Impact of Maternal COVID-19 Infection on Long-Term Neonatal Outcomes in Gestational Diabetes Mellitus Pregnancies: A Cohort Study Around the Lifting of COVID-19 Restrictions in China

Abstract Objective This study aimed to delineate the long-term outcomes for neonates born to mothers with GDM who contracted COVID-19 around the lifting of COVID-19 restrictions in china. Study Design: We enrolled 288 neonates born to GDM mothers who were admitted to the neonatal intensive care unit (NICU) between November 1, 2022, and January 31, 2023. The exposure was a positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in GDM mothers. Neonates were followed up for 12 months, with long-term outcomes including infant anthropometrics measures, hospital readmission, and subsequent SARS-CoV-2 infection. Associations between maternal COVID-19 status and infant outcomes were assessed using multivariable logistic regression. Results Neonates born to GDM mothers who had COVID-19 required increased respiratory support (1.6% vs. 6.3%; P = 0.031) and experienced higher rates of neonatal dysglycemia (14.1% vs. 24.0%; P = 0.037), while the incidence of neonatal infection decreased (11.5% vs. 24.0%; P = 0.012). There was a significant association between maternal SARS-CoV-2 positivity and two distinct outcomes in infants: an increased risk of hospital readmission (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.01–3.04) and a reduced risk of subsequent SARS-CoV-2 infection during the follow-up period (OR 0.26; 95% CI 0.15–0.46). Conclusions Around the lifting of COVID-19 restrictions, maternal SARS-CoV-2 infection was associated with an increased risk of neonatal rehospitalization and a reduced risk of subsequent SARS-CoV-2 infection in infants during the 12-month follow-up. Intensive care for newborns of GDM mothers with COVID-19 is essential to minimize the risk of rehospitalization.