Randomized Controlled Trial

. 2025 Jul;132(8):1087-1095.

doi: 10.1111/1471-0528.17938. Epub 2024 Aug 19.

Effect of treatment for early gestational diabetes mellitus on neonatal respiratory distress: A secondary analysis of the TOBOGM study

David Simmons¹, Jincy Immanuel¹, William M Hague², Suzette Coat², Helena Teede³, Christopher J Nolan⁴, Michael J Peek⁵, Jeff R Flack⁶, Mark McLean⁷, Vincent W Wong⁸, Emily J Hibbert⁹, Alexandra Kautzky-Willer¹⁰, Jürgen Harreiter^{10

11}, Helena Backman¹², Emily Gianatti¹³, Arianne Sweeting¹⁴, Viswanathan Mohan¹⁵, N Wah Cheung¹⁶; TOBOGM Research Group

Collaborators, Affiliations

Collaborators

TOBOGM Research Group:
Raiyomand Dalal, Georgia Soldatos, Suja Padmanabhan, Rohit Rajagopal, Victoria Rudland, Herbert Kiss, Erik Schwarcz, Ranjit Mohan Anjana, Uma Ram

Affiliations

¹ School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
² Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
³ Department of Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Medicine, Canberra Hospital and Australian National University, Canberra, Australian Capital Territory, Australia.
⁵ School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia.
⁶ Department of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.
⁷ Department of Medicine, Blacktown Hospital, Sydney, New South Wales, Australia.
⁸ Department of Medicine, Liverpool Hospital and University of New South Wales, Sydney, New South Wales, Australia.
⁹ Nepean Clinical School, Faculty of Medicine and Health, University of Sydney and Nepean Hospital, Sydney, New South Wales, Australia.
¹⁰ Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
¹¹ Department of Medicine, Landesklinikum Scheibbs, Scheibbs, Austria.
¹² Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
¹³ Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch, Western Australia, Australia.
¹⁴ Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
¹⁵ Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India.
¹⁶ Department of Medicine, Westmead Hospital, Sydney, New South Wales, Australia.

PMID: 39157877
PMCID: PMC12137773
DOI: 10.1111/1471-0528.17938

Randomized Controlled Trial

Effect of treatment for early gestational diabetes mellitus on neonatal respiratory distress: A secondary analysis of the TOBOGM study

David Simmons et al. BJOG. 2025 Jul.

. 2025 Jul;132(8):1087-1095.

doi: 10.1111/1471-0528.17938. Epub 2024 Aug 19.

Authors

Collaborators

TOBOGM Research Group:
Raiyomand Dalal, Georgia Soldatos, Suja Padmanabhan, Rohit Rajagopal, Victoria Rudland, Herbert Kiss, Erik Schwarcz, Ranjit Mohan Anjana, Uma Ram

Affiliations

¹ School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
² Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
³ Department of Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Medicine, Canberra Hospital and Australian National University, Canberra, Australian Capital Territory, Australia.
⁵ School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia.
⁶ Department of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.
⁷ Department of Medicine, Blacktown Hospital, Sydney, New South Wales, Australia.
⁸ Department of Medicine, Liverpool Hospital and University of New South Wales, Sydney, New South Wales, Australia.
⁹ Nepean Clinical School, Faculty of Medicine and Health, University of Sydney and Nepean Hospital, Sydney, New South Wales, Australia.
¹⁰ Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
¹¹ Department of Medicine, Landesklinikum Scheibbs, Scheibbs, Austria.
¹² Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
¹³ Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch, Western Australia, Australia.
¹⁴ Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
¹⁵ Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India.
¹⁶ Department of Medicine, Westmead Hospital, Sydney, New South Wales, Australia.

PMID: 39157877
PMCID: PMC12137773
DOI: 10.1111/1471-0528.17938

Abstract

Objective: To identify factors associated with neonatal respiratory distress (NRD) in early Gestational diabetes mellitus (eGDM).

Design: Nested case-control analysis of the TOBOGM trial.

Setting: Seventeen hospitals: Australia, Sweden, Austria and India.

Population: Pregnant women, <20 weeks' gestation, singleton, GDM risk factors.

Methods: Women with GDM risk factors completed an oral glucose tolerance test (OGTT) before 20 weeks: those with eGDM (WHO-2013 criteria) were randomised to immediate or deferred GDM treatment. Logistic regression compared pregnancies with/without NRD, and in pregnancies with NRD, those with/without high-dependency nursery admission for ≤24 h with those admitted for >24 h. Comparisons were adjusted for age, pre-pregnancy body mass index, ethnicity, smoking, primigravity, education and site. Adjusted odds ratios (95% CI) are reported.

Main outcome measures: NRD definition: ≥4 h of respiratory support (supplemental oxygen or supported ventilation) postpartum. Respiratory distress syndrome (RDS): Supported ventilation and ≥24 h nursery stay.

Results: Ninety-nine (12.5%) of 793 infants had NRD; incidence halved (0.50, 0.31-0.79) if GDM treatment was started early. NRD was associated with Caesarean section (2.31, 1.42-3.76), large for gestational age (LGA) (1.83, 1.09-3.08) and shorter gestation (0.95, 0.93-0.97 per day longer). Among NRD infants, >24 h nursery-stay was associated with higher OGTT 1-h glucose (1.38, 1.08-1.76 per mmol/L). Fifteen (2.0%) infants had RDS.

Conclusions: Identifying and treating eGDM reduces NRD risk. NRD is more likely with Caesarean section, LGA and shorter gestation. Further studies are needed to understand the mechanisms behind this eGDM complication and any long-term effects.

Keywords: diagnostic criteria; early gestational diabetes mellitus; first trimester; gestational diabetes mellitus; neonatal intensive care; neonatal respiratory distress; pregnancy; screening.

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Conflict of interest statement

None declared. Neither the funding sources nor the author‐affiliated institutions took part in the trial design, the collection, analysis and interpretation of the data, manuscript writing or the decision to submit it for publication.

References

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Effect of treatment for early gestational diabetes mellitus on neonatal respiratory distress: A secondary analysis of the TOBOGM study

Collaborators

Affiliations

Effect of treatment for early gestational diabetes mellitus on neonatal respiratory distress: A secondary analysis of the TOBOGM study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources