患有 GDM 的女性的婴儿在剖宫产术后复苏率与胰岛素之间的关系：一项回顾性研究。
Association between insulin and post-caesarean resuscitation rates in infants of women with GDM: A retrospective study.
机构信息
Sydney Medical School - Nepean, Discipline of Pediatrics, University of Sydney, Sydney, New South Wales, Australia.
Charles Perkins Centre - Nepean, The University of Sydney, Sydney, New South Wales, Australia.
出版信息
J Diabetes. 2020 Feb;12(2):151-157. doi: 10.1111/1753-0407.12974. Epub 2019 Sep 6.
BACKGROUND
Gestational diabetes mellitus (GDM) and caesarean deliveries independently increase the risk of postoperative complications. There are limited data on the influence of insulin use on the outcomes of neonates who were delivered via caesarean section. We sought to investigate the impact of insulin use in women with GDM on resuscitation rates of infants post caesarean delivery.
METHODS
A retrospective database review of women with singleton term (≥ 37 weeks) pregnancies who were on insulin for GDM delivering between January 2005 and December 2014 at a major metropolitan hospital in Sydney.
RESULTS
One thousand eight hundred and fifty-seven women with GDM were identified. The mean age was 31.01 ± 5.63 years and mean gestational period of 39.07 ± 1.00 weeks. 31.0% received insulin treatment for GDM. Women who were on insulin were older (31.9 ± 5.7 vs 30.6 ± 5.6 years, P < 0.001), had a higher body mass index (BMI) (31.2 ± 7.7 vs 29.0 ± 7.4 kg/m2, P < 0.001), higher rates of preeclampsia (7.3% vs 4.1%, P = 0.004), lower rates of alcohol consumption (0.4% vs 1.7%, P = 0.014), and had infants with lower resuscitation rates (21.2% vs 28.6%, P = 0.001). Infants who required resuscitation had a lower gestational age, lower five-minute APGAR score, and lower birth weight, length, and head circumferences. On multivariate analysis, women with GDM treated with insulin (odds ratio [OR] = 0.69, CI = 0.54-0.89, P = 0.004), higher gestational age (OR = 0.88, CI = 0.78-0.99, P = 0.032), higher maternal BMI (OR = 1.02, CI = 1.01-1.04, P = 0.005), and emergency caesarean (OR = 2.33, CI = 1.74-3.12, P < 0.001) independently predicted incidence of resuscitation.
CONCLUSIONS
The findings suggest a relationship between insulin use and reduced resuscitation rates of infants born from mothers with GDM. Further studies investigating the role, dosage, and criteria for insulin use in women with GDM are required.
背景
妊娠糖尿病（GDM）和剖宫产术都会独立增加术后并发症的风险。关于胰岛素使用对剖宫产新生儿结局的影响的数据有限。我们旨在研究 GDM 妇女使用胰岛素对剖宫产术后婴儿复苏率的影响。
方法
对 2005 年 1 月至 2014 年 12 月在悉尼一家主要大都市医院接受胰岛素治疗的单胎足月（≥37 周）妊娠 GDM 妇女进行回顾性数据库研究。
结果
确定了 1857 名 GDM 妇女。平均年龄为 31.01 ± 5.63 岁，平均孕龄为 39.07 ± 1.00 周。31.0%的妇女接受胰岛素治疗 GDM。使用胰岛素的妇女年龄较大（31.9 ± 5.7 岁 vs 30.6 ± 5.6 岁，P<0.001），BMI 更高（31.2 ± 7.7 千克/平方米 vs 29.0 ± 7.4 千克/平方米，P<0.001），子痫前期发生率更高（7.3% vs 4.1%，P=0.004），饮酒率更低（0.4% vs 1.7%，P=0.014），婴儿复苏率更低（21.2% vs 28.6%，P=0.001）。需要复苏的婴儿胎龄较小，5 分钟时 APGAR 评分较低，出生体重、身长和头围较低。多变量分析显示，使用胰岛素治疗的 GDM 妇女（比值比[OR] = 0.69，95%置信区间[CI] = 0.54-0.89，P=0.004）、较高的胎龄（OR = 0.88，CI = 0.78-0.99，P=0.032）、较高的母体 BMI（OR = 1.02，CI = 1.01-1.04，P=0.005）和紧急剖宫产术（OR = 2.33，CI = 1.74-3.12，P<0.001）独立预测了复苏的发生。
结论
研究结果表明，胰岛素的使用与 GDM 母亲所生婴儿的复苏率降低之间存在关联。需要进一步研究以确定 GDM 妇女胰岛素的作用、剂量和使用标准。
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