{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T07:04:02Z","timestamp":1792047842895,"version":"4.4.0"},"reference-count":79,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T00:00:00Z","timestamp":1617667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Respiratory distress is a significant contributor to newborn morbidity and mortality. An association between infants of diabetic mothers (IDMs) and respiratory distress syndrome (RDS) has been well recognized for decades. As obesity and diabetes prevalence have increased over the past several decades, more women are overweight and diabetic in the first trimester, and many more pregnant women are diagnosed with gestational diabetes. Glycemic control during pregnancy can be challenging due to the maternal need for higher caloric intake and higher insulin resistance. Surfactant is a complex molecule at the alveolar air\u2013liquid interface that reduces surface tension. Impaired surfactant synthesis is the primary etiology of RDS. In vitro cell line studies, in vivo animal studies with diabetic rat offspring, and clinical studies suggest hyperglycemia and hyperinsulinemia can disrupt surfactant lipid and protein synthesis, causing delayed maturation in surfactant in IDMs. A better understanding of the molecular mechanisms responsible for surfactant dysfunction in IDMs may improve clinical strategies to prevent diabetes-related complications and improve neonatal outcomes.<\/jats:p>","DOI":"10.3390\/children8040281","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T10:34:12Z","timestamp":1617705252000},"page":"281","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Molecular Mechanisms of Maternal Diabetes Effects on Fetal and Neonatal Surfactant"],"prefix":"10.3390","volume":"8","author":[{"given":"Hilal","family":"Yildiz Atar","sequence":"first","affiliation":[{"name":"Departments of Pediatrics (Neonatology), UH Rainbow Babies and Children\u2019s Hospital, Case Western Reserve University, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5870-1000","authenticated-orcid":false,"given":"John E.","family":"Baatz","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics (Neonatology), Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4588-3412","authenticated-orcid":false,"given":"Rita M.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics (Neonatology), UH Rainbow Babies and Children\u2019s Hospital, Case Western Reserve University, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"579","DOI":"10.2337\/diacare.28.3.579","article-title":"Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM screening program","volume":"28","author":"Dabelea","year":"2005","journal-title":"Diabetes Care"},{"key":"ref_2","first-page":"1081","article-title":"Diabetes and pregnancy: National trends over a 15 year period","volume":"61","author":"Mackin","year":"2018","journal-title":"Diabetologia"},{"key":"ref_3","unstructured":"International Diabetes Federation (2019). 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