383: Gestational diabetes mellitus: an independent risk factor for long-term respiratory morbidity of the offspring

Objective
To assess whether gestational diabetes mellitus (GDM) increases the risk for long- term respiratory morbidity of the offspring.
Study Design
A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to respiratory disease between singletons exposed and unexposed to GDM. Deliveries occurred between the years 1991-2014 in a tertiary medical center. Mothers with pre-gestational diabetes and children with congenital malformations were excluded from the study. Kaplan-Meier survival curve was used to estimate cumulative incidence of respiratory morbidity. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters.

Results
During the study period 256,270 deliveries met the inclusion criteria; 5.0% of mothers were diagnosed with GDM (n=12,889), of which 4.0% were classified as diet controlled diabetes (GDMA1; n=10,241) and 1.0% with treated diabetes (GDMA2; n=2,648). During the follow-up period, children born to women with GDMA2 had a significantly higher risk for respiratory disease as compared to GDMA1 and to patients without GDM (7.7% vs. 5.7% vs. 5.7%, respectively, p<0.001). Likewise, children born to women with GDMA2 had a higher cumulative incidence of respiratory morbidity, using a Kaplan-Meier survival curve (figure). In a GEE multivariable logistic regression model, controlling for the time-to-event, maternal age, gestational age at delivery and birth-weight, both GDMA1 and GDMA2 were noted as independent risk factors for long-term respiratory disease of the offspring (table).
Conclusion
In utero exposure to GDM is an independent risk factor for long-term pediatric respiratory morbidity.