Association between insulin and post-caesarean resuscitation rates in infants of women with GDM: A retrospective study

Background Gestational diabetes mellitus (GDM) and caesarean deliveries independently increase the risk of postoperative complications. There are limited data on the influence of insulin use on the outcomes of neonates who were delivered via caesarean section. We sought to investigate the impact of insulin use in women with GDM on resuscitation rates of infants post caesarean delivery. Methods A retrospective database review of women with singleton term (>= 37 weeks) pregnancies who were on insulin for GDM delivering between January 2005 and December 2014 at a major metropolitan hospital in Sydney. Results One thousand eight hundred and fifty-seven women with GDM were identified. The mean age was 31.01 +/- 5.63 years and mean gestational period of 39.07 +/- 1.00 weeks. 31.0% received insulin treatment for GDM. Women who were on insulin were older (31.9 +/- 5.7 vs 30.6 +/- 5.6 years, P < 0.001), had a higher body mass index (BMI) (31.2 +/- 7.7 vs 29.0 +/- 7.4 kg/m2, P < 0.001), higher rates of preeclampsia (7.3% vs 4.1%, P = 0.004), lower rates of alcohol consumption (0.4% vs 1.7%, P = 0.014), and had infants with lower resuscitation rates (21.2% vs 28.6%, P = 0.001). Infants who required resuscitation had a lower gestational age, lower five-minute APGAR score, and lower birth weight, length, and head circumferences. On multivariate analysis, women with GDM treated with insulin (odds ratio [OR] = 0.69, CI = 0.54-0.89, P = 0.004), higher gestational age (OR = 0.88, CI = 0.78-0.99, P = 0.032), higher maternal BMI (OR = 1.02, CI = 1.01-1.04, P = 0.005), and emergency caesarean (OR = 2.33, CI = 1.74-3.12, P < 0.001) independently predicted incidence of resuscitation. Conclusions The findings suggest a relationship between insulin use and reduced resuscitation rates of infants born from mothers with GDM. Further studies investigating the role, dosage, and criteria for insulin use in women with GDM are required.