Long-term endocrine outcome of small for gestational age infants born to mothers with and without gestational diabetes mellitus

Abstract

Small for gestational age (SGA) infants and infants born to mothers with gestational diabetes mellitus (GDM) are at an increased risk for significant morbidity and mortality, mainly metabolic disorders. We aimed to question the long-term endocrine morbidity of SGA infants born to mothers with GDM compared to SGA infants born to non- diabetic mothers. A population-based cohort study was performed to assess the risk for endocrine morbidity among children born SGA to mothers with and without GDM. The main outcome evaluated was endocrine morbidity of the offspring up to the age of 18 years, predefined in a set of ICD-9 codes. Endocrine morbidity included thyroid disease, insulin and non-insulin dependent diabetes mellitus, hypoglycemia, childhood obesity, parathyroid hormone disease, adrenal disease, and sex hormone disease. All SGA infants born between the years 1991 and 2014 and discharged alive from the hospital were included in the study. Multiple pregnancies, infants with congenital malformations or chromosomal abnormalities and mothers lacking prenatal care were excluded from the analysis. Kaplan–Meier survival curve was constructed to compare cumulative endocrine morbidity. A Cox proportional hazards model was conducted to control for confounders. During the study period, 9312 newborn infants met the inclusion criteria, of them 259 SGA infants were born to mothers with GDM and 9053 SGA infants were born to mother without GDM. No significant differences in long-term endocrine morbidity were noted between the groups (0.8% in children born to mothers with GDM vs. 0.5% in children born to non-diabetic mothers, p = .62). Likewise, the Kaplan–Meier survival curve did not demonstrate a significantly higher cumulative incidence of endocrine morbidity in offspring of women with GDM (log rank test p=.67). In a Cox regression model, while controlling for ethnicity, hypertensive disorders, preterm birth, and maternal age, delivery of an SGA neonate to mother with GDM was not associated with long-term endocrine morbidity of the offspring (adjusted HR 1.2, 95% confidence interval 0.27–5.00, p=.82). SGA infants born to mothers with GDM are not at an increased risk for long-term endocrine morbidity as compared with SGA infants born to non-diabetic mothers.

摘要

小于胎龄儿和患有妊娠糖尿病（GDM）的孕妇所生婴儿发病率和死亡率增加, 主要是代谢紊乱。我们的目的是探讨GDM孕妇所产的SGA婴儿与非糖尿病孕妇所产的SGA婴儿的远期内分泌疾病发病率。进行一项基于人群的队列研究, 以评估患有和不患有GDM的孕妇所生SGA的儿童内分泌疾病发病率的风险。评估的主要结局是18岁以下子代的一组ICD-9编码中预先定义的内分泌疾病的发病率。内分泌疾病包括甲状腺疾病、胰岛素和非胰岛素依赖型糖尿病、低血糖、儿童肥胖、甲状旁腺激素疾病、肾上腺疾病和性激素疾病。所有1991年至2014年出生并出院的SGA患儿均纳入研究。多胎妊娠、先天性畸形或染色体异常婴儿以及缺乏产前护理的孕妇不纳入研究范围。构建Kaplan-Meier生存曲线进行累积内分泌疾病发病率比较。采用Cox比例风险模型控制混杂因素。在研究期间, 9312名新生儿符合纳入标准, 其中259名SGA患儿的母亲患有GDM, 9053名SGA患儿的母亲没有GDM。两组远期内分泌疾病发病率没有显著差异(GDM孕妇生的SGA婴儿组0.8% vs.非糖尿病孕妇生的SGA婴儿组0.5%, p＝0.62). 同样,kaplan-meier生存曲线没有显示GDM孕妇所生后代的累积内分泌疾病发病率明显增高(对数秩检验p＝0.67)。Cox回归模型中, 在控制种族、高血压疾病、早产和母亲年龄时, SAG婴儿由GDM孕妇分娩与远期内分泌疾病发病率不相关。（调整后的HR1.2,95%置信区间0.27 - 5.00,p等于0.82)。与非糖尿病孕妇所生的SGA婴儿相比, GDM孕妇所产的SGA婴儿患远期内分泌疾病的风险并不高。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Long-term endocrine morbidity
• small for gestational age
• gestational diabetes mellitus

Acknowledgments

This study was conducted as part of the requirements for MD degree from the Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev.

Disclosure statement

No potential conflict of interest was reported by the authors.