Telethon Kids Institute, University of Western Australia, Perth, Australia.
School of Population and Global Health, The University of Western Australia, Perth, Australia.
BMC Pregnancy Childbirth. 2024 May 30;24(1):395. doi: 10.1186/s12884-024-06484-1.
Australian Aboriginal and Torres Strait Islander women with diabetes in pregnancy (DIP) are more likely to have glycaemic levels above the target range, and their babies are thus at higher risk of excessive fetal growth. Shoulder dystocia, defined by failure of spontaneous birth of fetal shoulder after birth of the head requiring obstetric maneuvers, is an obstetric emergency that is strongly associated with DIP and fetal size. The aim of this study was to investigate the epidemiology of shoulder dystocia in Aboriginal babies born to mothers with DIP.
Stratifying by Aboriginal status, characteristics of births complicated by shoulder dystocia in women with and without DIP were compared and incidence and time-trends of shoulder dystocia were described. Compliance with guidelines aiming at preventing shoulder dystocia in women with DIP were compared. Post-logistic regression estimation was used to calculate the population attributable fractions (PAFs) for shoulder dystocia associated with DIP and to estimate probabilities of shoulder dystocia in babies born to mothers with DIP at birthweights > 3 kg.
Rates of shoulder dystocia from vaginal births in Aboriginal babies born to mothers with DIP were double that of their non-Aboriginal counterparts (6.3% vs 3.2%, p < 0.001), with no improvement over time. Aboriginal mothers with diabetes whose pregnancies were complicated by shoulder dystocia were more likely to have a history of shoulder dystocia (13.1% vs 6.3%, p = 0.032). Rates of guideline-recommended elective caesarean section in pregnancies with diabetes and birthweight > 4.5 kg were lower in the Aboriginal women (28.6% vs 43.1%, p = 0.004). PAFs indicated that 13.4% (95% CI: 9.7%-16.9%) of shoulder dystocia cases in Aboriginal (2.7% (95% CI: 2.1%-3.4%) in non-Aboriginal) women were attributable to DIP. Probability of shoulder dystocia among babies born to Aboriginal mothers with DIP was higher at birthweights > 3 kg.
Aboriginal mothers with DIP had a higher risk of shoulder dystocia and a stronger association between birthweight and shoulder dystocia. Many cases were recurrent. These factors should be considered in clinical practice and when counselling women.
澳大利亚原住民和托雷斯海峡岛民女性在妊娠期间患有糖尿病（DIP）的情况下，血糖水平更有可能超过目标范围，因此她们的婴儿面临着过度胎儿生长的更高风险。肩难产定义为头部娩出后胎儿肩部无法自然娩出，需要产科干预，是一种与 DIP 和胎儿大小密切相关的产科急症。本研究旨在调查患有 DIP 的母亲所生的原住民婴儿中肩难产的流行病学。
按原住民身份分层，比较了患有和不患有 DIP 的女性中肩难产分娩的特征，并描述了肩难产的发生率和时间趋势。比较了旨在预防 DIP 女性肩难产的指南的依从性。采用后逻辑回归估计计算了与 DIP 相关的肩难产的人群归因分数（PAF），并估计了患有 DIP 的母亲所生出生体重超过 3 公斤的婴儿发生肩难产的概率。
患有 DIP 的原住民婴儿的阴道分娩肩难产发生率是其非原住民婴儿的两倍（6.3%比 3.2%，p<0.001），且随着时间的推移没有改善。糖尿病合并肩难产的原住民母亲更有可能有肩难产史（13.1%比 6.3%，p=0.032）。在患有糖尿病且出生体重超过 4.5 公斤的妊娠中，推荐的选择性剖宫产率在原住民女性中较低（28.6%比 43.1%，p=0.004）。PAF 表明，13.4%（95%CI：9.7%-16.9%）的原住民女性（2.7%（95%CI：2.1%-3.4%）的非原住民女性）的肩难产病例归因于 DIP。患有 DIP 的原住民母亲所生的婴儿出生体重超过 3 公斤时，肩难产的概率更高。
患有 DIP 的原住民母亲发生肩难产的风险更高，且体重与肩难产之间的关联更强。许多病例是复发性的。这些因素应在临床实践和妇女咨询中考虑。
