Harper Lorie M, Tita Alan T N, Biggio Joseph R, Chang Jen Jen
Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL.
System Co-Chair of Women's Services, Ochsner Clinic Foundation, New Orleans, LA and Clinical Professor of Obstetrics and Gynecology, The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA.
Ochsner J. 2020 Winter;20(4):373-380. doi: 10.31486/toj.20.0019.
The recommended gestational age to deliver pregnancies complicated by diabetes ranges from 34 to 39 weeks of gestation. The objective of this study was to determine the optimal gestational age for delivery of patients with diabetes to minimize perinatal death. We extracted a population-based cohort of singleton, nonanomalous infants of diabetic pregnancies from the Missouri birth registry for the period January 1, 1989 to December 31, 2005 and compared perinatal outcomes of planned deliveries at 37, 38, 39, and 40 weeks to expectant management. Planned deliveries were identified by induction or cesarean delivery without documented medical or obstetric indications. The primary outcome was perinatal death, defined as stillbirth or neonatal death within 28 days of birth. Secondary outcomes were independent stillbirth, independent neonatal death, and a composite adverse neonatal event of assisted ventilation >30 minutes, birth injury, seizures, or 5-minute Apgar score ≤3. Groups were compared using test and chi-square as appropriate. In 4,905 diabetic pregnancies reaching 37 weeks, 1,012 (20.6%) patients were insulin dependent. Overall, the risk of perinatal death at any gestational age examined was low (3/1,000 births or lower), as was the risk of the adverse perinatal outcome (<2%). When only patients who were insulin dependent were included in the analysis, the risk of perinatal death at any gestational age remained low at 6 per 1,000 births or fewer. Delivery as early as 37 weeks is reasonable for women who have diabetes, although the absolute risk of perinatal death is low at 37 to 39 weeks.
对于患有糖尿病的孕妇，推荐的分娩孕周为妊娠34至39周。本研究的目的是确定糖尿病患者的最佳分娩孕周，以尽量减少围产期死亡。我们从密苏里州出生登记处提取了1989年1月1日至2005年12月31日期间基于人群的糖尿病妊娠单胎、无畸形婴儿队列，并将37、38、39和40周计划分娩的围产期结局与期待治疗进行比较。计划分娩通过引产或剖宫产确定，且无记录在案的医学或产科指征。主要结局是围产期死亡，定义为死产或出生后28天内的新生儿死亡。次要结局是独立死产、独立新生儿死亡，以及辅助通气>30分钟、产伤、癫痫发作或5分钟阿氏评分≤3的复合不良新生儿事件。根据情况使用检验和卡方检验对各组进行比较。在4905例达到37周的糖尿病妊娠中，1012例（20.6%）患者依赖胰岛素。总体而言，在所检查的任何孕周，围产期死亡风险较低（每1000例出生3例或更低），不良围产期结局风险也较低（<2%）。当分析仅纳入依赖胰岛素的患者时，任何孕周的围产期死亡风险仍然较低，每1000例出生6例或更少。对于患有糖尿病的女性，早在37周分娩是合理的，尽管在37至39周时围产期死亡的绝对风险较低。
