[Insulin treatment of gestational diabetes and respiratory outcome in late-preterm and term babies]. / Diabète gestationnel traité par insuline et risque de détresse respiratoire sévère chez le nouveau-né de plus de 34 semaines d'aménorrhée.

While the incidence of diabetes mellitus (DM) during pregnancy has been steadily increasing in recent years, the link between gestational DM and respiratory outcome in neonates has not been firmly established. To address this gap in understanding, we asked whether DM status and its treatment during pregnancy influence risk of neonatal respiratory distress. We conducted retrospective analysis of a large cohort to determine the relationship between maternal DM status (non-DM, insulin-treated DM [DTI], and non-insulin-treated DM [DTR]) and respiratory distress in term and near-term singletons, born at Robert-Debré Hospital over a 7-year period. Of 18,095 singletons delivered at 34 weeks of gestation or later, 412 (2.3%) were admitted to the NICU for respiratory distress within the first hours of life. The incidence of NICU admissions due to respiratory distress was 2.2% in the non-DM group, 2.1% in the DTR group, and 5.7% in the DTI group. Insulin treatment of DM, together with several other perinatal factors, was associated with an increased risk for severe respiratory distress. In a multivariate model, we found that DTI, but not DTR, was a risk factor independent of gestational age and cesarean section, with an IRR of 1.44 (95% CI, 1.00-2.08). The data indicate that newborns of mothers with DM treated with diet are not at risk for severe respiratory distress. Conversely, newborns of mothers with DM treated with insulin are associated with elevated risk for severe respiratory disease and should therefore be closely monitored.

[Intrauterine growth retardation and the developing brain]. / Retard de croissance intra-utérin et cerveau en développement.

Fetal growth restriction is the second leading cause of perinatal morbidity and mortality, behind prematurity, and is present in 5-12% of all pregnancies in the general population. Often confused with children constitutionally small for gestational age, those who had not achieved their potential for fetal growth and therefore having true growth restriction can be identified using customized growth curves. The point is to accurately identify fetuses with slowing growth or cessation of growth reflecting a pathological process, because these are at risk of death in utero or chronic fetal hypoxia with a significant impact on brain development. The kinetics of growth and prenatal markers of fetal growth restriction will influence the decision to extract the fetus and the gestational age at birth, as well as other factors involved in the neurodevelopmental outcome. Cognitive deficits and executive, motor, and behavioral dysfunctions described in the short term seem to persist together with greater risk of metabolic syndrome in adulthood. Decisions of fetal extraction by C-section continue to be debated until new epidemiological data will be available on large cohorts monitored over the long term using accurate neurocognitive tools. Understanding the effects of fetal growth restriction on the structure and function of the developing brain is essential for improving the relevance of fetal extraction decisions, perinatal care, and early evaluation of treatments for the prevention of neurodevelopmental disorders.