Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, and the Division of Endocrinology, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York.
Obstet Gynecol. 2020 Jan;135(1):80-89. doi: 10.1097/AOG.0000000000003551.
To estimate whether women with diabetes are at risk for 60-day postpartum readmissions and associated complications.
The Nationwide Readmissions Database from 2010 to 2014 was analyzed to determine risk for 60-day postpartum readmissions among women with type 1 diabetes mellitus (DM), type 2 DM, gestational diabetes mellitus (GDM), and unspecified DM compared with women with no diabetes. Secondary outcomes included evaluating risk for overall severe maternal morbidity during readmissions, as well as wound complications, acute diabetic complications such as diabetic ketoacidosis, venous thromboembolism, and hypertensive diseases of pregnancy. Billing data were used to ascertain both exposures and outcomes. Adjusted log-linear regression models including demographic, hospital, medical and obstetric, and hospital factors were performed with adjusted risk ratios (aRRs) and with 95% Cis as measures of association.
Of an estimated 15.7 million delivery hospitalizations, 1.1 million occurred among women with diabetes, of whom 3.2% had type 1 DM, 9.1% type 2 DM, 86.6% GDM, and 1.1% unspecified diabetes. Compared with women without diabetes (1.5% risk for readmission), risk for readmission was significantly higher for women with type 1 DM (4.4%), unspecified diabetes (4.0%), type 2 DM (3.9%), and GDM (2.0%) (P<.01). After adjusting for hospital, demographic, medical, and obstetric risk factors, type 1 DM (aRR 1.77, 95% CI 1.69-1.87), type 2 DM (aRR 1.46, 95% CI 1.42-1.51), unspecified (aRR 1.73, 95% CI 1.59-1.89) and gestational diabetes (aRR 1.16, 95% CI 1.14-1.17) retained increased risk. Among women with diabetes public insurance, lower ZIP code income quartiles, and hospitals with high safety net burdens were associated with higher risk for readmission. In both unadjusted and adjusted analyses, all diabetes diagnoses were associated with readmissions for wound complications, hypertensive diseases of pregnancy, and severe maternal morbidity.
Although overall risk for readmission is low, pregnancies complicated by pregestational diabetes in particular are at increased risk. Women in this high-risk group should receive coordinated care and be monitored closely in the postpartum period.
评估患有糖尿病的女性是否存在产后 60 天内再次入院及相关并发症的风险。
本研究分析了 2010 年至 2014 年全国再入院数据库，以确定与无糖尿病的女性相比，1 型糖尿病（DM）、2 型 DM、妊娠期糖尿病（GDM）和未特指 DM 女性产后 60 天内再次入院的风险。次要结局包括评估再次入院时整体严重产妇发病率的风险，以及伤口并发症、急性糖尿病并发症（如糖尿病酮症酸中毒、静脉血栓栓塞和妊娠高血压疾病）的风险。计费数据用于确定暴露和结局。采用包括人口统计学、医院、医疗和产科以及医院因素的调整后对数线性回归模型，使用调整后的风险比（aRR）和 95%置信区间（CI）作为关联的衡量指标。
在估计的 1570 万例分娩住院治疗中，有 110 万例发生在患有糖尿病的女性中，其中 3.2%为 1 型 DM，9.1%为 2 型 DM，86.6%为 GDM，1.1%为未特指的糖尿病。与无糖尿病的女性（再次入院风险为 1.5%）相比，1 型 DM（4.4%）、未特指糖尿病（4.0%）、2 型 DM（3.9%）和 GDM（2.0%）的再次入院风险显著更高（均<0.01）。在校正了医院、人口统计学、医疗和产科危险因素后，1 型 DM（aRR 1.77，95%CI 1.69-1.87）、2 型 DM（aRR 1.46，95%CI 1.42-1.51）、未特指的（aRR 1.73，95%CI 1.59-1.89）和妊娠期糖尿病（aRR 1.16，95%CI 1.14-1.17）仍存在风险增加。在患有糖尿病的女性中，公共保险、较低的邮政编码收入四分位数和高安全网负担的医院与较高的再次入院风险相关。在未经调整和调整后的分析中，所有糖尿病诊断都与伤口并发症、妊娠高血压疾病和严重产妇发病率有关。
尽管总体再次入院风险较低，但特定于妊娠前糖尿病的妊娠风险较高。处于这一高风险组的女性应接受协调护理，并在产后期间密切监测。
