Effect of treatment of gestational diabetes mellitus on pregnancy outcomes
Effect of treatment of gestational diabetes mellitus on pregnancy outcomes
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DOI：
10.1056/nejmoa042973
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发表时间：
2005-06-16
影响因子：
158.5
通讯作者：
Robinson, JS
中科院分区：
文献类型：
--
作者：
Crowther, CA;Hiller, JE;Robinson, JS
背景：我们进行了一项随机临床试验，以确定妊娠期糖尿病的治疗是否降低了围产期并发症的风险。方法：我们随机将妊娠24-34周的妊娠期糖尿病患者随机分为两组，根据需要接受饮食建议、血糖监测和胰岛素治疗(干预组)或常规护理。主要结果包括严重的围产期并发症(定义为死亡、肩难产、骨折和神经麻痹)、进入新生儿托儿所、需要光疗的黄疸、引产、剖宫产、以及母亲的焦虑、抑郁和健康状况。结果：干预组中490名妇女的婴儿的严重围产期并发症的发生率显著低于常规护理组510名妇女中的婴儿(1%对4%；调整了母亲年龄、种族或民族和产次的相对风险，0.33；95%的可信区间，0.14-0.75；干预组产妇的引产率高于常规护理组(39%vs 29%；调整后相对危险度1.36；95%可信区间1.15至1.62；P=0.01)。
BACKGROUND:We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications.METHODS:We randomly assigned women between 24 and 34 weeks' gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status.RESULTS:The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01).However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01).Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P