Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
University Hospital Jena, Institute of Medical Statistics and Computer Science, Friedrich Schiller University, Jena, Germany.
Arch Gynecol Obstet. 2022 Jun;305(6):1445-1452. doi: 10.1007/s00404-021-06255-9. Epub 2021 Sep 24.
To evaluate the independent factors associated with the success of a trial of vaginal birth (TVB) in women with type 1 diabetes. Despite all therapeutic efforts and technological innovations, rates of caesarean sections (CS) in pregnant women with type 1 diabetes remain unchanged above 60%. Our aim was to point out influencing factors to improve the quality of antepartum counseling.
We performed a retrospective cohort study of 195 pregnancies with type 1 diabetes treated between 2000 and 2019. After exclusions, 118 women with near-term singleton pregnancies intended vaginal birth (TVB). Group differences between CS and successful vaginal delivery were analyzed. Multivariate logistic regression was performed by including clinical and metabolic variables to determine the independent effects on a successful vaginal delivery. Subgroup analysis for nulliparous women.
Of 118 women with TVB, 67 (56.8%) were delivered vaginally. History of previous vaginal delivery (OR 10.29; CI 2.39; 44.30), HbA1c changes during pregnancy (per % increase; OR 0.59; CI 0.36; 0.96) and gestational weight gain (per kg; OR 0.87; CI 0.80; 0.96) were independent predictors for a successful vaginal delivery. In nulliparous women, the duration of diabetes was independently and negatively associated with vaginal delivery.
Provided data can help to improve antepartum counseling in type 1 diabetic patients. It seems that women with type 1 diabetes should avoid postponing pregnancy and childbirth.
评估与 1 型糖尿病女性试产成功相关的独立因素。尽管进行了所有的治疗努力和技术创新，但 1 型糖尿病孕妇的剖宫产率（CS）仍保持在 60%以上不变。我们的目的是指出影响因素，以提高产前咨询的质量。
我们对 2000 年至 2019 年期间治疗的 195 例 1 型糖尿病妊娠进行了回顾性队列研究。排除后，有 118 例近足月单胎妊娠的女性计划阴道分娩（TVB）。分析 CS 与成功阴道分娩的组间差异。通过纳入临床和代谢变量进行多变量逻辑回归，以确定对成功阴道分娩的独立影响。对初产妇进行亚组分析。
在 118 例 TVB 的女性中，67 例（56.8%）经阴道分娩。既往阴道分娩史（OR 10.29；CI 2.39；44.30）、妊娠期间 HbA1c 变化（每增加%；OR 0.59；CI 0.36；0.96）和妊娠体重增加（每增加 kg；OR 0.87；CI 0.80；0.96）是成功阴道分娩的独立预测因素。在初产妇中，糖尿病病程与阴道分娩呈独立负相关。
提供的数据有助于改善 1 型糖尿病患者的产前咨询。看来，1 型糖尿病女性应避免推迟怀孕和分娩。
