妊娠期糖尿病筛查类型与剖宫产之间的关联。
Association Between Type of Screening for Gestational Diabetes Mellitus and Cesarean Delivery.
作者信息
Palatnik Anna, Swanson Kate, Churchill Tessa, Bilski Ania, Grobman William A, Miller Emily S
机构信息
Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin; and the Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
出版信息
Obstet Gynecol. 2017 Sep;130(3):539-544. doi: 10.1097/AOG.0000000000002195.
OBJECTIVE
To compare maternal and neonatal outcomes using two different testing strategies for gestational diabetes mellitus (GDM) diagnosis: the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan approaches. Specifically, we wanted to compare the rates of cesarean delivery between the two epochs.
METHODS
This was a retrospective cohort study of women with a singleton pregnancy delivering at 37 0/7 weeks of gestation or greater, between 2010 and 2015, in a single tertiary care center. The IADPSG testing was used for GDM diagnosis from December 2010 until July 2013 when institutional guidelines changed to Carpenter-Coustan testing. Maternal and neonatal outcomes were compared between these two different epochs using bivariable and multivariable analyses. The primary outcome was the frequency of cesarean delivery.
RESULTS
The analysis included a total of 23,509 women: 14,074 (60%) from the IADPSG epoch and 9,435 (40%) from the Carpenter-Coustan epoch. The incidence of GDM diagnosis was higher using the IADPSG compared with Carpenter-Coustan criteria (8.3% compared with 7.5%, P=.042). The total (27.0% compared with 25.5% P=.022) as well as primary cesarean delivery rates (19.1% compared with 18.0%, P=.041) were higher during the IADPSG epoch. The rates of total (39.1% compared with 37.5%, P=.594) and primary (27.3% compared with 27.0%, P=.903) cesarean delivery among women with GDM did not differ between the two epochs. Secondary outcomes of shoulder dystocia (2.5% compared with 2.1%, P=.043) and neonatal intensive care unit admission (3.2% compared with 2.0%, P<.001) also were significantly higher in women screened during the IADPSG epoch, whereas hypertensive disease of pregnancy (6.9% compared with 7.7%, P=.018) was less frequent during the IADPSG epoch. These findings persisted after adjusting for potential confounding factors.
CONCLUSION
Compared with testing using the Carpenter-Coustan criteria, the IADPSG criteria for diagnosis of GDM were associated with higher rates of GDM, cesarean delivery, shoulder dystocia, and neonatal intensive care unit admission. Obstetric care provider knowledge of GDM diagnosis might have affected decision-making regarding the route of delivery.
目的
比较采用两种不同检测策略诊断妊娠期糖尿病（GDM）时的母婴结局，这两种策略分别是国际糖尿病与妊娠研究组（IADPSG）和卡彭特 - 库斯坦方法。具体而言，我们想比较两个时期的剖宫产率。
方法
这是一项回顾性队列研究，研究对象为2010年至2015年期间在一家三级医疗中心单胎妊娠且妊娠37 0/7周及以上的妇女。2010年12月至2013年7月期间采用IADPSG检测进行GDM诊断，之后机构指南改为卡彭特 - 库斯坦检测。使用双变量和多变量分析比较这两个不同时期的母婴结局。主要结局是剖宫产的频率。
结果
分析共纳入23509名妇女：14074名（60%）来自IADPSG时期，9435名（40%）来自卡彭特 - 库斯坦时期。与卡彭特 - 库斯坦标准相比，采用IADPSG标准诊断的GDM发病率更高（8.3% 对 7.5%，P = 0.042）。IADPSG时期的总剖宫产率（27.0% 对 25.5%，P = 0.022）以及初次剖宫产率（19.1% 对 18.0%，P = 0.041）更高。两个时期GDM妇女的总剖宫产率（39.1% 对 37.5%，P = 0.594）和初次剖宫产率（27.3% 对 27.0%，P = 0.903）没有差异。IADPSG时期筛查的妇女中，肩难产（2.5% 对 2.1%，P = 0.043）和新生儿重症监护病房入院率（3.2% 对 2.0%，P < 0.001）等次要结局也显著更高，而IADPSG时期妊娠高血压疾病的发生率较低（6.9% 对 7.7%，P = 0.018）。在调整潜在混杂因素后，这些发现仍然存在。
结论
与使用卡彭特 - 库斯坦标准检测相比，IADPSG诊断GDM的标准与更高的GDM发病率、剖宫产率、肩难产率和新生儿重症监护病房入院率相关。产科护理人员对GDM诊断的了解可能影响了分娩方式的决策。
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