Biesty Linda M, Egan Aoife M, Dunne Fidelma, Smith Valerie, Meskell Pauline, Dempsey Eugene, Ni Bhuinneain G Meabh, Devane Declan
School of Nursing and Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland.
Cochrane Database Syst Rev. 2018 Feb 9;2(2):CD012948. doi: 10.1002/14651858.CD012948.
Pregnant women with pre-existing diabetes (Type 1 or Type 2) have increased rates of adverse maternal and neonatal outcomes. Current clinical guidelines support elective birth, at or near term, because of increased perinatal mortality during the third trimester of pregnancy.This review replaces a review previously published in 2001 that included "diabetic pregnant women", which has now been split into two reviews. This current review focuses on pregnant women with pre-existing diabetes (Type 1 or Type 2) and a sister review focuses on women with gestational diabetes.
To assess the effect of planned birth (either by induction of labour or caesarean birth) at or near term gestation (37 to 40 weeks' gestation) compared with an expectant approach, for improving health outcomes for pregnant women with pre-existing diabetes and their infants. The primary outcomes relate to maternal and perinatal mortality and morbidity.
We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (15 August 2017), and reference lists of retrieved studies.
We planned to include randomised trials (including those using a cluster-randomised design) and non-randomised trials (e.g. quasi-randomised trials using alternate allocation) which compared planned birth, at or near term, with an expectant approach for pregnant women with pre-existing diabetes.
Two of the review authors independently assessed study eligibility. In future updates of this review, at least two of the review authors will extract data and assess the risk of bias in included studies. We will also assess the quality of the evidence using the GRADE approach.
We identified no eligible published trials for inclusion in this review.We did identify one randomised trial which examined whether expectant management reduced the incidence of caesarean birth in uncomplicated pregnancies of women with gestational diabetes (requiring insulin) and with pre-existing diabetes. However, published data from this trial does not differentiate between pre-existing and gestational diabetes, and therefore we excluded this trial.
AUTHORS' CONCLUSIONS: In the absence of evidence, we are unable to reach any conclusions about the health outcomes associated with planned birth, at or near term, compared with an expectant approach for pregnant women with pre-existing diabetes.This review demonstrates the urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for pregnant women with pre-existing (Type 1 or Type 2) diabetes compared with an expectant approach.
患有糖尿病（1型或2型）的孕妇出现不良母婴结局的几率更高。目前的临床指南支持在孕晚期或接近足月时进行选择性分娩，因为妊娠晚期围产期死亡率会升高。本综述取代了2001年发表的一篇包含“糖尿病孕妇”的综述，该综述现已分为两篇综述。本综述聚焦于患有糖尿病（1型或2型）的孕妇，另一篇姊妹综述聚焦于妊娠期糖尿病妇女。
评估与期待疗法相比，在孕晚期（37至40周）或接近足月时计划分娩（引产或剖宫产）对患有糖尿病的孕妇及其婴儿健康结局的影响。主要结局涉及孕产妇和围产期死亡率及发病率。
我们检索了Cochrane妊娠与分娩试验注册库、ClinicalTrials.gov、世界卫生组织国际临床试验注册平台（ICTRP）（2017年8月15日）以及检索到的研究的参考文献列表。
我们计划纳入随机试验（包括采用整群随机设计的试验）和非随机试验（如采用交替分配的半随机试验），这些试验将患有糖尿病的孕妇在孕晚期或接近足月时的计划分娩与期待疗法进行比较。
两名综述作者独立评估研究的入选资格。在本综述的未来更新中，至少两名综述作者将提取数据并评估纳入研究的偏倚风险。我们还将使用GRADE方法评估证据质量。
我们未找到符合纳入本综述标准的已发表试验。我们确实找到了一项随机试验，该试验研究了期待管理是否能降低患有妊娠期糖尿病（需要胰岛素治疗）和糖尿病的孕妇在无并发症妊娠中的剖宫产发生率。然而，该试验发表的数据未区分糖尿病和妊娠期糖尿病，因此我们排除了该试验。
由于缺乏证据，我们无法就患有糖尿病的孕妇在孕晚期或接近足月时计划分娩与期待疗法相比的健康结局得出任何结论。本综述表明，迫切需要进行高质量试验，以评估患有糖尿病（1型或2型）的孕妇在孕晚期或接近足月时计划分娩与期待疗法相比的有效性。
