患有或未患有妊娠期糖尿病的亚洲印度裔孕妇的母婴结局比较：一项情景分析研究（WINGS-3）
Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3).
作者信息
Mahalakshmi Manni Mohanraj, Bhavadharini Balaji, Maheswari Kumar, Kalaiyarasi Gunasekaran, Anjana Ranjit Mohan, Ranjit Unnikrishnan, Mohan Viswanathan, Joseph Kurian, Rekha Kurian, Nallaperumal Sivagnanam, Malanda Belma, Kayal Arivudainambi, Belton Anne, Uma Ram
机构信息
Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
Department of Obstetrics and Gynecology, Joseph Nursing Home, Chennai, Tamil Nadu, India.
出版信息
Indian J Endocrinol Metab. 2016 Jul-Aug;20(4):491-6. doi: 10.4103/2230-8210.183469.
AIM
To compare the existing maternal and fetal outcomes in Asian Indian women with or without gestational diabetes mellitus (GDM) before the development of the Women in India with GDM Strategy (WINGS) GDM model of care (MOC).
MATERIALS AND METHODS
Records of pregnant women were extracted retrospectively from three maternity centers in Chennai. GDM was diagnosed using the International Association for Pregnancy Study Groups criteria or the Carpenter and Coustan criteria. Demographic details, obstetric history, antenatal follow-up, treatment for GDM, and outcomes of delivery were collected from the electronic medical records.
RESULTS
Of the 3642 records analyzed, 799 (21.9%) had GDM, of whom 456 (57.1%) were treated with insulin and medical nutrition therapy (MNT), 339 (42.4%) with MNT alone, and 4 (0.5%) with metformin. Women with GDM were older than those without (28.5 ± 4.5 vs. 27.1 ± 4.5 years; P < 0.001) and had higher mean body mass index at first booking (26.4 ± 5.2 kg/m(2) vs. 25.2 ± 5.1 kg/m(2); P < 0.001). Rates of cesarean section (26.2% vs. 18.7%; P < 0.001), preeclampsia (1.8% vs. 0.8%; P = 0.04), and macrosomia (13.9% vs. 10.8%; P = 0.02) were significantly higher among women with GDM. In women with GDM treated with insulin and MNT, emergency cesarean section (16.2% vs. 36.6%; P < 0.0001), preeclampsia (0.7% vs. 3.2%; P = 0.015), and macrosomia (9.9% vs. 18.6%; P = 0.0006) were significantly lesser compared to those treated with MNT alone.
CONCLUSION
Pregnancy outcomes were in general worse in GDM women. Treatment with insulin was associated with a significantly lower risk of complications. However, in countries with limited access to insulin and other medicines may lead to poor follow-up and management of GDM. Data from this retrospective study will form the basis for the development of the WINGS GDM MOC, which will address these gaps in GDM care in low-resource settings.
目的
比较在印度患有妊娠期糖尿病（GDM）的亚洲印度女性与未患GDM的女性在印度GDM护理模式（MOC）即“印度GDM女性战略（WINGS）”出现之前的现有母婴结局。
材料与方法
回顾性提取钦奈三个产科中心的孕妇记录。采用国际妊娠研究组协会标准或卡彭特和库斯坦标准诊断GDM。从电子病历中收集人口统计学细节、产科病史、产前随访、GDM治疗情况及分娩结局。
结果
在分析的3642份记录中，799例（21.9%）患有GDM，其中456例（57.1%）接受胰岛素和医学营养治疗（MNT），339例（42.4%）仅接受MNT，4例（0.5%）接受二甲双胍治疗。患有GDM的女性比未患GDM的女性年龄更大（28.5±4.5岁对27.1±4.5岁；P<0.001），首次产检时平均体重指数更高（26.4±5.2kg/m²对25.2±5.1kg/m²；P<0.001）。GDM女性的剖宫产率（26.2%对18.7%；P<0.001）、先兆子痫发生率（1.8%对0.8%；P = 0.04）和巨大儿发生率（13.9%对10.8%；P = 0.02）显著更高。在接受胰岛素和MNT治疗的GDM女性中，急诊剖宫产率（16.2%对36.6%；P<0.0001）、先兆子痫发生率（0.7%对3.2%；P = 0.015）和巨大儿发生率（9.9%对18.6%；P = 0.0006）明显低于仅接受MNT治疗的女性。
结论
GDM女性的妊娠结局总体较差。胰岛素治疗与并发症风险显著降低相关。然而，在胰岛素及其他药物获取受限的国家，可能导致GDM的随访和管理不佳。这项回顾性研究的数据将为WINGS GDM MOC的制定奠定基础，该模式将填补资源匮乏地区GDM护理的这些空白。
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