Delivery outcomes of large-for-gestational-age newborns stratified by the presence or absence of gestational diabetes mellitus
Delivery outcomes of large-for-gestational-age newborns stratified by the presence or absence of gestational diabetes mellitus
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DOI：
10.1002/ijgo.12387
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发表时间：
2018-04-01
影响因子：
3.8
通讯作者：
Aviram, Amir
中科院分区：
文献类型：
--
作者：
Rosen, Hadar;Shmueli, Anat;Aviram, Amir
目的：评估妊娠期糖尿病 (GDM) 和大于胎龄 (LGA) 对分娩结局的单独和综合影响。方法：在以色列特拉维夫 2007 年至 2014 年期间足月单胎分娩的回顾性队列研究中，比较了非 GDM/AGA 妊娠（参考）和三个研究组：非 GDM/LGA、GDM/适合胎龄的结局(AGA) 和 GDM/LGA。 结果：总体而言，共有 62102 例分娩，其中 53201 例 (85.7%) 符合纳入条件。其中，43775 例 (82.3%) 为非 GDM/AGA，6441 例 (12.1%) 非 GDM/LGA，2351 例 (4.4%) GDM/AGA，634 例 (1.2%) GDM/LGA。与参考组相比，研究组的平均产妇年龄较高，既往剖宫产率、羊水过多、引产率和剖宫产率较高。仅考虑尝试阴道分娩的女性，三组与不良结局独立相关，包括剖宫产（非 GDM/LGA、GDM/AGA 和 GDM/LGA 的调整比值比 [aOR] 分别为 1.5、1.6 和 2.6），主要与第一产程延长和低血糖（aOR 分别为 1.9、2.5 和 4.6）。伴或不伴 GDM 的 LGA 与肩难产（aOR 分别为 14.5 和 6.9）、第二产程延长和黄疸相关。 结论：GDM 和 LGA 在妊娠并发症方面具有相似性。两者的存在会产生累积影响。
Objective: To evaluate separate and combined contributions of gestational diabetes mellitus (GDM) and large-for-gestational age (LGA) on delivery outcomes.Methods: In a retrospective cohort study of term singleton deliveries between 2007 and 2014 in Tel Aviv, Israel, outcomes were compared between non-GDM/AGA pregnancies (reference) and three study groups: non-GDM/LGA, GDM/appropriate for gestational age (AGA) and GDM/LGA.Results: Overall, there were 62102 deliveries, of which 53201 (85.7%) were eligible for inclusion. Of these, 43775 (82.3%) were non-GDM/AGA, 6441 (12.1%) non-GDM/LGA, 2351 (4.4%) GDM/AGA, and 634 (1.2%) GDM/LGA. Compared with the reference group, the study groups had higher mean maternal age and higher rates of previous cesarean delivery, polyhydramnios, induction of labor, and cesarean delivery. Considering only women attempting vaginal delivery, the three groups were independently associated with adverse outcomes including cesarean delivery (adjusted odds ratio [aOR], 1.5, 1.6, and 2.6 for non-GDM/LGA, GDM/AGA, and GDM/LGA, respectively), mainly for prolonged first stage of labor, and hypoglycemia (aOR, 1.9, 2.5, and 4.6, respectively). LGA with and without GDM was associated with shoulder dystocia (aOR, 14.5 and 6.9, respectively), prolonged second stage, and jaundice.Conclusion: GDM and LGA share similarities in pregnancy complications. The presence of both has a cumulative impact.