Maternal DM linked to newborn persistent pulmonary hypertension

  • Shu LP & al.
  • Can J Diabetes
  • 31/10/2019

  • Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Maternal diabetes mellitus (DM) is associated with increased risk for persistent pulmonary hypertension of the newborn (PPHN).
  • For babies with refractory hypoxemia born to mothers with diabetes, PPHN should be considered.

Why this matters

  • PPHN is a major cause of respiratory failure and even death in neonates.

Study design

  • Systematic review identified 5 observational cohort and 2 case-control studies, including 5083 PPHN cases.
  • Funding: National Natural Science Foundation of China; Beijing Municipal Administration of Hospital’s Youth Program; others.

Key results

  • PPHN incidence was approximately 0.2% and significantly higher (~6%) among preterm infants with gestational age
  • Compared with mothers without diabetes, pooled adjusted risk ratio (aRR) for PPHN for mothers with diabetes (either preexisting or gestational) was 1.37 (95% CI, 1.23-1.51).
  • Association was significant in case-control studies (aRR, 1.91; 95% CI, 1.02-2.79) and in cohort studies (aRR, 1.36; 95% CI, 1.22-1.50).
  • After exclusion of a single study of extremely preterm infants, a significant association between maternal diabetes and PPHN persisted among the 6 studies of late-preterm infants (aRR, 1.42; 95% CI, 1.28-1.56), with no evidence of heterogeneity.

Limitations

  • Potential for selection bias.
  • Missing information on variables such as weight, medications, lifestyle.
  • Varying degree of confounder adjustment across studies.