Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Am J Perinatol. 2023 Jul;40(9):929-936. doi: 10.1055/s-0043-1764206. Epub 2023 Feb 27.
We estimated the association between diabetes and shoulder dystocia by infant birth weight subgroups (<4,000, 4,000-4,500, and >4,500 g) in an era of prophylactic cesarean delivery for suspected macrosomia.
A secondary analysis from the National Institute of Child Health and Human Development U.S. Consortium for Safe Labor of deliveries at ≥24 weeks with a nonanomalous, singleton fetus with vertex presentation undergoing a trial of labor. The exposure was either pregestational or gestational diabetes compared with no diabetes. The primary outcome was shoulder dystocia and secondarily, birth trauma with a shoulder dystocia. We calculated adjusted risk ratios (aRRs) with modified Poison's regression between diabetes and shoulder dystocia and the number needed to treat (NNT) to prevent a shoulder dystocia with cesarean delivery.
Among 167,589 assessed deliveries (6% with diabetes), pregnant individuals with diabetes had a higher risk of shoulder dystocia at birth weight <4,000 g (aRR: 1.95; 95% confidence interval [CI]: 1.66-2.31) and 4,000 to 4,500 g (aRR: 1.57; 95% CI: 1.24-1.99), albeit not significantly at birth weight >4,500 g (aRR: 1.26; 95% CI: 0.87-1.82) versus those without diabetes. The risk of birth trauma with shoulder dystocia was higher with diabetes (aRR: 2.29; 95% CI: 1.54-3.45). The NNT to prevent a shoulder dystocia with diabetes was 11 and 6 at ≥4,000 and >4,500 g, versus without diabetes, 17 and 8 at ≥4,000 and >4,500 g, respectively.
Diabetes increased the risk of shoulder dystocia, even at lower birth weight thresholds than at which cesarean delivery is currently offered. Guidelines providing the option of cesarean delivery for suspected macrosomia may have decreased the risk of shoulder dystocia at higher birth weights.
· >Diabetes increased the risk of shoulder dystocia, even at lower birth weight thresholds than at which cesarean delivery is currently offered.. · Cesarean delivery for suspected macrosomia may have decreased the risk of shoulder dystocia at higher birth weights.. · These findings can inform delivery planning for providers and pregnant individuals with diabetes..
在预防性剖宫产用于疑似巨大儿的时代，我们通过婴儿出生体重亚组（<4000g、4000-4500g 和>4500g）估计糖尿病与肩难产之间的关联。
这是美国国家儿童健康与人类发展研究所美国安全分娩联合体的一项二次分析，纳入了 24 周以上、非畸形、单胎、头位分娩并进行试产的孕妇。暴露因素为孕前或妊娠期糖尿病，与无糖尿病的孕妇进行比较。主要结局为肩难产，次要结局为肩难产相关的分娩创伤。我们采用改良泊松回归计算了糖尿病与肩难产之间的调整风险比（aRR）和需要行剖宫产术预防肩难产的例数（NNT）。
在 167589 例评估分娩中（6%的孕妇患有糖尿病），出生体重<4000g 的糖尿病孕妇肩难产的风险更高（aRR：1.95；95%置信区间[CI]：1.66-2.31）和 4000-4500g（aRR：1.57；95% CI：1.24-1.99），但出生体重>4500g 时无显著差异（aRR：1.26；95% CI：0.87-1.82）。患有糖尿病的孕妇肩难产相关分娩创伤的风险更高（aRR：2.29；95% CI：1.54-3.45）。与无糖尿病的孕妇相比，在出生体重≥4000g 和>4500g 时，预防糖尿病肩难产的 NNT 分别为 11 和 6，而在出生体重≥4000g 和>4500g 时，无糖尿病的 NNT 分别为 17 和 8。
即使在低于目前剖宫产提供的出生体重阈值的情况下，糖尿病也会增加肩难产的风险。提供疑似巨大儿行剖宫产术的指南可能降低了较高出生体重的肩难产风险。
糖尿病增加了肩难产的风险，即使在低于目前剖宫产提供的出生体重阈值的情况下也是如此。
对于疑似巨大儿的孕妇，行剖宫产术可能降低了较高出生体重的肩难产风险。
这些发现可为有糖尿病的孕妇及其医疗服务提供者提供分娩计划的参考依据。
