Helen Schneider Hospital for Women, Rabin Medical Center, 39 Jabotinsky St., 4941492, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2019 Aug;300(2):299-303. doi: 10.1007/s00404-019-05183-z. Epub 2019 May 3.
To compare maternal and neonatal outcomes in women with good glycemic controlled gestational diabetes mellitus (GDM) undergoing induction of labor at early and late term.
A retrospective cohort study of all women with singleton pregnancies and well-controlled GDM undergoing induction of labor for non-GDM indications in the early (37 + 0-38 + 6 gestational weeks) and late term (39 + 0-40 + 6 weeks), in a single university-affiliated medical center (2014-2016). Exclusion criteria included: pre-gestational diabetes, multiple gestations and elective cesarean delivery. Maternal and neonatal outcomes were compared between groups. Composite maternal outcome included: post-partum hemorrhage, blood products transfusion, and cesarean or instrumental delivery. Composite neonatal outcome included: neonatal intensive care unit admission, respiratory distress syndrome, hypoglycemia and jaundice.
Overall, 430 women met inclusion criteria. Amongst them, 193 (44.88%) were induced at early term and 237 (55.11%) were induced at late term. There were higher rates of hypertensive complications of any kind and pre-eclampsia, in women induced at early term (11.04% vs. 4.26%, p = 0.021, and 5.92% vs. 1.60%, p = 0.04, respectively). There were no differences in maternal and neonatal outcomes between groups. Rates of composite maternal outcome and composite neonatal outcome did not differ between groups (OR 0.92, 95% CI 0.59-1.44, p = 0.73 and OR 0.78, 95% CI 0.47-1.3, p = 0.36, respectively).
Women with good glycemic controlled GDM may be safely induced at early term, when other indications exist, without an increased risk for adverse maternal or neonatal outcomes.
比较血糖控制良好的妊娠期糖尿病（GDM）产妇在早期和晚期行引产时的母婴结局。
这是一项在单所大学附属医院进行的回顾性队列研究，纳入了所有因非 GDM 指征行引产且血糖控制良好的单胎妊娠 GDM 孕妇（孕 37+0-38+6 周为早期，孕 39+0-40+6 周为晚期）。排除标准包括：孕前糖尿病、多胎妊娠和选择性剖宫产。比较两组患者的母婴结局。复合母体结局包括：产后出血、输血和剖宫产或器械分娩。复合新生儿结局包括：新生儿重症监护病房（NICU）入住、呼吸窘迫综合征、低血糖和黄疸。
共有 430 名患者符合纳入标准。其中，193 名（44.88%）在早期引产，237 名（55.11%）在晚期引产。早期引产组发生任何类型的高血压并发症和子痫前期的比例均高于晚期引产组（11.04%比 4.26%，p=0.021；5.92%比 1.60%，p=0.04）。两组间的母婴结局无差异。两组间复合母体结局和复合新生儿结局的发生率也无差异（OR 0.92，95%CI 0.59-1.44，p=0.73；OR 0.78，95%CI 0.47-1.3，p=0.36）。
血糖控制良好的 GDM 孕妇如存在其他引产指征，可在早期安全引产，不会增加母婴不良结局的风险。
