Elucidating the Relationship Between Maternal Diabetes and Neonatal Abstinence Syndrome: A 2017-2018 Project WATCH Study in Rural Appalachia.
Arin Jennings, Collin John, Christa Lilly and 2 others
PMID 34138790WHAT IT FOUND
Among substance-exposed infants, maternal diabetes was linked with fewer NAS diagnoses, but this was seen only in term births, not preterm births.
It was not tested as a cause, and NAS diagnosis relied on clinician judgment.
Key findings
01Among infants with intrauterine substance exposure, maternal diabetes was associated with lower odds of NAS (unadjusted OR 0.74; adjusted OR 0.70).
02In stratified analysis, lower NAS odds with maternal diabetes remained significant in term births (adjusted OR 0.67) but not in preterm births (OR 0.85).
03In the substance-exposed group, 1814 infants (34.97%) developed NAS and 253 (5.02%) had maternal diabetes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
NAS diagnosis was made by physicians using a broad definition and transcribed by nurses, and it was subjective and may vary by practitioner. The study did not know diabetes onset, duration, control, severity, or type after grouping diabetes as yes or no. It did not distinguish types or amounts of substances, or multiple exposures. 144 cases had missing diabetes data, and the chi-square analysis included 5044 infants. The association was significant in term births but not preterm births, and NAS scoring may be less tailored for preterm infants. Symptoms of NAS and hypoglycemia overlap, and the broad NAS definition may label hypoglycemia as NAS. Observational data cannot show maternal diabetes caused lower NAS; the authors postulate glucose or dextrose masking or metabolic pathways.
Declared interests
The authors declared no conflicts of interest. No funding source is stated in the supplied text.
The easy way to misread this
Do not conclude that maternal diabetes prevents NAS or that infants with maternal diabetes need less monitoring. This was an observational association, not a tested intervention, and it was significant in term births but not preterm births.