University of Utah Health, Salt Lake City, Utah; Intermountain Health Care, Murray, Utah; Northwestern University, Feinberg School of Medicine, Chicago, Illinois; RTI International, Research Triangle Park, North Carolina; the University of Health Sciences, Van Training and Research Hospital, Van, Turkey; University of Virginia Healthcare, Charlottesville, Virginia; the University of Texas Medical Branch at Galveston, Galveston, Texas; Columbia University, New York, New York; the University of Texas Health Science Center at Houston, Houston, Texas; the Rollins School of Public Health, Emory University, Atlanta, Georgia; the University of Texas at Austin, Austin, Texas; the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Brown University, Providence, Rhode Island; and Yale School of Medicine, New Haven, Connecticut.
Obstet Gynecol. 2020 Dec;136(6):1095-1102. doi: 10.1097/AOG.0000000000004117.
To characterize stillbirths associated with pregestational diabetes and gestational diabetes mellitus (GDM) in a large, prospective, U.S. case-control study.
A secondary analysis of stillbirths among patients enrolled in a prospective; multisite; geographically, racially, and ethnically diverse case-control study in the United States was performed. Singleton gestations with complete information regarding diabetes status and with a complete postmortem evaluation were included. A standard evaluation protocol for stillbirth cases included postmortem evaluation, placental pathology, clinical testing as performed at the discretion of the health care professional, and a recommended panel of tests. A potential cause of death was assigned to stillbirth cases using a standardized classification tool. Demographic and delivery characteristics among women with pregestational diabetes and GDM were compared with characteristics of women with no diabetes in pairwise comparisons using χ or two-sample t tests as appropriate. Sensitivity analysis was performed excluding pregnancies with genetic conditions or major fetal malformations.
Of 455 stillbirth cases included in the primary analysis, women with stillbirth and diabetes were more likely to be older than 35 years and have a higher body mass index. They were also more likely to have a gestational hypertensive disorder than women without diabetes (28% vs 9.1%; P<.001). Women with pregestational diabetes had more large-for-gestational-age (LGA) neonates (26% vs 3.4%; P<.001). Stillbirths occurred more often at term in women with pregestational diabetes (36%) and those with GDM (52%). Maternal medical complications, including pregestational diabetes and others, were more often identified as a probable or possible cause of death among stillbirths with maternal diabetes (43% vs 4%, P<.001) as compared with stillbirths without diabetes.
Compared with stillbirths in women with no diabetes, stillbirths among women with pregestational diabetes and GDM occur later in pregnancy and are associated with hypertensive disorders of pregnancy, maternal medical complications, and LGA.
在美国一项大型前瞻性病例对照研究中，对与孕前糖尿病和妊娠期糖尿病（GDM）相关的死胎进行特征描述。
对美国一项前瞻性、多地点、地理、种族和民族多样化的病例对照研究中纳入的患者的死胎进行了二次分析。纳入了具有完整糖尿病状态信息且具有完整死后评估的单胎妊娠。对死胎病例采用了标准评估方案，包括死后评估、胎盘病理学、临床检查（由医疗保健专业人员自行决定）以及推荐的一组检查。使用标准化分类工具为死胎病例指定潜在死因。使用 χ 检验或两样本 t 检验（视情况而定）对有孕前糖尿病和 GDM 的女性与无糖尿病的女性进行了配对比较，比较了两组之间的人口统计学和分娩特征。进行了敏感性分析，排除了患有遗传疾病或主要胎儿畸形的妊娠。
在主要分析中纳入的 455 例死胎病例中，患有死胎和糖尿病的女性年龄大于 35 岁和体重指数较高的可能性更大。与无糖尿病的女性相比，她们也更有可能患有妊娠期高血压疾病（28%比 9.1%；P<.001）。患有孕前糖尿病的女性中巨大儿（LGA）新生儿更多（26%比 3.4%；P<.001）。患有孕前糖尿病的死胎（36%）和患有 GDM 的死胎（52%）更常发生在足月。患有孕前糖尿病和其他疾病等母体医学并发症的患者，与无糖尿病的死胎相比，更常被确定为死胎的可能或确定死因（43%比 4%；P<.001）。
与无糖尿病的死胎相比，患有孕前糖尿病和 GDM 的女性的死胎发生在妊娠晚期，与妊娠高血压疾病、母体医学并发症和 LGA 相关。
