妊娠期糖尿病治疗对妊娠结局的影响。

Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.

作者信息

Crowther Caroline A, Hiller Janet E, Moss John R, McPhee Andrew J, Jeffries William S, Robinson Jeffrey S

机构信息

Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia.

出版信息

N Engl J Med. 2005 Jun 16;352(24):2477-86. doi: 10.1056/NEJMoa042973. Epub 2005 Jun 12.

DOI:10.1056/NEJMoa042973

PMID:15951574

Abstract

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<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women's mood and quality of life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group.

CONCLUSIONS

Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman's health-related quality of life.

摘要

背景

我们进行了一项随机临床试验，以确定对妊娠糖尿病女性进行治疗是否能降低围产期并发症的风险。

方法

我们将妊娠24至34周患有妊娠糖尿病的女性随机分组，一组接受饮食建议、血糖监测，并根据需要进行胰岛素治疗（干预组），另一组接受常规护理。主要结局包括严重围产期并发症（定义为死亡、肩难产、骨折和神经麻痹）、入住新生儿重症监护室、需要光疗的黄疸、引产、剖宫产以及产妇的焦虑、抑郁和健康状况。

结果

干预组490名女性所生婴儿中严重围产期并发症的发生率显著低于常规护理组510名女性所生婴儿（1% 对4%；根据产妇年龄、种族或族裔以及产次调整后的相对风险为0.33；95%置信区间为0.14至0.75；P = 0.01）。然而，干预组中更多女性的婴儿被送入新生儿重症监护室（71% 对61%；调整后的相对风险为1.13；95%置信区间为1.03至1.23；P = 0.01）。干预组女性的引产率高于常规护理组女性（39% 对29%；调整后的相对风险为1.36；95%置信区间为1.15至1.62；P < 0.001），尽管剖宫产率相似（分别为31%和32%；调整后的相对风险为0.97；95%置信区间为0.81至1.16；P = 0.73）。产后三个月，573名女性的情绪和生活质量数据显示，干预组的抑郁发生率较低且得分较高，这与健康状况改善一致。