Lucas Isabelle M, Barr Elizabeth L M, Barzi Federica, Longmore Danielle K, Lee I-Lynn, Kirkwood Marie, Whitbread Cherie, Connors Christine, Boyle Jacqueline A, Simon David, Goodrem Adeliesje, Brown Alex D H, Oats Jeremy, McIntyre Harold D, Shaw Jonathan E, Maple-Brown Louise
Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Department of Obstetrics & Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Int J Gynaecol Obstet. 2021 Nov;155(2):296-304. doi: 10.1002/ijgo.13846. Epub 2021 Aug 19.
To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non-Indigenous women, compared with normoglycemia.
Data were from 1102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Age-adjusted associations of gestational diabetes mellitus (GDM) or pre-existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500 ml) were assessed using logistic regression. Multivariable-adjusted models included Indigenous ethnicity, diabetes type and their interaction.
A higher proportion of Indigenous women developed PPH than non-Indigenous women (32% versus 22%; P < 0.001). Compared with non-Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were higher (odds ratio [OR] 1.83, 95% confidence intervals [CI] 1.11-3.02, and OR 1.72, 95% CI 0.99-3.00 after age adjustment, OR 1.84, 95% CI 1.06-3.19, and OR 1.33, 95% CI 0.70-2.54 after adjustment for school education and delivery mode, and OR 1.62, 95% CI 0.95-2.77, and OR 0.99, 95% CI 0.53-1.86 after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH.
The significantly higher rates of PPH experienced by Indigenous women compared with non-Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.
在一个由原住民和非原住民女性组成的前瞻性队列中，评估孕期高血糖与产后出血（PPH）风险之间的关联，并与血糖正常情况进行比较。
数据来自澳大利亚偏远地区妊娠与新生儿糖尿病结局（PANDORA）研究中的1102名女性（48%为原住民）。使用逻辑回归评估妊娠糖尿病（GDM）或孕前2型糖尿病（T2DM）、产科和人口统计学协变量与PPH（失血≥500毫升）的年龄调整关联。多变量调整模型包括原住民种族、糖尿病类型及其相互作用。
与非原住民女性相比，原住民女性发生PPH的比例更高（32%对22%；P<0.001）。与血糖正常的非原住民女性相比，患有GDM或T2DM的原住民女性发生PPH的风险更高（年龄调整后的优势比[OR]为1.83，95%置信区间[CI]为1.11-3.02，OR为1.72，95%CI为0.99-3.00；在调整学校教育和分娩方式后，OR为1.84，95%CI为1.06-3.19，OR为1.33，95%CI为0.70-2.54；在调整出生体重后，OR为1.62，95%CI为0.95-2.77，OR为0.99，95%CI为0.53-1.86）。重要的是，孕期无高血糖的原住民女性发生PPH的风险并未增加。
与非原住民女性相比，原住民女性PPH发生率显著更高，这可能是由于GDM对原住民女性的影响更大，而出生体重仅部分解释了这一现象。
