Billionnet Cécile, Mitanchez Delphine, Weill Alain, Nizard Jacky, Alla François, Hartemann Agnès, Jacqueminet Sophie
Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France.
Division of Neonatology, Department of Perinatology, Armand Trousseau Hospital, APHP, Paris, France.
Diabetologia. 2017 Apr;60(4):636-644. doi: 10.1007/s00125-017-4206-6. Epub 2017 Feb 15.
AIMS/HYPOTHESIS: The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort.
All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated.
The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother-infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]).
CONCLUSIONS/INTERPRETATION: GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes.
目的/假设：本研究旨在评估一个大型全国队列中妊娠期糖尿病（GDM）患者发生围产期不良结局的风险。
通过提取医院出院数据库和国家医疗保险系统的数据，纳入2012年在法国发生的所有22周后分娩的病例。母亲的糖尿病状态通过使用降糖药物和医院诊断来确定。根据糖尿病类型对结局进行分析，在GDM组中，还分析了糖尿病是否接受胰岛素治疗。
796,346例分娩队列中，有57,629名（7.24%）母亲患有GDM。705,198例分娩实现了母婴关联。GDM患者发生不良结局的风险远低于孕前糖尿病患者。在将分析限制在28周后分娩以减少永存时间偏倚后，与非糖尿病人群相比，GDM患者早产（比值比[OR]1.3[95%置信区间（CI）1.3,1.4]）、剖宫产（OR 1.4[95%CI 1.4,1.4]）、先兆子痫/子痫（OR 1.7[95%CI 1.6,1.7]）、巨大儿（OR 1.8[95%CI 1.7,1.8]）、呼吸窘迫（OR 1.1[95%CI 1.0,1.3]）、产伤（OR 1.3[95%CI 1.1,1.5]）和心脏畸形（OR 1.3[95%CI 1.1,1.4]）的风险增加。胰岛素治疗的GDM患者比饮食治疗的GDM患者风险更高。在将分析限制在足月分娩后，观察到围产儿死亡率增加。在排除疑似未诊断出的孕前糖尿病患者后，仅饮食治疗的GDM患者风险仍适度增加（OR 1.3[95%CI 1.0,1.6]）。
结论/解读：GDM与围产期不良结局风险适度增加相关，对于大多数结局，胰岛素治疗的GDM患者风险高于非胰岛素治疗的GDM患者。
