Pregestational Diabetes and Duration of Active Labour Compared With Non-Diabetic Women: A Population-Based Cohort Study

IF 4.3 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Bjog-An International Journal of Obstetrics and Gynaecology Pub Date : 2025-07-07 DOI:10.1111/1471-0528.18276

Sofia Nevander, Sara Carlhäll, Karin Källén, Caroline Lilliecreutz, Marie Blomberg

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Abstract

Objective

To evaluate the impact of pregestational diabetes on duration of active labour (DAL) in induced and spontaneous labour and to compare caesarean section (CS) rates and indications between women with and without diabetes.

Design

A population-based cohort study.

Setting

Sweden.

Population

243 537 nulliparous women, registered in the Swedish Pregnancy Register, who delivered a singleton fetus at ≥ 34⁺⁰ gestational weeks + days between 2014 and 2020. Women with gestational diabetes mellitus were excluded.

Methods

DAL was compared between women with pregestational diabetes and those without diabetes using Kaplan-Meier survival analysis and Cox regression analysis.

Main Outcome Measures

DAL. Rates and indications for CS.

Results

Women with pregestational diabetes had longer active labour and a reduced chance of vaginal delivery at a given time-point compared to women without diabetes, adjusted hazard ratio 0.65 (95% CI: 0.60–0.70, p < 0.001). Among those with spontaneous labour, median DAL in diabetic vs. non-diabetic women was 9.60 h versus 8.75 h, difference 0.85 h (95% CI 0.20–1.50), p < 0.001. Corresponding numbers for induced labours were 8.92 h versus 7.20 h, difference 1.72 h (95% CI 0.94–2.49), p < 0.001.

Elective and emergency CS rates were higher in women with pregestational diabetes than non-diabetic women (7.4% and 29.4% vs. 2.6% and 7.1% respectively), with suspected macrosomia (50.4%) and fetal distress (31.9%) being the most common indications for CS among women with pregestational diabetes.

Conclusions

The prolonged labour duration in women with pregestational diabetes highlights the importance of the labour ward staff's support and patience in managing diabetic parturients, potentially allowing more time before diagnosing labour dystocia. Extended labour duration may also influence women's birth experience.

Abstract Image

查看原文本刊更多论文

与非糖尿病妇女相比，妊娠期糖尿病和产程持续时间：一项基于人群的队列研究。

目的评价妊娠期糖尿病对引产和自然分娩时产程（DAL）的影响，比较有糖尿病和无糖尿病妇女剖宫产（CS）率和适应证。设计：基于人群的队列研究。背景：瑞典。在2014年至2020年期间，在瑞典妊娠登记处登记的537名分娩≥34+0孕周+天的单胎妇女。排除有妊娠期糖尿病的妇女。方法采用Kaplan-Meier生存分析和Cox回归分析，比较妊娠期糖尿病患者与非妊娠期糖尿病患者的sdal。主要结果测量。CS的发生率和适应症。结果：与没有糖尿病的妇女相比，妊娠期糖尿病妇女在给定时间点的主动分娩时间更长，阴道分娩的机会减少，调整后的风险比为0.65 （95% CI: 0.60-0.70, p < 0.001）。在自然分娩中，糖尿病妇女与非糖尿病妇女的中位DAL分别为9.60 h和8.75 h，差异0.85 h (95% CI 0.20-1.50), p < 0.001。引产时间分别为8.92 h和7.20 h，差异为1.72 h (95% CI 0.94 ~ 2.49), p < 0.001。妊娠期糖尿病妇女的选择性和急诊CS发生率高于非糖尿病妇女（分别为7.4%和29.4%，分别为2.6%和7.1%），疑似巨大儿（50.4%）和胎儿窘迫（31.9%）是妊娠期糖尿病妇女CS最常见的适应症。结论妊娠期糖尿病患者的分娩时间延长，凸显了产房工作人员对糖尿病患者的支持和耐心的重要性，可能为诊断难产提供更多时间。分娩时间延长也可能影响妇女的分娩经历。

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来源期刊

Bjog-An International Journal of Obstetrics and Gynaecology 医学-妇产科学

CiteScore

10.90

自引率

5.20%

发文量

345

审稿时长

3-6 weeks

期刊介绍： BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.