The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
The Boden Initiative, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2022 Aug;62(4):525-535. doi: 10.1111/ajo.13505. Epub 2022 Mar 28.
BACKGROUND/AIMS: To evaluate maternal birth and neonatal outcomes among women with gestational diabetes mellitus (GDM), but without specific medical conditions and eligible for vaginal birth who underwent induction of labour (IOL) at term compared with those who were expectantly managed.
Population-based cohort study of women with GDM, but without medical conditions, who had a singleton, cephalic birth at 38-41 completed weeks gestation, in New South Wales, Australia between January 2010 and December 2016. Women who underwent IOL at 38, 39, 40 weeks gestation (38-, 39-, 40-induction groups) were compared with those who were managed expectantly and gave birth at and/or beyond the respective gestational age group (38-, 39-, 40-expectant groups). Multivariable logistic regression analysis was used to assess the association between IOL and adverse maternal birth and neonatal outcomes taking into account potential confounding by maternal age, country of birth, smoking, residential location, residential area of socioeconomic disadvantage and birth year.
Of 676 762 women who gave birth during the study period, 66 606 (10%) had GDM; of these, 34799 met the inclusion criteria. Compared with expectant management, those in 38- (adjusted odds ratio (aOR) 1.11; 95% CI, 1.04-1.18), 39- (aOR 1.21; 95% CI, 1.14-1.28) and 40- (aOR 1.50; 95% CI, 1.40-1.60) induction groups had increased risk of caesarean section. Women in the 38-induction group also had an increased risk of composite neonatal morbidity (aOR 1.10; 95% CI, 1.01-1.21), which was not observed at 39- and 40-induction groups. We found no difference between groups in perinatal death or neonatal intensive care unit admission for births at any gestational age.
In women with GDM but without specific medical conditions and eligible for vaginal birth, IOL at 38, 39, 40 weeks gestation is associated with an increased risk of caesarean section.
背景/目的：评估患有妊娠期糖尿病（GDM）但无特定医疗条件且适合阴道分娩的女性在足月时行引产（IOL）与期待管理相比的母婴分娩和新生儿结局。
这是一项基于人群的队列研究，纳入了 2010 年 1 月至 2016 年 12 月在澳大利亚新南威尔士州，38-41 孕周时患有 GDM 但无医疗条件的单胎头位分娩的女性。38 周、39 周和 40 周行 IOL 的女性（38-、39-、40-引产组）与期待管理且在相应的孕龄组及以后分娩的女性（38-、39-、40-期待组）进行比较。采用多变量逻辑回归分析，在考虑产妇年龄、出生国、吸烟、居住地点、居住地区社会经济劣势和分娩年份等潜在混杂因素的情况下，评估 IOL 与不良母婴分娩和新生儿结局之间的关联。
在研究期间分娩的 676762 名女性中，有 66606 名（10%）患有 GDM；其中 34799 名符合纳入标准。与期待管理相比，38-（校正优势比（aOR）1.11；95%CI，1.04-1.18）、39-（aOR 1.21；95%CI，1.14-1.28）和 40-（aOR 1.50；95%CI，1.40-1.60）引产组行剖宫产的风险增加。38 引产组的新生儿复合发病率（aOR 1.10；95%CI，1.01-1.21）也增加，但 39-和 40 引产组未见增加。在任何孕周分娩时，各组间围产儿死亡或新生儿重症监护病房（NICU）入院率无差异。
对于患有 GDM 但无特定医疗条件且适合阴道分娩的女性，在 38、39、40 孕周行 IOL 与剖宫产风险增加相关。
