Strand-Holm Karen M, Fuglsang Jens, Ovesen Per G, Maimburg Rikke D
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Denmark.
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Denmark; Department of Clinical Medicine, Aarhus University, Incuba / Skejby Building 2 Palle Juul-Jensens Boulevard 82, Aarhus DK-8200, Denmark.
Midwifery. 2019 Feb;69:121-127. doi: 10.1016/j.midw.2018.11.010. Epub 2018 Nov 22.
Diabetes Mellitus in pregnancy is increasing. No existing studies have examined Diabetes Mellitus as the primary exposure for lower genital tract tears after vaginal birth. The objective was to study the association between Diabetes Mellitus (all types combined), Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus and Gestational Diabetes Mellitus and lower genital tract tears after vaginal birth.
A register-based cohort study of women with singleton pregnancy and without a previous cesarean section at near-term (≥ 35 + 0 weeks) and term (≥ 37 + 0 weeks) gestational age, n = 31,297 at Aarhus University Hospital, Denmark from 1 January 2004 to 31 December 2012. The associations between Diabetes Mellitus and lower genital tract tears were analysed using a fixed multiple logistic regression analyses.
Approximately 32,000 women were eligible for the study; 796 women had diabetes (2.5%) and 1318 experienced anal sphincter injury (4.3%). The overall risk of lower genital tract tears was similar among women with a diagnosis of diabetes (Type1 Diabetes Mellitus, Type 2 Diabetes Mellitus, and Gestational Diabetes Mellitus) compared to women without diabetes, except for nulliparous women with Type1 Diabetes Mellitus who experienced a higher risk of episiotomies, crude and adjusted odds ratios (OR 2.13, 95% CI 1.14-3.97) and (OR 2.48, 95% CI 1.21-5.10), respectively.
Women with Diabetes Mellitus without a previous cesarean section who gave birth vaginally to a single child at term or near term did not experienced an increased risk of lower genital tract tears. However, nulliparous women with Type 1 Diabetes Mellitus experienced a higher risk of episiotomy. These results may be used to individualised counselling of women with Diabetes Mellitus regarding mode of birth and may reduce worries about genital tract tears in women with Diabetes Mellitus considering vaginal birth.
妊娠期糖尿病的发病率正在上升。目前尚无研究将糖尿病作为阴道分娩后下生殖道撕裂的主要暴露因素进行研究。本研究的目的是探讨糖尿病（所有类型合并）、1型糖尿病、2型糖尿病和妊娠期糖尿病与阴道分娩后下生殖道撕裂之间的关联。
基于登记的队列研究，研究对象为单胎妊娠且既往无剖宫产史、孕晚期（≥35+0周）和足月（≥37+0周）的女性，2004年1月1日至2012年12月31日期间丹麦奥胡斯大学医院共有31297例。采用固定多重逻辑回归分析糖尿病与下生殖道撕裂之间的关联。
约32000名女性符合研究条件；796名女性患有糖尿病（2.5%），1318名女性发生肛门括约肌损伤（4.3%）。与无糖尿病女性相比，诊断为糖尿病（1型糖尿病、2型糖尿病和妊娠期糖尿病）的女性下生殖道撕裂的总体风险相似，但未生育的1型糖尿病女性会阴切开术的风险较高，粗比值比和调整后比值比分别为（OR 2.13，95%CI 1.14-3.97）和（OR 2.48，95%CI 1.21-5.10）。
既往无剖宫产史、足月或近足月阴道分娩单胎的糖尿病女性下生殖道撕裂风险并未增加。然而，未生育的1型糖尿病女性会阴切开术的风险较高。这些结果可用于对糖尿病女性进行个性化的分娩方式咨询，并可能减少考虑阴道分娩的糖尿病女性对生殖道撕裂的担忧。
