Massachusetts General Hospital, Division of Maternal Fetal Medicine, 55 Fruit Street, Founders 4th Floor, Boston, MA 02114, USA.
Curr Diab Rep. 2013 Feb;13(1):12-8. doi: 10.1007/s11892-012-0338-8.
Fetal macrosomia and maternal diabetes are independent risk factors for shoulder dystocia, an obstetrical emergency that may cause permanent neonatal injury. Randomized trials of glycemic control in pregnancies complicated by gestational diabetes reveal decreased rates of macrosomia and shoulder dystocia among those treated. However, definitions of gestational diabetes vary and a specific glycemic threshold for clinically significant risk reduction remains to be delineated. This review discusses risks associated with gestational diabetes including macrosomia (birth weight above 4000-4500 g) and delivery-related morbidity, specifically, shoulder dystocia. Subsequently, we will review recent randomized trials assessing the impact of glycemic control on these delivery-related morbidities. Finally, we will examine a large observational study that found associations with delivery-related morbidity and hyperglycemia below current diabetic thresholds, observations which may suggest reexamination of current diagnosis guidelines for gestational diabetes.
胎儿巨大儿和母亲糖尿病是肩难产的独立危险因素，肩难产是一种产科急症，可能导致新生儿永久性损伤。妊娠期糖尿病患者血糖控制的随机试验显示，治疗后巨大儿和肩难产的发生率降低。然而，妊娠期糖尿病的定义存在差异，临床显著降低风险的特定血糖阈值仍有待明确。这篇综述讨论了与妊娠期糖尿病相关的风险，包括巨大儿（出生体重超过 4000-4500 克）和与分娩相关的发病率，特别是肩难产。随后，我们将回顾最近评估血糖控制对这些与分娩相关的发病率影响的随机试验。最后，我们将研究一项大型观察性研究，该研究发现与目前糖尿病阈值以下的与分娩相关的发病率和高血糖有关的关联，这些观察结果可能表明需要重新检查目前的妊娠期糖尿病诊断指南。
