糖尿病酮症酸中毒的妊娠结局：一项系统综述。

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-05-28 DOI:10.1016/j.ajogmf.2025.101711

Gabriella D. Cozzi-Glaser MD , Allison M. Davis MD , Megan Bell MLIS, AHIP , Ashley N. Battarbee MD, MSCR

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引用次数: 0

摘要

目的：本系统综述的主要目的是评估妊娠期或妊娠期糖尿病患者至少发生一次糖尿病酮症酸中毒（DKA）后的妊娠结局。数据来源：对PubMed、EMBASE、Web of Science和谷歌Scholars网站上的英文出版物进行电子搜索，检索时间为1990年1月至2023年6月。研究资格标准：入选标准包括妊娠期DKA患者的随机临床试验或观察性研究（即队列研究、病例对照研究），以及对孕产妇或新生儿结局的评估。排除系统评价、专家评价、病例报告、病例系列、动物研究或未经同行评议的出版物；此外，那些只有摘要或没有全文手稿的出版物被排除在外。研究评价和综合方法：每项研究由两位共同作者详细审查。采用随机试验的Cochrane偏倚风险工具和乔安娜布里格斯研究所（JBI）的队列和病例对照分析评估工具对每项研究的质量进行评估。结果：在数据检索中确定的1,313项研究中，有7项符合最终纳入标准。研究异质性排除了任何荟萃分析。在妊娠期至少有一次DKA发作的患者中，产妇和新生儿不良结局的发生率很高，死产发生率为7-35%，剖宫产发生率为49-64%，早产发生率为25-83%，新生儿ICU住院率为40-65%。最近的研究指出死产率为7-31%，大多数分析发现死产率为7%。结论：缺乏设计良好的研究来评估DKA的妊娠结局。DKA后的产妇和胎儿结局仍然很差，尽管死产可能随着时间的推移而逐渐减少。随着糖尿病护理和DKA管理的进步，未来的回顾性和前瞻性分析应评估DKA的管理和结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Pregnancy outcomes following diabetic ketoacidosis: a systematic review

OBJECTIVE

The primary objective of this systematic review was to evaluate pregnancy outcomes following at least 1 episode of diabetic ketoacidosis in patients with gestational or pregestational diabetes mellitus.

DATA SOURCES

An electronic search of English-language publications in PubMed, Embase, Web of Science, and Google Scholar covered the period from January 1990 to June 2023.

STUDY ELIGIBILITY CRITERIA

The eligibility criteria included randomized clinical trials or observational studies (ie, cohort studies, case–control studies) of patients with diabetic ketoacidosis in pregnancy and evaluation of maternal or neonatal outcomes. Systematic reviews, expert reviews, case reports, case series, animal studies, non–peer-reviewed publications, abstract-only publications, and publications without available full-text articles were excluded.

METHODS

Each study was reviewed in detail by 2 coauthors. The quality of each study was appraised using the Cochrane RoB 2 risk-of-bias tool for randomized trials and the JBI Critical Appraisal tools for cohort and case–control analyses.

RESULTS

Of the 1313 studies identified through data search, 7 met the final inclusion criteria. Study heterogeneity precluded any meta-analysis. High rates of adverse maternal and neonatal outcomes were found among those with at least 1 episode of diabetic ketoacidosis in pregnancy, with the following incidence rates: 7% to 35% for stillbirth, 49% to 64% for cesarean delivery, 25% to 83% for preterm birth, and 40% to 65% for neonatal intensive care unit admission. The most recent studies note a stillbirth rate of 7% to 31%, with most analyses finding a rate <17%.

CONCLUSION

There is a paucity of well-designed studies evaluating pregnancy outcomes associated with diabetic ketoacidosis. Maternal and fetal outcomes following diabetic ketoacidosis remain poor, although stillbirth may be incrementally decreasing over time. As diabetes care and diabetic ketoacidosis management advance, future retrospective and prospective analyses should evaluate the management and outcomes of diabetic ketoacidosis.

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.