Department of Obstetrics and Gynecology, Rambam Health Care Campus, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2019 Jul;300(1):79-86. doi: 10.1007/s00404-019-05171-3. Epub 2019 May 7.
To evaluate whether induction of labor (IOL), as compared with expectant management, in gestational diabetes mellitus (GDM) mothers at term (between 37 and 40), decreases caesarean section (CS) rate and the rate of adverse composite neonatal outcomes.
A retrospective cohort study, of all women with GDM and a singleton gestation who delivered at term in a single, tertiary, university-affiliated medical center (2007-2014). We compared outcomes of women who underwent IOL at each week of gestation between 37 and 40 weeks with women who were managed expectantly. The primary outcome was CS rate.
Overall, 2472 GDM patients included in the study, of which 880 women had IOL. CS rate was not found to be significantly different between the groups at any gestational age. IOL at 37 weeks was associated with adverse composite neonatal outcome (aOR 2.2, 95% CI 1.4-3.6) and NICU admission (aOR 2.5, 95% CI 1.4-4.4). At 38 weeks, with NICU admission (aOR 2.0, 95% CI 1.4-2.9), and at 39 weeks with fracture of the clavicle. In a sub-analysis of nulliparous women, IOL at 37 weeks had higher odds of NICU admission and adverse composite neonatal outcomes, at 38 weeks with CS and at 39 weeks with fracture of the clavicle.
IOL in GDM mothers at term does not reduce CS rate and may be associated with increased CS rate among nulliparous women at 38 weeks. It is also associated with increased risk for adverse composite neonatal outcome or NICU admission when done prior to 39 weeks.
评估在妊娠糖尿病（GDM）母亲足月（37 至 40 周）时进行引产（IOL）与期待管理相比，是否会降低剖宫产率和不良复合新生儿结局的发生率。
对 2007 年至 2014 年期间在一家单一体检、三级、大学附属医院分娩的所有 GDM 且单胎妊娠的女性进行回顾性队列研究。我们比较了在 37 至 40 周之间的每个孕周接受 IOL 与期待管理的女性的结局。主要结局是剖宫产率。
研究共纳入 2472 例 GDM 患者，其中 880 例女性接受了 IOL。在任何孕周，两组的剖宫产率均无显著差异。37 周时进行 IOL 与不良复合新生儿结局（aOR 2.2，95%CI 1.4-3.6）和新生儿重症监护病房（NICU）入住（aOR 2.5，95%CI 1.4-4.4）有关。在 38 周时，与 NICU 入住（aOR 2.0，95%CI 1.4-2.9），在 39 周时与锁骨骨折有关。在初产妇的亚分析中，37 周时进行 IOL 与 NICU 入住和不良复合新生儿结局的可能性更高，38 周时与剖宫产有关，39 周时与锁骨骨折有关。
在 GDM 母亲足月时进行 IOL 并不能降低剖宫产率，并且可能与 38 周时初产妇的剖宫产率增加有关。在 39 周之前进行 IOL 还与不良复合新生儿结局或 NICU 入住的风险增加有关。
