Type-2 diabetes mellitus: does prenatal care affect outcomes?
Type-2 diabetes mellitus: does prenatal care affect outcomes?
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DOI：
10.1080/14767058.2016.1276558
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发表时间：
2018-01-01
影响因子：
1.8
通讯作者：
Caughey, Aaron B.
中科院分区：
文献类型：
--
作者：
Allen, Allison J.;Snowden, Jonathan M.;Caughey, Aaron B.
目的：确定产前护理是否会影响患有 2 型糖尿病 (T2DM) 的孕妇的不良围产期结局。研究设计：这是一项针对 1997 年至 2006 年间在加利福尼亚州患有孕前糖尿病的孕妇的回顾性队列研究，使用了与出生证明相关的生命统计数据。妇女按就诊时间进行分层，我们比较了在妊娠早期、妊娠晚期就诊的妇女以及分娩前未接受产前护理的妇女。观察的围产期结局包括：先兆子痫、巨大儿、早产、剖腹产和宫内胎儿死亡（IUFD）。通过卡方检验对两组进行比较以确定统计显着性。结果：在患有妊娠前糖尿病的女性中，在分娩时就诊的女性发生 IUFD 的风险为 11.3%，而在妊娠早期就诊的女性则为 0.9%。晚期就诊队列中的早产率也有所增加（分娩时为 29.4%，而妊娠前三个月为 21.0%）。使用逻辑回归模型调整可能的混杂变量后，IUFD 和早产率仍然具有统计学意义，调整后的比值比分别为 11.37（95% CI：6.10-21.16）和 1.55（95% CI：1.03-2.32）。三个队列之间巨大儿或先兆子痫的发生率没有差异。结论：整个怀孕期间 T2DM 的治疗可改善孕产妇和新生儿的结局。
Objective: To determine if prenatal care affects adverse perinatal outcomes in pregnant women with Type-2 diabetes mellitus (T2DM).Study design: This was a retrospective cohort study of pregnant women with pregestational diabetes mellitus pregnancies in the state of California between 1997 and 2006, using vital statistics data linked to birth certificates. Women were stratified by time of presentation to care and we compared those who presented in the first trimester, third trimester, and those who had no prenatal care prior to delivery. Perinatal outcomes looked at included: preeclampsia, macrosomia, preterm delivery, cesarean delivery, and intrauterine fetal demise (IUFD). The two groups were compared with chi-squared testing to determine statistical significance.Results: In women with pregestational diabetes those who presented at time of delivery had an 11.3% risk of IUFD compared to 0.9% in those who presented in the first trimester. There was also an increased rate of preterm birth in the late presentation cohort (29.4% at time of delivery versus 21.0% in the first trimester). After adjusting for possible confounding variables using logistic regression models, rates of IUFD and preterm delivery were still found to be statistically significant with adjusted odds ratios of 11.37 (95% CI: 6.10-21.16) and 1.55 (95% CI: 1.03-2.32), respectively. There were no differences in rates of macrosomia or preeclampsia between the three cohorts.Conclusions: Treatment of T2DM throughout pregnancy leads to improved maternal and neonatal outcomes.