BMJ open · 2025
Associations between gestational diabetes mellitus and survival without bronchopulmonary dysplasia in very preterm infants: a multicentre cohort study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Lei Xiaoping, Du Juan, Jiang Siyuan, Zhou Jianguo, Hu Liyuan, Xiao Tiantian, Zhu Yanping, Shi Wei, Qian Aimin, Bai Ruimiao, Dang Dan, Han Yujie, Li Shujuan, Gu Xinyue, Du Li-Zhong, Hei Mingyan, Lee Shoo K, Zhou Wenhao, Dong Wenbin, Chinese Neonatal Network
Аннотация
OBJECTIVE: To investigate whether gestational diabetes mellitus (GDM) was associated with survival without bronchopulmonary dysplasia (BPD) in very preterm infants (VPIs).
DESIGN: Retrospective multicentre cohort study.
SETTING: A total of 79 neonatal intensive care units across China, January 2019 to December 2021.
PARTICIPANTS: A total of 23 752 VPIs (<32 weeks' gestation) or very low birth weight infants (<1500 g), comprising 4452 GDM-exposed and 19 300 unexposed infants.
MAIN OUTCOME MEASURES: The primary outcomes are survival without BPD at 36 weeks' postmenstrual age (PMA) and its components.
RESULTS: Infants exposed to GDM were associated with a higher rate of survival without BPD (aOR 1.12, 95% CI 1.04 to 1.21) at 36 weeks PMA and lower mortality (aOR 0.75, 95% CI 0.64 to 0.84) before 36 weeks PMA than unexposed infants. However, no significant association was observed between GDM and BPD at 36 weeks PMA (aOR 0.94, 95% CI 0.87 to 1.02), respiratory distress syndrome, need for advanced resuscitation or mechanical ventilation. After propensity score matching, GDM-exposed VPIs maintained higher survival without BPD (aOR 1.13, 95% CI 1.02 to 1.26) and lower mortality (aOR 0.81, 95% CI 0.68 to 0.97). These associations were strongest in infants born before 28 weeks (aOR 1.32, 95% CI 1.11 to 1.57) and those small for gestational age (aOR 1.41, 95% CI 1.11 to 1.80).
CONCLUSIONS: GDM was not associated with worsened BPD in VPIs. The positive association with survival and survival without BPD warrants could reflect a selection bias.
DESIGN: Retrospective multicentre cohort study.
SETTING: A total of 79 neonatal intensive care units across China, January 2019 to December 2021.
PARTICIPANTS: A total of 23 752 VPIs (<32 weeks' gestation) or very low birth weight infants (<1500 g), comprising 4452 GDM-exposed and 19 300 unexposed infants.
MAIN OUTCOME MEASURES: The primary outcomes are survival without BPD at 36 weeks' postmenstrual age (PMA) and its components.
RESULTS: Infants exposed to GDM were associated with a higher rate of survival without BPD (aOR 1.12, 95% CI 1.04 to 1.21) at 36 weeks PMA and lower mortality (aOR 0.75, 95% CI 0.64 to 0.84) before 36 weeks PMA than unexposed infants. However, no significant association was observed between GDM and BPD at 36 weeks PMA (aOR 0.94, 95% CI 0.87 to 1.02), respiratory distress syndrome, need for advanced resuscitation or mechanical ventilation. After propensity score matching, GDM-exposed VPIs maintained higher survival without BPD (aOR 1.13, 95% CI 1.02 to 1.26) and lower mortality (aOR 0.81, 95% CI 0.68 to 0.97). These associations were strongest in infants born before 28 weeks (aOR 1.32, 95% CI 1.11 to 1.57) and those small for gestational age (aOR 1.41, 95% CI 1.11 to 1.80).
CONCLUSIONS: GDM was not associated with worsened BPD in VPIs. The positive association with survival and survival without BPD warrants could reflect a selection bias.