Akinyemi Oluwasegun A, Weldeslase Terhas Asfiha, Odusanya Eunice, Akueme Ngozi T, Omokhodion Ofure V, Fasokun Mojisola E, Makanjuola Deborah, Fakorede Mary, Ogundipe Temitayo
Health Policy and Management, University of Maryland School of Public Health, College Park, USA.
Surgery, Howard University, Washington DC, USA.
Cureus. 2023 Jul 4;15(7):e41360. doi: 10.7759/cureus.41360. eCollection 2023 Jul.
Introduction Gestational diabetes mellitus (GDM) is a major contributor to adverse pregnancy outcomes both in the United States and globally. As the prevalence of obesity continues to rise, the incidence of GDM is anticipated to increase as well. Despite the significant impact of GDM on maternal and neonatal health, research examining the independent associations between GDM and adverse outcomes remains limited in the U.S. context. Objective This study aims to address this knowledge gap and further elucidate the relationship between GDM and maternal and neonatal health outcomes. Method We performed a retrospective study using data from the United States Vital Statistics Records, encompassing deliveries that occurred between January 2015 and December 2019. Our analysis aimed to establish the independent association between GDM and various adverse maternal and neonatal outcomes. The multivariate analysis incorporated factors such as maternal socioeconomic demographics, preexisting comorbidities, and conditions during pregnancy to account for potential confounders and elucidate the relationship between GDM and the outcomes of interest. Result Between 2015 and 2019, there were 1,212,589 GDM-related deliveries, accounting for 6.3% of the 19,249,237 total deliveries during the study period. Among women with GDM, 46.4% were Non-Hispanic Whites, 11.4% were Non-Hispanic Blacks, 25.7% were Hispanics, and 16.5% belonged to other racial/ethnic groups. The median age of women with GDM was 31 years, with an interquartile range of 27-35 years. The cesarean section rate among these women was 46.5%. GDM was identified as an independent predictor of adverse maternal and neonatal outcomes, including cesarean section (OR=1.40; 95% CI: 1.39-1.40), maternal blood transfusion (OR=1.15; 95% CI: 1.12-1.18), intensive care unit admission (OR=1.16; 95% CI: 1.10-1.21), neonatal intensive care unit admission (OR=1.53; 95% CI: 1.52-1.54), assisted ventilation (OR=1.37; 95% CI: 1.35-1.39), and low 5-minute Apgar score (OR=1.01; 95% CI: 1.00-1.03). Conclusion GDM serves as an independent risk factor for adverse maternal and neonatal outcomes, emphasizing the importance of early detection and management in pregnant women.
引言
妊娠期糖尿病（GDM）是美国乃至全球不良妊娠结局的主要促成因素。随着肥胖患病率持续上升，预计GDM的发病率也会增加。尽管GDM对孕产妇和新生儿健康有重大影响，但在美国背景下，研究GDM与不良结局之间的独立关联仍然有限。
目的
本研究旨在填补这一知识空白，进一步阐明GDM与孕产妇和新生儿健康结局之间的关系。
方法
我们使用美国生命统计记录的数据进行了一项回顾性研究，涵盖2015年1月至2019年12月期间的分娩情况。我们的分析旨在确定GDM与各种不良孕产妇和新生儿结局之间的独立关联。多变量分析纳入了孕产妇社会经济人口统计学、既往合并症以及孕期状况等因素，以考虑潜在的混杂因素，并阐明GDM与感兴趣结局之间的关系。
结果
2015年至2019年期间，有1,212,589例与GDM相关的分娩，占研究期间19,249,237例总分娩数的6.3%。在患有GDM的女性中，46.4%为非西班牙裔白人，11.4%为非西班牙裔黑人，25.7%为西班牙裔，16.5%属于其他种族/族裔群体。患有GDM的女性的中位年龄为31岁，四分位间距为27 - 35岁。这些女性的剖宫产率为46.5%。GDM被确定为不良孕产妇和新生儿结局的独立预测因素，包括剖宫产（OR = 1.40；95% CI：1.39 - 1.40）、孕产妇输血（OR = 1.15；95% CI：1.12 - 1.18）、入住重症监护病房（OR = 1.16；95% CI：1.10 - 1.21）、新生儿入住重症监护病房（OR = 1.53；95% CI：1.52 - 1.54）、辅助通气（OR = 1.37；95% CI：1.35 - 1.39）以及5分钟阿氏评分低（OR = 1.01；95% CI：1.00 - 1.03）。
结论
GDM是不良孕产妇和新生儿结局的独立危险因素，强调了对孕妇进行早期检测和管理的重要性。
