Bas-Lando Maayan, Srebnik Naama, Farkash Rivka, Ioscovich Alexander, Samueloff Arnon, Grisaru-Granovsky Sorina
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine, Jerusalem, Israel,
Arch Gynecol Obstet. 2014 Nov;290(5):905-12. doi: 10.1007/s00404-014-3313-6. Epub 2014 Jun 28.
To evaluate the effect of elective induction at term for women with gestational diabetes mellitus (GDM) on the risk for cesarean delivery.
This is a retrospective case-control matched study, based on a single-center computerized database, 2005-2011. The medical records were reviewed for GDM management and glycemic control. For the study, two groups were defined: Group 1, women diagnosed with GDM with an estimated fetal weight <4,000 g, electively induced at term; Group 2, women induced due to Term-PROM, an indication for term induction in normoglycemic women with uncomplicated pregnancies, matched for age and parity (ratio 1:2). The primary outcome was cesarean delivery and secondary outcomes included other maternal and neonatal events. Descriptive analyses and multivariate analyses models were fitted.
GDM was diagnosed in 1,873 (2.6 %) women of 72,374 births; 227 (12.1 %) were eligible for inclusion in Group 1 and matched with 454 women in Group 2. GDM management included diet in 103 (45.4 %), insulin in 81 (35.7 %), and oral hypoglycemic agents in 43 (18.9 %).The cesarean delivery rate was significantly higher in Group 1, 17.1 vs. 11.2 % (p = 0.02). Three out of four births complicated by shoulder dystocia and BW <4,000 g, occurred in Group 1 (p = 0.076) and were associated with no glycemic control. Other obstetrical-related outcomes such as instrumental birth, severe perineal tears, early postpartum hemorrhage and peripartum transfusion were similar between groups.
Elective induction at term for women with GDM is associated with an increased risk for cesarean delivery as compared to other elective induction of labor.
评估足月选择性引产对妊娠期糖尿病（GDM）女性剖宫产风险的影响。
这是一项回顾性病例对照匹配研究，基于2005 - 2011年单中心计算机数据库。对GDM管理和血糖控制的病历进行了审查。在本研究中，定义了两组：第1组，诊断为GDM且估计胎儿体重<4000g的女性，足月选择性引产；第2组，因足月胎膜早破引产的女性，这是血糖正常且无并发症妊娠的足月引产指征，按年龄和胎次匹配（比例1:2）。主要结局是剖宫产，次要结局包括其他母体和新生儿事件。进行了描述性分析和多变量分析模型拟合。
在72374例分娩的女性中，1873例（2.6%）被诊断为GDM；227例（12.1%）符合纳入第1组的条件，并与第2组的454名女性匹配。GDM管理包括饮食控制103例（45.4%）、胰岛素治疗81例（35.7%）、口服降糖药治疗43例（18.9%）。第1组的剖宫产率显著更高，分别为17.1%和11.2%（p = 0.02）。4例因肩难产且出生体重<4000g的分娩中有3例发生在第1组（p = 0.076），且与血糖未得到控制有关。两组之间其他与产科相关的结局，如器械助产、严重会阴裂伤、早期产后出血和围产期输血情况相似。
与其他选择性引产相比，GDM女性足月选择性引产与剖宫产风险增加有关。
