妊娠糖尿病:不良后果与疾病严重程度的关系。

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Rebecca Karkia, Tara Giacchino, Frederick Hii, Charline Bradshaw, Ghada Ramadan, Ranjit Akolekar
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引用次数: 0

摘要

目的:准确估算妊娠期糖尿病(GDM)妇女发生孕产妇和新生儿并发症的风险,并研究这些风险的影响大小与通过饮食调节、二甲双胍和胰岛素治疗的GDM亚组的关联:这是一项大型回顾性队列研究,于 2010 年 1 月至 2022 年 6 月期间在英国一家大型产科医院进行。我们纳入了在妊娠 11-13 周时在本单位预约的单胎妊娠。我们将由多学科团队(MDT)在专科高危门诊处理的 GDM 孕妇与非糖尿病孕妇的孕产妇和新生儿并发症发生率进行了比较。我们将 GDM 孕妇分为通过饮食、二甲双胍和胰岛素治疗的孕妇和未患糖尿病的孕妇。我们进行了逻辑回归分析,以确定GDM孕妇及其治疗亚组的妊娠并发症风险。风险以绝对风险(AR)和几率比(OR)(95% 置信区间 [CI])表示。采用森林图来显示风险:研究对象包括 51,211 例单胎妊娠,其中 2089 例(4.1%)患有 GDM,49,122 例(95.9%)对照组未患糖尿病。在患有 GDM 的孕妇中,有 1247 人(59.7%)通过饮食控制血糖,451 人(21.6%)使用二甲双胍,391 人(18.7%)需要使用胰岛素维持优生。患有 GDM 的孕妇的年龄和体重指数(BMI)较高,非裔加勒比人和南亚人的比例较高,慢性高血压的比例也较高。与非糖尿病对照组相比,GDM 孕妇的早产率、LGA 新生儿分娩率、多羊水、子痫前期、需要人工晶体植入术、择期和急诊 CS 以及 PPH 的发生率均有所上升,而 SGA 新生儿分娩率和无助阴道分娩的可能性则较低。在患有糖尿病的孕妇中,需要使用胰岛素的孕妇发生孕产妇和新生儿并发症的风险明显高于仅靠饮食控制的孕妇:结论:不良后果的风险与 GDM 的严重程度呈线性关系,与病情较轻只需调整饮食的孕妇相比,接受胰岛素治疗的孕妇并发症的风险更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Gestational diabetes mellitus: relationship of adverse outcomes with severity of disease.

Aims: To derive accurate estimates of risk of maternal and neonatal complications in women with gestational diabetes mellitus (GDM) and to investigate the association of the effect size of these risks on subgroups of GDM managed with dietary modification, metformin and insulin therapy.

Methods: This was a large retrospective cohort study undertaken at a large maternity unit in the United Kingdom between January 2010 and June 2022. We included singleton pregnancies that booked at our unit at 11-13 weeks' gestation. The rates of maternal and neonatal complications in pregnancies with GDM that were managed by a multidisciplinary team (MDT) in the specialist high-risk clinic were compared to those in non-diabetic pregnancies. We stratified pregnancies with GDM into those that were managed with diet, metformin and insulin to pregnancies without diabetes. Logistic regression analysis was carried out to determine risks of pregnancy complications in pregnancies with GDM and its treatment subgroups. Risks were expressed as absolute risks (AR) and odds ratio (OR) (95% confidence intervals [CI]). Forest plots were used to graphically demonstrate risks.

Results: The study population included 51,211 singleton pregnancies including 2089 (4.1%) with GDM and 49,122 (95.9%) controls without diabetes. In pregnancies with GDM, there were 1247 (59.7%) pregnancies managed with diet, 451 (21.6%) with metformin and 391 (18.7%) who required insulin for maintaining euglycaemia. Pregnancies with GDM had higher maternal age, body mass index (BMI), higher rates of Afro-Caribbean and South Asian racial origin and higher rates of chronic hypertension. In pregnancies with GDM compared to non-diabetic controls, there was an increased rate of preterm delivery, delivery of LGA neonate, polyhydramnios, preeclampsia, need for IOL, elective and emergency CS and PPH whereas the rate of delivery of SGA neonates and likelihood of an unassisted vaginal delivery were lower. In pregnancies with GDM, there is significantly increased risk of maternal and neonatal complications in those that require insulin compared to those that are managed on dietary modification alone.

Conclusions: There is a linear association between the risk of adverse outcomes and the severity of GDM with those on insulin treatment demonstrating an increased association with complications compared to those that have milder disease requiring only dietary modification.

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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
217
审稿时长
2-3 weeks
期刊介绍: The official journal of The European Association of Perinatal Medicine, The Federation of Asia and Oceania Perinatal Societies and The International Society of Perinatal Obstetricians. The journal publishes a wide range of peer-reviewed research on the obstetric, medical, genetic, mental health and surgical complications of pregnancy and their effects on the mother, fetus and neonate. Research on audit, evaluation and clinical care in maternal-fetal and perinatal medicine is also featured.
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