妊娠期糖尿病与新生儿呼吸系统疾病的相关性。
Association of Gestational Diabetes Mellitus With Neonatal Respiratory Morbidity.
机构信息
Brown University, Providence, Rhode Island; Dartmouth College, Lebanon, New Hampshire; the George Washington University Biostatistics Center, Washington, DC; Columbia University, New York, New York; the University of Texas Health Science Center at Children's Memorial Hermann Hospital, Houston, Texas; the University of Alabama at Birmingham, Birmingham, Alabama; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Emory University, Atlanta, Georgia; the University of Texas Medical Branch, Galveston, Texas; The Ohio State University, Columbus, Ohio; the University of Utah Health Sciences Center, Salt Lake City, Utah; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio; Northwestern University, Chicago, Illinois; Duke University, Durham, North Carolina; Stanford University, Stanford, California; the University of Texas Southwestern Medical Center, Dallas, Texas; University of Pittsburgh, Pittsburgh, Pennsylvania; Oregon Health and Science University, Portland, Oregon; and Wayne State University, Detroit, Michigan.
出版信息
Obstet Gynecol. 2019 Feb;133(2):349-353. doi: 10.1097/AOG.0000000000003053.
OBJECTIVE
To assess neonatal respiratory morbidity in pregnancies with and without gestational diabetes mellitus (GDM) at imminent risk of late preterm delivery in a modern U.S. cohort.
METHODS
Secondary analysis of a randomized placebo-controlled trial in which women with singleton pregnancies at high risk for delivery between 34 0/7 and 36 5/7 weeks of gestation were allocated to betamethasone or placebo. The primary outcome for the trial and this secondary analysis was a composite outcome of neonatal respiratory morbidity in the first 72 hours of life. Secondary outcomes included neonatal severe respiratory complications, neonatal intensive care unit (NICU) admission greater than or equal to 3 days, and hyperbilirubinemia. We examined associations between neonatal morbidities and GDM status after adjustment for baseline differences and study group allocation using modified Poisson regression. Models incorporating a product interaction term between GDM status and treatment arm (betamethasone or placebo) were also evaluated.
RESULTS
Of the 2,831 women enrolled in the trial, 306 (10.8%) had GDM. Women with GDM were significantly older and were more likely to be parous and to have hypertensive disorders of pregnancy than those without GDM, but they were similar regarding race, gestational age at randomization (35.6 weeks) and at delivery (36.1 weeks), and study group assignment. Neonates born to women with GDM were no more likely to meet the primary outcome than those born to women without GDM, even after adjusting for differences in age, parity, and hypertensive disorders of pregnancy (12.1% vs 13.1%, adjusted RR 0.84; 95% CI 0.61-1.17), nor were they more likely to have severe respiratory complications or prolonged NICU admission.
CONCLUSION
Maternal GDM is not associated with increased neonatal respiratory morbidity in this study population who were at high risk for late preterm birth.
目的
在一个现代美国队列中，评估有和没有妊娠糖尿病（GDM）的孕妇在即将发生晚期早产时的新生儿呼吸发病率。
方法
这是一项随机安慰剂对照试验的二次分析，该试验纳入了妊娠风险较高的单胎孕妇，预计分娩时间在 34 0/7 至 36 5/7 周之间，将其随机分配至倍他米松或安慰剂组。该试验和此次二次分析的主要结局是新生儿出生后前 72 小时内的复合呼吸发病率。次要结局包括新生儿严重呼吸并发症、新生儿重症监护病房（NICU）入住时间超过 3 天和高胆红素血症。我们在调整了基线差异和研究分组后，使用校正泊松回归分析了新生儿发病率与 GDM 状况之间的关联。我们还评估了包含 GDM 状况和治疗臂（倍他米松或安慰剂）之间乘积交互项的模型。
结果
在该试验中，共纳入了 2831 名孕妇，其中 306 名（10.8%）患有 GDM。患有 GDM 的孕妇年龄较大，且更可能是经产妇，患有妊娠高血压疾病的可能性也更大，而她们的种族、随机分组时的孕周（35.6 周）和分娩时的孕周（36.1 周）以及研究分组均相似。即使在调整了年龄、经产次和妊娠高血压疾病的差异后，患有 GDM 的孕妇所生的新生儿发生主要结局的可能性与未患有 GDM 的孕妇相似（12.1% vs. 13.1%，校正 RR 0.84；95%CI 0.61-1.17），也不太可能发生严重呼吸并发症或延长 NICU 入住时间。
结论
在这个有晚期早产高风险的研究人群中，母亲的 GDM 与新生儿呼吸发病率增加无关。
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