Oriot Philippe, Leroy Charlotte, Van Leeuw Virginie, Philips Jean Christophe, Vanderijst Jean François, Vuckovic Aline, Costa Elena, Debauche Christian, Chantraine Frederic
Department of Diabetology, Mouscron Hospital Centre, Avenue de Fécamp 49, 7700, Mouscron, Belgium.
Centre d'Épidémiologie Périnatale (CEpiP), Clos Chapelle-aux-Champs 30, bte B1.30.04, 1200 Brussels, Belgium.
Heliyon. 2022 Apr 12;8(4):e09251. doi: 10.1016/j.heliyon.2022.e09251. eCollection 2022 Apr.
To appraise adverse pregnancy outcomes after the adoption of IADPSG/WHO guidelines in Belgium.
A retrospective study of the Center for Perinatal Epidemiology registry was conducted. Demographic changes and adverse pregnancy outcomes were compared between a pre- and post-guideline period in women with and without hyperglycemia in pregnancy (HIP). Adjusted odds ratios with a 95% confidence interval (CI) were used to compare maternal and neonatal outcomes controlling for potential confounders (maternal age, body mass index (BMI), hypertension, parity, and multiple births).
The prevalence of HIP increased (6.0%-9.2%). In the overall population regardless of glycemic status, gestational weight gain (12.3 ± 5.7 vs 11.9 ± 5.8; p < 0.001), hypertension (0.92; 95% CI, 0.89-0.94; p < 0.001), and neonatal intensive care unit/special care nursery (0.89; 95% CI, 0.87-0.91; p < 0.001) decreased despite increasing maternal age and pre-pregnancy BMI. Emergency cesarean section rates (1.07; 95% CI, 1.05-1.09; p < 0.001) increased, but not in the HIP population (1.02; 95% CI, 0.95-1.10; ). The overall incidence of preterm birth (1.09; 95% CI, 1.06-1.12; p < 0.001), stillbirth (1.10; 95% CI, 1.01-1.21; p < 0.05), and perinatal mortality (1.10; 95% CI, 1.01-1.19; p < 0.05) increased, except in the HIP population (1.03; 95% CI, 0.95-1.11; ns), (1.04; 95% CI, 0.74-1.47; ns) and (1.09; 95% CI, 0.80-1.49; ns), respectively. The overall incidence of small- for-gestational-age remained unchanged (0.99; 95%CI, 0.97-1.01; ns) regardless of glycemic status. In the HIP population, large-for-gestational age (0.90; 95% CI, 0.84-0.95; p < 0.001) and macrosomia (0.84; 95% CI, 0.78-0.92; p < 0.001) decreased.
After the implementation of IADPSG/WHO guidelines, the prevalence of HIP increased by 53.7% and the incidence of major HIP-related pregnancy complications appears to be lower. However, we cannot conclude that the reduction of LGA-macrosomia is due to a better management of diabetes or due to greater recruitment of women with mild HIP associated with a lower risk of obstetrical complications.
评估比利时采用国际糖尿病与妊娠研究组协会（IADPSG）/世界卫生组织（WHO）指南后的不良妊娠结局。
对围产期流行病学中心登记处进行回顾性研究。比较了妊娠期间患有和未患有高血糖症（HIP）的女性在指南实施前后的人口统计学变化和不良妊娠结局。采用调整后的比值比及95%置信区间（CI）来比较孕产妇和新生儿结局，并对潜在混杂因素（产妇年龄、体重指数（BMI）、高血压、产次和多胎妊娠）进行控制。
HIP的患病率有所上升（从6.0%升至9.2%）。在总体人群中，无论血糖状态如何，尽管产妇年龄和孕前BMI增加，但孕期体重增加（12.3±5.7与11.9±5.8；p<0.001）、高血压（0.92；95%CI，0.89 - 0.94；p<0.001）以及新生儿重症监护病房/特殊护理病房入住率（0.89；95%CI，0.87 - 0.91；p<0.001）均有所下降。急诊剖宫产率（1.07；95%CI，1.05 - 1.09；p<0.001）上升，但HIP人群中未出现这种情况（1.02；95%CI，0.95 - 1.10；[此处原文似乎不完整]）。早产（1.09；95%CI，1.06 - 1.12；p<0.001）、死产（1.10；95%CI，1.01 - 1.21；p<0.05）和围产期死亡率（1.10；95%CI，1.01 - 1.19；p<0.05）的总体发生率上升，但HIP人群中除外（分别为1.03；95%CI，0.95 - 1.11；无显著性差异（ns））、（1.04；95%CI，0.74 - 1.47；ns）和（1.09；95%CI，0.80 - 1.49；ns）。无论血糖状态如何，小于胎龄儿的总体发生率保持不变（0.99；95%CI，0.97 - 1.01；ns）。在HIP人群中，大于胎龄儿（0.90；95%CI，0.84 - 0.95；p<0.001）和巨大儿（0.84；95%CI，0.78 - 0.92；p<0.001）有所减少。
实施IADPSG/WHO指南后，HIP的患病率上升了53.7%，与HIP相关的主要妊娠并发症的发生率似乎较低。然而，我们不能得出大于胎龄儿 - 巨大儿减少是由于糖尿病管理改善或由于招募了更多患有轻度HIP且产科并发症风险较低的女性所致的结论。
