127 infants of diabetic mothers (diabetic group) with 127 infants of nondiabetic mothers (controls) for the above factors. Diabetic mothers enrolled before nine weeks' gestation were randomly assigned to one of two groups: I. "strict management," to achieve euglycemic (fasting blood glucose less than 80 mg/dL, 1.5-hour-postprandial blood glucose less than 120 mg/dL); II. "customary management," to provide care "as practiced in the community" (fasting blood glucose 100 mg/dL or less, postprandial blood glucose less than 140 mg/dL). A group enrolled after the first trimester (III) was managed identically to group II. Infants of diabetic mothers had a rate of RDS of 13.4%, not significantly different from the rate of 15% in controls (P greater than .05). When analyzed by gestational age groups of less than 36, or 36 or more weeks' gestation, there was also no difference in frequency of RDS between the diabetic group and controls. By logistic regression analysis, the presence of RDS in infants of diabetic mothers significantly correlated with lower gestational age (P less than .0001), and delivery by cesarean section not preceded by labor (P less than .01)(ABSTRACT TRUNCATED AT 250 WORDS)