Diabetes Center and Diabetes Education Center, Kiel, Germany.
Institute of Epidemiology, Kiel University, Kiel, Germany.
Am J Obstet Gynecol. 2022 Oct;227(4):631.e1-631.e19. doi: 10.1016/j.ajog.2022.05.027. Epub 2022 May 14.
Gestational diabetes mellitus is one of the most frequent pregnancy complications with a global prevalence of 13.4% in 2021. Pregnant women with COVID-19 and gestational diabetes mellitus are 3.3 times more likely to be admitted to an intensive care unit than women without gestational diabetes mellitus. Data on the association of gestational diabetes mellitus with maternal and neonatal pregnancy outcomes in pregnant women with SARS-CoV-2 infection are lacking.
This study aimed to investigate whether gestational diabetes mellitus is an independent risk factor for adverse maternal and fetal and neonatal outcomes in pregnant women with COVID-19.
The COVID-19-Related Obstetric and Neonatal Outcome Study is a registry-based multicentric prospective observational study from Germany and Linz, Austria. Pregnant women with clinically confirmed COVID-19 were enrolled between April 3, 2020, and August 24, 2021, at any stage of pregnancy. Obstetricians and neonatologists of 115 hospitals actively provided data to the COVID-19-Related Obstetric and Neonatal Outcome Study. For collecting data, a cloud-based electronic data platform was developed. Women and neonates were observed until hospital discharge. Information on demographic characteristics, comorbidities, medical history, COVID-19-associated symptoms and treatments, pregnancy, and birth outcomes were entered by the local sites. Information on the periconceptional body mass index was collected. A primary combined maternal endpoint was defined as (1) admission to an intensive care unit (including maternal mortality), (2) viral pneumonia, and/or (3) oxygen supplementation. A primary combined fetal and neonatal endpoint was defined as (1) stillbirth at ≥24 0/7 weeks of gestation, (2) neonatal death ≤7 days after delivery, and/or (3) transfer to a neonatal intensive care unit. Multivariable logistic regression analysis was performed to evaluate the modulating effect of gestational diabetes mellitus on the defined endpoints.
Of the 1490 women with COVID-19 (mean age, 31.0±5.2 years; 40.7% nulliparous), 140 (9.4%) were diagnosed with gestational diabetes mellitus; of these, 42.9% were treated with insulin. Overall, gestational diabetes mellitus was not associated with an adverse maternal outcome (odds ratio, 1.50; 95% confidence interval, 0.88-2.57). However, in women who were overweight or obese, gestational diabetes mellitus was independently associated with the primary maternal outcome (adjusted odds ratio, 2.69; 95% confidence interval, 1.43-5.07). Women who were overweight or obese with gestational diabetes mellitus requiring insulin treatment were found to have an increased risk of a severe course of COVID-19 (adjusted odds ratio, 3.05; 95% confidence interval, 1.38-6.73). Adverse maternal outcomes were more common when COVID-19 was diagnosed with or shortly after gestational diabetes mellitus diagnosis than COVID-19 diagnosis before gestational diabetes mellitus diagnosis (19.6% vs 5.6%; P<.05). Maternal gestational diabetes mellitus and maternal preconception body mass index of ≥25 kg/m increased the risk of adverse fetal and neonatal outcomes (adjusted odds ratio, 1.83; 95% confidence interval, 1.05-3.18). Furthermore, overweight and obesity (irrespective of gestational diabetes mellitus status) were influential factors for the maternal (adjusted odds ratio, 1.87; 95% confidence interval, 1.26-2.75) and neonatal (adjusted odds ratio, 1.81; 95% confidence interval, 1.32-2.48) primary endpoints compared with underweight or normal weight.
Gestational diabetes mellitus, combined with periconceptional overweight or obesity, was independently associated with a severe maternal course of COVID-19, especially when the mother required insulin and COVID-19 was diagnosed with or after gestational diabetes mellitus diagnosis. These combined factors exhibited a moderate effect on neonatal outcomes. Women with gestational diabetes mellitus and a body mass index of ≥25 kg/m were a particularly vulnerable group in the case of COVID-19.
妊娠糖尿病是最常见的妊娠并发症之一，2021 年全球患病率为 13.4%。患有 COVID-19 和妊娠糖尿病的孕妇入住重症监护病房的可能性是没有妊娠糖尿病的孕妇的 3.3 倍。关于妊娠糖尿病与 SARS-CoV-2 感染孕妇母婴和新生儿妊娠结局的关联的数据尚缺乏。
本研究旨在探讨妊娠糖尿病是否是 COVID-19 孕妇不良母婴和胎儿及新生儿结局的独立危险因素。
COVID-19 相关产科和新生儿结局研究是一项来自德国和奥地利林茨的基于注册的多中心前瞻性观察研究。在妊娠的任何阶段，于 2020 年 4 月 3 日至 2021 年 8 月 24 日期间，临床确诊 COVID-19 的孕妇被纳入研究。115 家医院的产科医生和新生儿科医生积极向 COVID-19 相关产科和新生儿结局研究提供数据。为了收集数据，开发了一个基于云的电子数据平台。对女性和新生儿进行观察，直到出院。由当地机构输入人口统计学特征、合并症、病史、COVID-19 相关症状和治疗、妊娠和分娩结局的信息。收集围孕期体重指数的信息。主要复合母婴终点定义为（1）入住重症监护病房（包括产妇死亡），（2）病毒性肺炎和/或（3）氧疗。主要复合胎儿和新生儿终点定义为（1）≥24 0/7 周胎龄的死产，（2）新生儿死亡≤7 天后，和/或（3）转至新生儿重症监护病房。采用多变量逻辑回归分析评估妊娠糖尿病对定义终点的调节作用。
在 1490 名患有 COVID-19 的女性中（平均年龄 31.0±5.2 岁；40.7%为初产妇），140 名（9.4%）被诊断为妊娠糖尿病；其中，42.9%接受胰岛素治疗。总体而言，妊娠糖尿病与不良母婴结局无关（比值比，1.50；95%置信区间，0.88-2.57）。然而，在超重或肥胖的女性中，妊娠糖尿病与主要母婴结局独立相关（调整后的比值比，2.69；95%置信区间，1.43-5.07）。需要胰岛素治疗的超重或肥胖且患有妊娠糖尿病的女性发生 COVID-19 严重病程的风险增加（调整后的比值比，3.05；95%置信区间，1.38-6.73）。与妊娠糖尿病诊断前相比，当 COVID-19 诊断时或之后诊断妊娠糖尿病时，不良母婴结局更为常见（19.6%比 5.6%；P<.05）。妊娠糖尿病和母亲孕前体重指数≥25 kg/m2增加了不良胎儿和新生儿结局的风险（调整后的比值比，1.83；95%置信区间，1.05-3.18）。此外，超重和肥胖（无论妊娠糖尿病状态如何）是影响母婴（调整后的比值比，1.87；95%置信区间，1.26-2.75）和新生儿（调整后的比值比，1.81；95%置信区间，1.32-2.48）主要结局的因素，与体重不足或正常体重相比。
妊娠糖尿病与围孕期超重或肥胖相结合，与 COVID-19 孕妇严重的母婴病程独立相关，尤其是当母亲需要胰岛素且 COVID-19 在妊娠糖尿病诊断前或之后诊断时。这些合并因素对新生儿结局有中度影响。患有妊娠糖尿病和体重指数≥25 kg/m2的女性在 COVID-19 病例中是一个特别脆弱的群体。
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