Simmons David, Immanuel Jincy, Hague William M, Coat Suzette, Teede Helena, Nolan Christopher J, Peek Michael J, Flack Jeff R, McLean Mark, Wong Vincent W, Hibbert Emily J, Kautzky-Willer Alexandra, Harreiter Jürgen, Backman Helena, Gianatti Emily, Sweeting Arianne, Mohan Viswanathan, Cheung N Wah
School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
BJOG. 2025 Jul;132(8):1087-1095. doi: 10.1111/1471-0528.17938. Epub 2024 Aug 19.
To identify factors associated with neonatal respiratory distress (NRD) in early Gestational diabetes mellitus (eGDM).
Nested case-control analysis of the TOBOGM trial.
Seventeen hospitals: Australia, Sweden, Austria and India.
Pregnant women, <20 weeks' gestation, singleton, GDM risk factors.
Women with GDM risk factors completed an oral glucose tolerance test (OGTT) before 20 weeks: those with eGDM (WHO-2013 criteria) were randomised to immediate or deferred GDM treatment. Logistic regression compared pregnancies with/without NRD, and in pregnancies with NRD, those with/without high-dependency nursery admission for ≤24 h with those admitted for >24 h. Comparisons were adjusted for age, pre-pregnancy body mass index, ethnicity, smoking, primigravity, education and site. Adjusted odds ratios (95% CI) are reported.
NRD definition: ≥4 h of respiratory support (supplemental oxygen or supported ventilation) postpartum. Respiratory distress syndrome (RDS): Supported ventilation and ≥24 h nursery stay.
Ninety-nine (12.5%) of 793 infants had NRD; incidence halved (0.50, 0.31-0.79) if GDM treatment was started early. NRD was associated with Caesarean section (2.31, 1.42-3.76), large for gestational age (LGA) (1.83, 1.09-3.08) and shorter gestation (0.95, 0.93-0.97 per day longer). Among NRD infants, >24 h nursery-stay was associated with higher OGTT 1-h glucose (1.38, 1.08-1.76 per mmol/L). Fifteen (2.0%) infants had RDS.
Identifying and treating eGDM reduces NRD risk. NRD is more likely with Caesarean section, LGA and shorter gestation. Further studies are needed to understand the mechanisms behind this eGDM complication and any long-term effects.
确定妊娠早期糖尿病（eGDM）中与新生儿呼吸窘迫（NRD）相关的因素。
对TOBOGM试验进行巢式病例对照分析。
17家医院：澳大利亚、瑞典、奥地利和印度。
妊娠<20周的单胎孕妇，有妊娠期糖尿病（GDM）风险因素。
有GDM风险因素的女性在20周前完成口服葡萄糖耐量试验（OGTT）：符合eGDM（WHO-2013标准）的女性被随机分为立即或延迟GDM治疗组。逻辑回归比较有无NRD的妊娠情况，以及在有NRD的妊娠中，入住高依赖病房≤24小时与>24小时的情况。比较时对年龄、孕前体重指数、种族、吸烟、初产、教育程度和地点进行了调整。报告调整后的比值比（95%可信区间）。
NRD定义：产后呼吸支持（补充氧气或辅助通气）≥4小时。呼吸窘迫综合征（RDS）：辅助通气且住院≥24小时。
793例婴儿中有99例（12.5%）发生NRD；如果早期开始GDM治疗，发病率减半（0.50，0.31-0.79）。NRD与剖宫产（2.31，1.42-3.76）、大于胎龄儿（LGA）（1.83，1.09-3.08）和孕周较短（每延长一天为0.95，0.93-0.97）相关。在发生NRD的婴儿中，住院>24小时与OGTT 1小时血糖较高相关（每mmol/L为1.38，1.08-1.76）。15例（2.0%）婴儿发生RDS。
识别和治疗eGDM可降低NRD风险。剖宫产、LGA和孕周较短时发生NRD的可能性更大。需要进一步研究以了解这种eGDM并发症背后的机制以及任何长期影响。
