2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland.
Department of Medical Simulation, Chair of Medical Education, Poznan University of Medical Sciences, 41 Jackowskiego St, 60-512, Poznan, Poland.
BMC Pregnancy Childbirth. 2022 Aug 19;22(1):654. doi: 10.1186/s12884-022-04980-w.
Gestational diabetes mellitus (GDM) is a frequent pregnancy complication, affecting the maternal and neonatal health. The new diagnostic strategy for GDM, proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010 and World Health Organization in 2013, raised hope to reduce perinatal complications. The purpose of the study was to compare risk factors influencing maternal and foetal outcomes in a group of pregnant women diagnosed with GDM, and in a group of pregnant women without GDM, regardless of the adopted diagnostic criteria. Also, the aim of the study was to evaluate the impact of risk factors on perinatal results and the "cost" of reducing adverse pregnancy outcomes in patients with GDM.
It was a retrospective study based on the analysis of births given after 37 weeks of pregnancy at the 2nd Department of Obstetrics and Gynaecology, Warsaw Medical University during the years 2013 to 2015. All pregnant women had a 75 g OGTT between the 24th and 28th weeks of pregnancy. The study compared risk factors for perinatal complications in 285 GDM patients and in 202 randomly selected women without GDM. The impact of selected risk factors on perinatal outcomes was analysed.
Both the diagnosis of GDM and maternal BMI prior to pregnancy, significantly modified the risk of excessive and insufficient weight gain during pregnancy. The parameters significantly influencing the risk of the composite adverse maternal outcome were the maternal abdominal circumference [OR: 1.08 (1.04; 1.11)] and multiparity, which reduced the risk by almost half [OR: 0.47 (0.30; 0.75)]. The maternal abdominal circumference before the delivery was a strong factor correlating with the occurrence of perinatal complications in both the mother and the foetus in the entire cohort. A circumference over 100 cm increased the risk of at least one maternal complication (increased blood loss, soft tissue injury, pre-eclampsia) by almost 40% (OR 1.38, p < 0.001).
No differences were found in maternal and foetal outcomes in GDM and non-GDM women except gestational weight gain below Institute of Medicine recommendations. The only "cost" of reducing adverse pregnancy outcomes in GDM patients seems to be lowering gestational weight gain, the future impact of which on GDM pregnant population should be assessed. The maternal abdominal circumference measured before delivery not the severity of carbohydrate intolerance, remained the main predictor for significant perinatal complications.
妊娠糖尿病（GDM）是一种常见的妊娠并发症，会影响母婴健康。国际糖尿病和妊娠研究组于 2010 年和世界卫生组织于 2013 年提出的新的 GDM 诊断策略，有望降低围产期并发症。本研究的目的是比较一组 GDM 孕妇和一组无 GDM 孕妇的影响母婴结局的危险因素，无论采用何种诊断标准。此外，本研究还旨在评估危险因素对围产期结果的影响，以及降低 GDM 患者不良妊娠结局的“代价”。
这是一项回顾性研究，基于 2013 年至 2015 年在华沙医科大学第二妇产科分娩的 37 周后妊娠的分析。所有孕妇在妊娠 24 至 28 周时均进行 75gOGTT。本研究比较了 285 例 GDM 患者和 202 例随机选择的无 GDM 孕妇的围产期并发症危险因素。分析了选定危险因素对围产期结局的影响。
GDM 的诊断和孕前 BMI 显著改变了妊娠期间体重过度和不足增加的风险。显著影响复合不良母体结局风险的参数是母体腹围[OR：1.08（1.04；1.11）]和多胎妊娠，这将风险降低了近一半[OR：0.47（0.30；0.75）]。分娩前的母体腹围是整个队列中母婴围产期并发症发生的一个强有力的因素。周长超过 100cm 会使至少一种母体并发症（出血量增加、软组织损伤、子痫前期）的风险增加近 40%（OR 1.38，p<0.001）。
除了不符合医学研究所建议的妊娠体重增加外，GDM 妇女和非 GDM 妇女的母婴结局无差异。降低 GDM 患者不良妊娠结局的唯一“代价”似乎是降低妊娠体重增加，未来应对 GDM 孕妇人群的影响进行评估。分娩前测量的母体腹围而不是碳水化合物不耐受的严重程度，仍然是发生重大围产期并发症的主要预测因素。
