MATERNO-FETAL MEDICINE Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks Pauline Vignoles • Catherine Gire • Julien Mancini • Florence Bretelle • Le´on Boubli • Eustase Janky • Xavier Carcopino Received: 23 September 2010 / Accepted: 6 December 2010 / Published online: 18 December 2010 Ó Springer-Verlag 2010 Abstract Purpose To evaluate if gestational diabetes (GD) exposes neonates delivered after 34 weeks to an increased risk of severe neonatal respiratory failure (NRF). Methods Data from 3,237 women who delivered after 34 weeks with systematic screening for GD were analyzed. Diagnosis of severe NRF required the association of clin- ical and radiological criteria with a minimum of 24 h of ventilation and admission to neonatal intensive care unit. Results A total of 166 (5.1%) cases of GD were identi- fied. Severe NRF was diagnosed in 7 (4.21%) cases among women with GD as compared to 13 (0.42%) in others (p \ 0.001). The rate of severe NRF was also significantly higher in cases of premature delivery (p \ 0.001), fetal growth retardation (p \ 0.001), and cesarean section (p = 0.005). After adjustment for these variables, GD was identified as an independent risk factor for NRF (AOR 11.55, 95% CI 3.9–33.9, p \ 0.001). Two other risk factors were also identified: late preterm delivery (AOR 6.13, 95% CI 1.8–21.2, p = 0.004); and hypotrophy (AOR 9.16, 95% CI 2.7–30.5, p \ 0.001). Conclusions GD is an independent risk factor for severe NRF after 34 weeks. Neonates from such pregnancies should be monitored carefully. Keywords Diabetes mellitus Á Gestational diabetes Á Neonatal respiratory failure Á Ventilation Á Late preterm delivery Introduction Gestational diabetes (GD) represents a major public health concern. Its prevalence varies from 1.4 to 14% with con- stantly increasing trend [1]. Diabetes during pregnancy, whether pregestational (i.e., diabetes prior to pregnancy) or developed during pregnancy (i.e., gestational diabetes), exposes mothers and neonates to severe complications [2–4]. In neonates, diabetes during pregnancy is a major risk factor for macrosomia and associated complications, including fetopelvic disproportion leading to cesarean delivery and shoulder dystocia [3, 5]. The incidence of neonatal disorders such as severe neonatal hypoglycemia, hyperbilirubinemia and hypocalcemia is also increased [2, 3]. Finally, neonates from women with diabetes during pregnancy are exposed to an increased risk of neonatal respiratory morbidity [3, 6]. But the impact of the type of diabetes, whether pregestational or gestational, on this risk remains unclear, particularly in neonates delivered after 34 weeks of gestation. Neonatal respiratory failure (NRF) is a major cause of immediate and long-term neonatal morbidity and mortality in preterm neonates, but also in term ones [7]. Respiratory failure requiring mechanical ventilation therefore P. Vignoles Á E. Janky Service de Gyne´cologie Obste´trique, Hoˆpital de Pointe-a` Pitre Abymes, 97159 Pointe a` Pitre Cedex, Guadeloupe, France P. Vignoles Á F. Bretelle Á L. Boubli Á X. Carcopino (&) Service de Gyne´cologie Obste´trique, Hoˆpital Nord, Chemin des Bourrely, 13915 Cedex 20, Marseille, France e-mail: xcarco@free.fr J. Mancini Service Sante´ Publique, Hoˆpital de la Timone, 264, Rue Saint-Pierre, 13385 Marseille Cedex 5, France C. Gire Service de Pe´diatrie, Hoˆpital Nord, Chemin des Bourrely, 13915 Cedex 20, Marseille, France 123 Arch Gynecol Obstet (2011) 284:1099–1104 DOI 10.1007/s00404-010-1810-9