Feghali Maisa N, Caritis Steve N, Catov Janet M, Scifres Christina M
Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Am J Obstet Gynecol. 2016 Aug;215(2):243.e1-7. doi: 10.1016/j.ajog.2016.03.006. Epub 2016 Mar 11.
Women with gestational diabetes mellitus (GDM) commonly undergo induction of labor (IOL) at term, but the risks and benefits of IOL are incompletely understood.
We examined the relationship among gestational age, IOL, and the rate of cesarean delivery (CD) in women with GDM.
We identified 863 women with GDM who underwent either IOL or spontaneous labor ≥37 0/7 weeks. Demographic, cervical favorability, and outcome data were abstracted from the medical record. We compared the CD rate in women undergoing IOL at each week of gestation with expectant management to a later gestational age.
When compared to women who were expectantly managed, IOL at 37 weeks (adjusted odds ratio [aOR], 1.53; 95% confidence interval [CI], 0.76-3.06; P = .23), 38 weeks (aOR, 2.07; 95% CI, 0.89-4.80; P = .09), and 39 weeks (aOR, 0.79; 95% CI, 0.44-1.42; P = .43)) was associated with similar risk for CD as expectant management after adjustment for nulliparity, body mass index, baseline simplified Bishop score, and maternal age. CD rates were higher in nulliparous women, but did not differ significantly in those undergoing IOL or expectant management. In multiparous women, IOL was significantly associated with an increased risk for CD at 38 weeks (aOR, 7.47; 95% CI, 1.6-34.8; P = .01) and rates of CD (17.39% vs 2.2%, P = .001) were significantly higher in multiparous women with an unfavorable Bishop score induced <39 weeks. Neonatal morbidity was similar across gestational ages after adjustment for maternal body mass index and maternal glycemic control.
IOL results in similar risk for CD as expectant management between 37-40 weeks of gestation. Rates of CD differed based on cervical exam and parity. These findings suggest that gestational age alone does not significantly impact maternal and neonatal outcomes, but that decisions regarding delivery in women with GDM should take into account cervical exam and parity.
妊娠期糖尿病（GDM）女性通常在足月时接受引产（IOL），但IOL的风险和益处尚未完全明确。
我们研究了GDM女性的孕周、IOL与剖宫产（CD）率之间的关系。
我们确定了863例孕周≥37 0/7周且接受IOL或自然分娩的GDM女性。从病历中提取人口统计学、宫颈条件及结局数据。我们将各孕周接受IOL的女性与期待治疗至较晚孕周的女性的CD率进行比较。
与接受期待治疗的女性相比，37周时IOL（校正优势比[aOR]，1.53；95%置信区间[CI]，0.76 - 3.06；P = 0.23）、38周时IOL（aOR，2.07；95% CI，0.89 - 4.80；P = 0.09）和39周时IOL（aOR，0.79；95% CI，0.44 - 1.42；P = 0.43）在调整初产情况、体重指数、基线简化Bishop评分和产妇年龄后，与期待治疗的CD风险相似。初产妇的CD率较高，但接受IOL或期待治疗的初产妇之间无显著差异。经产妇中，38周时IOL与CD风险增加显著相关（aOR，7.47；95% CI，1.6 - 34.8；P = 0.01），Bishop评分不佳且在<39周引产的经产妇CD率（17.39%对2.2%，P = 0.001）显著更高。在调整产妇体重指数和血糖控制后，各孕周的新生儿发病率相似。
在妊娠37 - 40周之间，IOL导致的CD风险与期待治疗相似。CD率因宫颈检查和产次而异。这些发现表明，仅孕周本身不会显著影响母体和新生儿结局，但GDM女性的分娩决策应考虑宫颈检查和产次。
