NICU Admissions Higher in Pregestational Diabetes

Neonatal intensive care unit (NICU) admission rates were significantly higher among infants born to mothers with pregestational diabetes than among those born to mothers with gestational diabetes (GD).
METHODOLOGY:
This Irish study compared risks for NICU admission across maternal diabetes subtypes (type 1 diabetes [T1D], type 2 diabetes [T2D], and GD) to refine counselling and neonatal care.
Researchers conducted a retrospective analysis of 25,238 births (January 2018 to December 2020) and identified 3905 neonates born ≥ 34 weeks to mothers with diabetes, including those with T1D (n = 67), T2D (n = 60), and GD (n = 3712).
Data on gestational age, birth weight, mode of delivery, and maternal age were extracted from the registry. NICU admission details (indications, hypoglycaemia, and respiratory support) and maternal characteristics (body mass index [BMI] > 30 and preeclampsia) were obtained via electronic records.
The analysis was performed using quasi-Poisson regression for assessing NICU admission risk ratios (RRs), analysis of variance for comparing gestational age/birth weight, and chi-square tests for comparing categorical variables.
The primary outcome was the NICU admission rate; secondary outcomes included respiratory distress, severe hypoglycaemia, and maternal discharge timing.
TAKEAWAY:
Neonates born to mothers with T1D and T2D had a admission rate of 41.8% (RR, 3.32) and 31.1% (RR, 3.89), respectively, with both significantly higher than that in those born to mothers with GD (12.5%; RR, 0.133; P ≤ .001); the hospital baseline admission rate was 11.5%.
≤ .001); the hospital baseline admission rate was 11.5%. Neonates of mothers with T1D were born earlier (mean, 37 + 1 weeks) than those of mothers with T2D (mean, 38 + 1 weeks; P = .0019) and GD (mean, 39 weeks; P ≤ .001).
= .0019) and GD (mean, 39 weeks; ≤ .001). Moreover, they showed significantly higher birth weight centiles than those of mothers with T2D and GD at 25th (T1D vs T2D, P = .0042; T1D vs GD, P ≤ .001), median ( P ≤ .0001 for both), and 75th centiles (T1D vs T2D, P ≤ .0001; T1D vs GD, P = .0009).
= .0042; T1D vs GD, ≤ .001), median ( ≤ .0001 for both), and 75th centiles (T1D vs T2D, ≤ .0001; T1D vs GD, = .0009). Respiratory distress dominated T1D admissions (36.7%), while hypoglycaemia was primary in T2D (73.7%).
Mothers with pregestational diabetes were more frequently discharged before their infants (T1D, 42.9%; T2D, 31.5%) than those with GD (21.2%).
IN PRACTICE:
"It is important to counsel mothers on risks and expectations for the newborn period," the authors of the study wrote. "The aim of our study is to describe how the type of maternal diabetes impacts admission to NICU and to provide up-to-date, local data to support healthcare professionals when counselling patients with diabetes in pregnancy," they added.
SOURCE:
This study was led by Dearbhla Hillick, Rotunda Hospital, Dublin, Ireland. It was published online on May 22, 2025, in the European Journal of Pediatrics .
LIMITATIONS:
This study was limited by the dataset being unbalanced, with most neonates born to mothers with GD. Neonates of mothers without diabetes requiring NICU admission were not included. Factors such as maternal smoking, raised BMI, or preeclampsia possibly confounded the NICU admission risk.
DISCLOSURES:
Open access funding was provided by the IReL Consortium. The authors reported having no relevant conflicts of interest.

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