Date of Award

December 2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Teresa S Johnson

Committee Members

Sandeep Gopalakrishnan, Jennifer T Fink, Diane M Schadewald

Keywords

Diabetes, Disparities, Fetal Outcomes, Infant Outcomes, Maternal Outcomes

Abstract

ABSTRACT

THE IMPACT OF MATERNAL DIABETES ON FETAL AND INFANT OUTCOMES:

A SECONDARY ANALYSIS OF PERIDATA.NET® FROM 2013 TO 2017

Christina Dzioba, MS, ARNP, WHNP-BC, C-EFM

Background: Diabetes is a leading cause of morbidity and mortality for most of the developed world and is known to contribute to adverse maternal, fetal, and infant outcomes. The purpose of this study was to examine the relationship of maternal diabetes to fetal and infant outcomes for infants born in a small heterogeneous urban community with significant disparities in infant mortality using data in the PeriData.Net® database.

Methods: Women with diabetes were case matched to women without diabetes by pre-pregnancy BMI and race to mitigate obesity effects on outcomes in this secondary analysis of PeriData.Net®.

Results (p<0.05= *,p -<0.01 = **, p<0.001 = ***): Compared to Caucasian and Hispanic women with diabetes, African-American women with diabetes had less gestational/more preexisting diabetes (65.3%, CI 56.5-73.9% vs 86.8%, CI 83.7-89.9%***), more pre-pregnancy hypertension (15.7%, CI 9.0-22.3% vs. 7.2%, CI 4.9-9.6%**) and more prematurity (37.4%, CI 28.5-46.2% vs. 23.6%, CI 19.8-27.5%**), and more infant mortality (4.3%, CI 0.6-8.1% vs. 0.9%,CI 0.0-1.7%**). Women of all races with diabetes had higher C-section (44.8%, CI 41.1-48.6% vs. 30.6%, CI 28.1-33.1%***) and hypertension (22.4%, CI 19.2%-25.6% vs.13.8%, CI 11.9%-15.6%***), while diabetes exposed infants experienced more prematurity (25.3%, CI 22.0-28.6% vs. 12.9%, CI 11.1-14.7%,***), NICU admission (18.2%, CI 15.1-21.0% vs. 10.4%, CI 8.6-11.9%***), respiratory distress (9.5%, CI 7.2-11.6% vs. 4.7%, CI 3.5-5.8%,***), hypoglycemia (7.7%, CI 5.6-9.6% vs. 2.3%, CI 1.5-3.1%***), hyperbilirubinemia (8.6%, CI 6.5-10.8% vs. 3.9% CI 2.9-5.0%***), LGA (18.2%, CI 15.2-21.1% vs. 11.6%, CI 9.9-13.4%***) and risk of SGA (OR 1.51, CI 1.04-2.19*). Women with diabetes gained less weight and had heavier infants when adjusted for gestational age.

Conclusions: Diabetes increased cesarean sections and hypertension prevalence for all women. Maternal diabetes increased LGA, SGA, prematurity, hypoglycemia, hyperbilirubinemia and respiratory distress which also increases risk for infant morbidity and mortality. A higher prevalence of preexisting diabetes and prematurity contributes to an increased risk of mortality for African-American infants.

Available for download on Monday, January 04, 2021

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