Lau Sue Lynn, Chung Alex, Kao Joanna, Hendon Susan, Hawke Wendy, Lau Sue Mei
Western Sydney University, Campbelltown, NSW, Australia.
Blacktown-Mount Druitt Hospital, Blacktown, NSW, Australia.
Clin Diabetes Endocrinol. 2023 Mar 15;9(1):2. doi: 10.1186/s40842-023-00149-2.
The risk of adverse outcomes in recurrent GDM pregnancy has not been well documented, particularly in women who have already had an adverse outcome. The aim of this study was to compare the risk of recurrent adverse delivery outcome (ADO) or adverse neonatal outcome (ANO) between consecutive gestational diabetes (GDM) pregnancies.
In this retrospective study of 424 pairs of consecutive ("index" and "subsequent") GDM pregnancies, we compared the risk of ADO (instrumental delivery, emergency Caesarean section) and ANO (large for gestational age (LGA and small for gestational age (SGA)) in women with and without a history of adverse outcome in their index pregnancy.
Subsequent pregnancies had higher rates of elective Caesarean (30.4% vs 17.0%, p < 0.001) and lower rates of instrumental delivery (5% vs 13.9%, p < 0.001), emergency Caesarean (7.1% vs 16.3%, p < 0.001) and vaginal delivery (62.3% vs 66.3%, p = 0.01). Index pregnancy adverse outcome was associated with a higher risk of repeat outcome: RR 3.09 (95%CI:1.30,7.34) for instrumental delivery, RR 2.20 (95%CI:1.06,4.61) for emergency Caesarean, RR 4.55 (95%CI:3.03,6.82) for LGA, and RR 5.01 (95%CI:2.73,9.22) for SGA). The greatest risk factor for subsequent LGA (RR 3.13 (95%CI:2.20,4.47)) or SGA (RR 4.71 (95%CI:2.66,8.36)) was having that outcome in the index pregnancy.
A history of an adverse outcome is a powerful predictor of the same outcome in the subsequent GDM pregnancy. These high-risk women may warrant more directed management over routine GDM care such as altered glucose targets or increased frequency of ultrasound assessment.
复发性妊娠期糖尿病（GDM）孕妇出现不良结局的风险尚未得到充分记录，尤其是那些已经有过不良结局的女性。本研究的目的是比较连续两次妊娠期糖尿病（GDM）妊娠中复发性不良分娩结局（ADO）或不良新生儿结局（ANO）的风险。
在这项对424对连续的（“索引”和“后续”）GDM妊娠进行的回顾性研究中，我们比较了索引妊娠中有或无不良结局史的女性发生ADO（器械助产、急诊剖宫产）和ANO（大于胎龄儿（LGA）和小于胎龄儿（SGA））的风险。
后续妊娠中择期剖宫产率较高（30.4%对17.0%，p<0.001），器械助产率较低（5%对13.9%，p<0.001）、急诊剖宫产率较低（7.1%对16.3%，p<0.001）以及阴道分娩率较低（62.3%对66.3%，p=0.01）。索引妊娠不良结局与再次出现相同结局的风险较高相关：器械助产的风险比（RR）为3.09（95%置信区间：1.30,7.34），急诊剖宫产的RR为2.20（95%置信区间：1.06,4.61），LGA的RR为4.55（95%置信区间：3.03,6.82），SGA的RR为5.01（95%置信区间：2.73,9.22）。后续LGA（RR 3.13（95%置信区间：2.20,4.47））或SGA（RR 4.71（95%置信区间：2.66,8.36））的最大风险因素是索引妊娠中出现该结局。
不良结局史是后续GDM妊娠中出现相同结局的有力预测因素。这些高危女性可能需要比常规GDM护理更有针对性的管理，如调整血糖目标或增加超声评估频率。
