Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1).
Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel(1).
Eur J Obstet Gynecol Reprod Biol. 2020 May;248:24-29. doi: 10.1016/j.ejogrb.2020.03.019. Epub 2020 Mar 7.
We aimed to compare pregnancy outcomes in association with placental pathology in pregnancies complicated by macrosomia in diabetic vs. non-diabetic women.
Pregnancies complicated by macrosomia (≥4000gr) were included. Pregnancy and delivery characteristics, neonatal outcomes and placental histopathology reports were compared between macrosomia in diabetic [pre-gestational or Gestational Diabetes Mellitus (GDM)] women (diabetic-macrosomia group) vs. non-diabetic women (non-diabetic macrosomia group). Adverse neonatal outcome was defined as ≥1 neonatal complications. Multivariate analysis was used to identify independent associations with adverse neonatal outcome.
The diabetic macrosomia group (n = 160) was characterized by higher maternal age (p = 0.002), Body Mass Index (BMI) (p < 0.001), and smoking (p = 0.03), and lower gestational age at delivery (p = 0.001). The diabetic-macrosomia group had higher rates of scheduled Cesarean deliveries (CDs) (58.9 % vs23.7 %,p < 0.001) while the non-diabetic macrosomia group (n = 214) had higher rates of emergent CDs (76.3 % vs.40.7 %,p < 0.001), perineal tears (p = 0.027) and Post Partum Hemorrhage (PPH) (p = 0.006). Placentas from the non-diabetic macrosomia group were characterized by higher rates of maternal and fetal inflammatory response lesions (p < 0.001). Except for higher jaundice rate in the diabetic macrosomia group (p < 0.001), none of the other neonatal outcomes including shoulder dystocia differed between the groups. In multivariate analysis GA < 37 weeks (aOR = 1.4,95 %,CI-1.2-3.9), and emergent CDs (aOR = 1.7,95 %,CI-1.4-4.1) but not diabetes (aOR = 1.1,95 %,CI-0.7-3.9) were associated with adverse neonatal outcome.
Despite major differences in maternal demographics, mode of delivery, maternal morbidity, and placental characteristics- adverse neonatal outcome did not differ between macrosomia in diabetic vs. non-diabetic women and was high in both groups. Clinicians should be aware of the high rate of adverse neonatal outcome in macrosomic fetuses, even in the absence of diabetes mellitus.
比较糖尿病合并巨大儿与非糖尿病合并巨大儿孕妇的胎盘病理与妊娠结局。
纳入巨大儿（≥4000g）孕妇。比较糖尿病合并巨大儿（孕前或妊娠期糖尿病）孕妇（糖尿病巨大儿组）与非糖尿病巨大儿孕妇（非糖尿病巨大儿组）的妊娠和分娩特征、新生儿结局及胎盘组织病理学报告。不良新生儿结局定义为≥1 种新生儿并发症。采用多变量分析确定与不良新生儿结局相关的独立因素。
糖尿病巨大儿组（n=160）的产妇年龄较大（p=0.002）、体重指数（BMI）较高（p<0.001）、吸烟率较高（p=0.03）、分娩时的孕龄较低（p=0.001）。糖尿病巨大儿组剖宫产率较高（58.9% vs.23.7%，p<0.001），而非糖尿病巨大儿组剖宫产紧急程度较高（76.3% vs.40.7%，p<0.001），会阴撕裂伤（p=0.027）和产后出血（PPH）（p=0.006）的发生率较高。非糖尿病巨大儿组胎盘的母体和胎儿炎症反应病变发生率较高（p<0.001）。除糖尿病巨大儿组黄疸发生率较高（p<0.001）外，两组新生儿结局（包括肩难产）均无差异。多变量分析显示，GA<37 周（aOR=1.4，95%CI-1.2-3.9）和紧急剖宫产（aOR=1.7，95%CI-1.4-4.1），而非糖尿病（aOR=1.1，95%CI-0.7-3.9）与不良新生儿结局相关。
尽管糖尿病合并巨大儿与非糖尿病合并巨大儿孕妇在产妇人口统计学、分娩方式、产妇发病率和胎盘特征方面存在显著差异，但两组的不良新生儿结局发生率均较高。临床医生应意识到巨大儿胎儿的不良新生儿结局发生率较高，即使不存在糖尿病。
