Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
Department of Obstetrics and Gynecology, IRCSS S. Matteo Hospital, v.le Golgi, 27100 Pavia, Italy.
Diabetes Res Clin Pract. 2014 Mar;103(3):444-51. doi: 10.1016/j.diabres.2013.12.019. Epub 2014 Jan 3.
To investigate the effects of uncomplicated vaginal delivery and epidural analgesia on fetal acid-base parameters in women with gestational diabetes (GDM) compared with controls.
A retrospective case-control study of 142 women with gestational diabetes and 284 controls. To evaluate the effect of diabetes and analgesia on acid-base status correcting for potential confounders we used ordered logistic equations including quartiles of fetal arterial acid-base parameters collected at birth as outcomes and categories of diabetes and epidural analgesia as explanatory variables.
In the GDM group cord base deficit (-2.63 mmol/l, interquartile range [IQR]=4.2 to -0.65 mmol/l vs. -1.9 mmol/l, IQR=-3.3 to -0.2 mmol/l, p=0.009, odds ratio (OR)=1.51, 95% confidence interval (CI)=1.04-2.18) was lower and concentration of calcium higher (1.49 mmol/l, IQR=1.42-1.56 mmol/l vs. 1.47 mmol/l, IQR=1.41-1.51 mmol/l, p=0.009, OR=1.69, 95% CI=1.12-2.56) compared with controls. Epidural analgesia in the GDM group was associated with reduced cord concentration of glucose (84.0mg/dl [4.7 mmol/l], IQR=70-103.3mg/dl vs. 92.5mg/dl [5.1 mmol/l], IQR=76.5-121.8 mg/dl, p=0.004), lactate (2.65 mmol/l (IQR=1.80-4.20) vs. 3.70 mmol/l (IQR=2.90-5.55 mmol/l), p=0.002) and less pronounced base deficit (-2.05 mmol/l, IQR=-3.90 to -0.17 mmol/l vs. -2.8, IQR=-5.57 to -1.05 mmol/l, p=0.01, OR=0.7, 95% CI=0.49-0.99).
In uncomplicated pregnancies and deliveries, well-controlled gestational diabetes mellitus has potentially significant detrimental effects on fetal acid-base status at birth. Epidural analgesia reduces cord arterial glucose and lactates.
研究与对照组相比，单纯阴道分娩和硬膜外镇痛对患有妊娠期糖尿病（GDM）女性胎儿酸碱参数的影响。
这是一项回顾性病例对照研究，共纳入 142 名患有妊娠期糖尿病的女性和 284 名对照。为了评估糖尿病和镇痛对酸碱状态的影响，我们使用有序逻辑方程，将出生时采集的胎儿动脉酸碱参数的四分位数作为结局，并将糖尿病和硬膜外镇痛的类别作为解释变量。
在 GDM 组中，脐带基础不足（-2.63mmol/L，四分位距[IQR]=4.2 至-0.65mmol/L 与-1.9mmol/L，IQR=-3.3 至-0.2mmol/L，p=0.009，优势比[OR]=1.51，95%置信区间[CI]=1.04-2.18）较低，钙浓度较高（1.49mmol/L，IQR=1.42-1.56mmol/L 与 1.47mmol/L，IQR=1.41-1.51mmol/L，p=0.009，OR=1.69，95%CI=1.12-2.56）与对照组相比。GDM 组硬膜外镇痛与脐带血葡萄糖浓度降低相关（84.0mg/dl[4.7mmol/L]，IQR=70-103.3mg/dl 与 92.5mg/dl[5.1mmol/L]，IQR=76.5-121.8mg/dl，p=0.004）、乳酸浓度（2.65mmol/L（IQR=1.80-4.20）与 3.70mmol/L（IQR=2.90-5.55mmol/L），p=0.002）和基础不足程度降低（-2.05mmol/L，IQR=-3.90 至-0.17mmol/L 与-2.8，IQR=-5.57 至-1.05mmol/L，p=0.01，OR=0.7，95%CI=0.49-0.99）。
在单纯的妊娠和分娩中，控制良好的妊娠期糖尿病可能对胎儿出生时的酸碱状态产生显著的不利影响。硬膜外镇痛降低脐带动脉葡萄糖和乳酸水平。
