Fishel Bartal Michal, Ward Clara, Refuerzo Jerrie S, Ashimi Sunbola S, Joycelyn Cornthwaite A, Chen Han-Yang, Chauhan Suneet P, Sibai Baha M
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
Am J Perinatol. 2020 Jan;37(1):30-36. doi: 10.1055/s-0039-1694733. Epub 2019 Aug 20.
To determine whether basal insulin analogs reduce the rate of composite neonatal morbidity compared with neutral protamine Hagedorn (NPH) in women with type 2 diabetes mellitus (T2DM).
This was a retrospective cohort study of women with T2DM and singleton pregnancy at a single tertiary center. Primary outcome was a composite neonatal morbidity of any of the following: shoulder dystocia, large for gestational age, neonatal intensive care unit admission, neonatal hypoglycemia, or respiratory distress syndrome. Secondary outcomes were rates of maternal hypoglycemic events, hypertensive disorders, preterm birth, and primary cesarean delivery. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated.
Of 233 women with T2DM that met the inclusion criteria, 114 (49%) were treated with basal insulin analogs and 119 (51%) with NPH. The rate of composite neonatal morbidity was similar between groups (73 vs. 60%; aRR: 1.18; 95% CI: 0.92-1.51). There were no differences in the rates of maternal adverse outcomes between the groups. Basal insulin analog was associated with a lower rate of primary cesarean delivery as compared with NPH (21 vs. 36%; aRR: 0.44; 95% CI: 0.25-0.78).
Among pregnant women with T2DM managed with either basal or NPH insulin regimen, the rates of composite neonatal morbidity and maternal complications were similar.
确定与中性鱼精蛋白锌胰岛素（NPH）相比，基础胰岛素类似物是否能降低2型糖尿病（T2DM）女性的新生儿复合发病率。
这是一项在单一三级中心对患有T2DM且单胎妊娠的女性进行的回顾性队列研究。主要结局是以下任何一种情况的新生儿复合发病率：肩难产、大于胎龄儿、新生儿重症监护病房入院、新生儿低血糖或呼吸窘迫综合征。次要结局是母体低血糖事件、高血压疾病、早产和剖宫产的发生率。计算调整后的相对风险（aRR）和95%置信区间（CI）。
在符合纳入标准的233例T2DM女性中，114例（49%）接受基础胰岛素类似物治疗，119例（51%）接受NPH治疗。两组之间的新生儿复合发病率相似（73%对60%；aRR：1.18；95%CI：0.92 - 1.51）。两组之间母体不良结局的发生率没有差异。与NPH相比，基础胰岛素类似物与较低的剖宫产率相关（21%对36%；aRR：0.44；95%CI：0.25 - 0.78）。
在采用基础胰岛素或NPH胰岛素方案治疗的T2DM孕妇中，新生儿复合发病率和母体并发症发生率相似。
