Article Text

Download PDFPDF
Association of maternal diabetes mellitus with preterm infant outcomes: a systematic review and meta-analysis
  1. Abdul Razak,
  2. Maheer Faden
  1. Department of Pediatrics, Princess Nourah Bint Abdulrahman University, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
  1. Correspondence to Dr Abdul Razak, Division of Neonatology, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; aabdulkhader{at}; aarazak{at}


Context The association between maternal diabetes and outcomes of infants who are born preterm is unclear.

Objective To perform a systematic review and meta-analysis of clinical studies exploring the association between maternal diabetes and preterm infant outcomes.

Methods Medline, PubMed and Cumulative Index of Nursing and Allied Health Literature databases were searched without language restriction from 1 January 2000 until 19 August 2019. Studies examining preterm infants <37 weeks gestational age and reporting prespecified outcomes of this review based on maternal diabetes as primary exposure variable were included.

Results Of 7956 records identified through database searches, 9 studies were included in the study. No significant association was found between maternal diabetes and in-hospital mortality (adjusted RR (aRR) 0.90 (95% CI 0.73 to 1.11); 6 studies; participants=1 191 226; I2=83%). Similarly, no significant association was found between maternal diabetes and bronchopulmonary dysplasia (aRR 1.00 (95% CI 0.92 to 1.07); 4 studies; participants=107 902; I2=0%), intraventricular haemorrhage or cystic periventricular leukomalacia (aRR 0.91 (95% CI 0.80 to 1.03); 3 studies; participants=115 050; I2=0%), necrotising enterocolitis (aRR 1.13 (95% CI 0.90 to 1.42); 5 studies; participants=142 579; I2=56%) and retinopathy of prematurity (ROP) (aRR 1.17 (95% CI 0.85 to 1.61); 5 studies; participants=126 672; I2=84). A sensitivity analysis where low risk of bias studies were included in the meta-analyses showed similar results; however, the heterogeneity was lower for in-hospital mortality and ROP.

Conclusion Maternal diabetes was not associated with in-hospital mortality and severe neonatal morbidities in preterm infants. Future studies should explore the association between the severity of maternal diabetes with preterm infant outcomes.

  • neonatology
  • mortality
  • endocrinology
  • epidemiology

Statistics from


  • Twitter @DrAbdulRazak_MD

  • Presented at The study findings were accepted for scientific presentation at Pediatric Academic Societies 2020; however, the results were not presented as the conference was called off due to the Coronavirus pandemic.

  • Contributors AR conceptualised and designed the study, performed the initial screening of the articles, abstracted the data, performed meta-analyses including risk of bias assessment, drafted the manuscript and approved the final version. MF co-conceptualised the study, double checked the initial screening of articles and double checked all the data extraction from included studies, reviewed the study protocol and helped revise the manuscript and approved the final version.

  • Funding This research was funded by the Deanship of Scientific Research at Princess Nourah Bint Abdulrahman University through the Fast track Research Funding Programme. The funder had no role in conceiving the study design, collection, analysis and interpretation of the data, and decision to publish the study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Not required

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.