按分娩方式划分的孕期患糖尿病母亲所生足月单胎头位活产新生儿的结局：一项基于新南威尔士州人群的回顾性队列研究。

Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study.

作者信息

Zeki Reem, Wang Alex Y, Lui Kei, Li Zhuoyang, Oats Jeremy J N, Homer Caroline S E, Sullivan Elizabeth A

机构信息

Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia.

School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia.

出版信息

BMJ Paediatr Open. 2018 Jan 30;2(1):e000224. doi: 10.1136/bmjpo-2017-000224. eCollection 2018.

DOI:10.1136/bmjpo-2017-000224

PMID:29637191

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5843011/

Abstract

OBJECTIVES

To investigate the association between the mode of birth and adverse neonatal outcomes of macrosomic (birth weight ≥4000 g) and non-macrosomic (birth weight <4000 g) live-born term singletons in vertex presentation (TSV) born to mothers with diabetes (pre-existing and gestational diabetes mellitus (GDM)).

DESIGN

A population-based retrospective cohort study.

SETTING

New South Wales, Australia.

PATIENTS

All live-born TSV born to mothers with diabetes from 2002 to 2012.

INTERVENTION

Comparison of neonatal outcomes by mode of birth (prelabour caesarean section (CS) and planned vaginal birth resulted in intrapartum CS, non-instrumental or instrumental vaginal birth).

MAIN OUTCOME MEASURES

Five-minute Apgar score <7, admission to neonatal intensive care unit (NICU) or special care nursery (SCN) and the need for resuscitation.

RESULTS

Among the 48 882 TSV born to mothers with diabetes, prelabour CS was associated with a significant increase in the rate of admission to NICU/SCN compared with planned vaginal birth.For TSV born to mothers with pre-existing diabetes, compared with non-instrumental vaginal birth, instrumental vaginal birth was associated with increased odds of the need for resuscitation in macrosomic (adjusted ORs (AOR) 2.6; 95% CI (1.2 to 7.5)) and non-macrosomic TSV (AOR 3.3; 95% CI (2.2 to 5.0)).For TSV born to mothers with GDM, intrapartum CS was associated with increased odds of the need for resuscitation compared with non-instrumental vaginal birth in non-macrosomic TSV (AOR 2.3; 95% CI (2.1 to 2.7)). Instrumental vaginal birth was associated with increased likelihood of requiring resuscitation compared with non-instrumental vaginal birth for both macrosomic (AOR 2.3; 95% CI (1.7 to 3.1)) and non-macrosomic (AOR 2.5; 95% CI (2.2 to 2.9)) TSV.

CONCLUSION

Pregnant women with diabetes, particularly those with suspected fetal macrosomia, need to be aware of the increased likelihood of adverse neonatal outcomes following instrumental vaginal birth and intrapartum CS when planning mode of birth.

摘要

目的

探讨糖尿病（包括孕前糖尿病和妊娠期糖尿病（GDM））母亲所生的足月单胎头先露活产儿中，巨大儿（出生体重≥4000g）和非巨大儿（出生体重<4000g）的出生方式与不良新生儿结局之间的关联。

设计

基于人群的回顾性队列研究。

地点

澳大利亚新南威尔士州。

研究对象

2002年至2012年糖尿病母亲所生的所有足月单胎头先露活产儿。

干预措施

按出生方式（临产前剖宫产（CS）、计划阴道分娩但产时转为剖宫产、非器械助产或器械助产阴道分娩）比较新生儿结局。

主要观察指标

5分钟Apgar评分<7、入住新生儿重症监护病房（NICU）或特殊护理病房（SCN）以及复苏需求。

结果

在糖尿病母亲所生的48882例足月单胎头先露活产儿中，与计划阴道分娩相比，临产前剖宫产导致入住NICU/SCN的比率显著增加。对于孕前糖尿病母亲所生的足月单胎头先露活产儿，与非器械助产阴道分娩相比，器械助产阴道分娩使巨大儿（校正比值比（AOR）2.6；95%置信区间（CI）（1.2至7.5））和非巨大儿足月单胎头先露活产儿（AOR 3.3；95%CI（2.2至5.0））复苏需求的几率增加。对于妊娠期糖尿病母亲所生的足月单胎头先露活产儿，在非巨大儿足月单胎头先露活产儿中，产时剖宫产与非器械助产阴道分娩相比，复苏需求的几率增加（AOR 2.3；95%CI（2.1至2.7））。对于巨大儿（AOR 2.3；95%CI（1.7至3.1））和非巨大儿（AOR 2.5；95%CI（2.2至2.9））足月单胎头先露活产儿，器械助产阴道分娩与非器械助产阴道分娩相比，需要复苏的可能性增加。