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妊娠期糖尿病与不良妊娠结局显著相关
作者:小柯机器人 发布时间:2022/5/29 15:05:56

中南大学湘雅医院刘方琨团队对妊娠期糖尿病与不良妊娠结局进行了系统回顾和荟萃分析。2022年5月25日,《英国医学杂志》发表了这一成果。

为了在校正最小混杂因素后,研究妊娠期糖尿病与妊娠不良结局之间的关系,研究组在科学引文索引、PubMed、Medline和Cochrane系统评论数据库中检索从1990年1月1日至2021年11月1日的相关文献,筛选出报道妊娠期糖尿病妇女妊娠并发症的队列研究和对照试验,进行系统回顾与荟萃分析。

根据胰岛素的使用情况,该研究分为三个亚组:未使用胰岛素(患者在疾病过程中从未使用过胰岛素)、使用胰岛素(不同比例的患者接受过胰岛素治疗)和未报告使用胰岛素。根据国家(发达国家或发展中国家)、研究质量、诊断标准和筛查方法进行亚组分析。根据接受过胰岛素治疗的患者比例应用荟萃回归模型。

研究组共纳入156项研究,包括7506061例妊娠,其中50项(32.1%)显示出中低偏倚风险。在未使用胰岛素的研究中,校正混杂因素后,妊娠期糖尿病妇女剖腹产(优势比1.16)、早产(1.51)、1分钟Apgar评分较低(1.43)、巨大儿(1.70)和大于胎龄儿(1.57)的几率显著增加。

在使用胰岛素的研究中,校正混杂因素后,妊娠期糖尿病患者中大于胎龄儿(优势比1.61)、患有呼吸窘迫综合征(1.57)、新生儿黄疸(1.28)、需要进入新生儿重症监护病房(2.29)的几率显著高于妊娠期非糖尿病患者。

校正混杂因素后,未发现明确证据表明患有和未患有妊娠期糖尿病的妇女在器械分娩、肩难产、产后出血、死产、新生儿死亡、5分钟低Apgar评分、低出生体重和小于胎龄儿方面存在差异。国家状况、体重指数的校正和筛查方法显著地影响了几种不良妊娠结局研究之间的异质性。

研究结果表明,校正混杂因素后,妊娠期糖尿病与妊娠并发症显著相关。这些发现有助于更全面地了解妊娠期糖尿病相关的不良妊娠结局。未来的主要研究应常规考虑校正更完整的预后因素。

附:英文原文

Title: Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis

Author: Wenrui Ye, Cong Luo, Jing Huang, Chenglong Li, Zhixiong Liu, Fangkun Liu

Issue&Volume: 2022/05/25

Abstract:

Objective To investigate the association between gestational diabetes mellitus and adverse outcomes of pregnancy after adjustment for at least minimal confounding factors.

Design Systematic review and meta-analysis.

Data sources Web of Science, PubMed, Medline, and Cochrane Database of Systematic Reviews, from 1 January 1990 to 1 November 2021.

Review methods Cohort studies and control arms of trials reporting complications of pregnancy in women with gestational diabetes mellitus were eligible for inclusion. Based on the use of insulin, studies were divided into three subgroups: no insulin use (patients never used insulin during the course of the disease), insulin use (different proportions of patients were treated with insulin), and insulin use not reported. Subgroup analyses were performed based on the status of the country (developed or developing), quality of the study, diagnostic criteria, and screening method. Meta-regression models were applied based on the proportion of patients who had received insulin.

Results 156 studies with 7506061 pregnancies were included, and 50 (32.1%) showed a low or medium risk of bias. In studies with no insulin use, when adjusted for confounders, women with gestational diabetes mellitus had increased odds of caesarean section (odds ratio 1.16, 95% confidence interval 1.03 to 1.32), preterm delivery (1.51, 1.26 to 1.80), low one minute Apgar score (1.43, 1.01 to 2.03), macrosomia (1.70, 1.23 to 2.36), and infant born large for gestational age (1.57, 1.25 to 1.97). In studies with insulin use, when adjusted for confounders, the odds of having an infant large for gestational age (odds ratio 1.61, 1.09 to 2.37), or with respiratory distress syndrome (1.57, 1.19 to 2.08) or neonatal jaundice (1.28, 1.02 to 1.62), or requiring admission to the neonatal intensive care unit (2.29, 1.59 to 3.31), were higher in women with gestational diabetes mellitus than in those without diabetes. No clear evidence was found for differences in the odds of instrumental delivery, shoulder dystocia, postpartum haemorrhage, stillbirth, neonatal death, low five minute Apgar score, low birth weight, and small for gestational age between women with and without gestational diabetes mellitus after adjusting for confounders. Country status, adjustment for body mass index, and screening methods significantly contributed to heterogeneity between studies for several adverse outcomes of pregnancy.

Conclusions When adjusted for confounders, gestational diabetes mellitus was significantly associated with pregnancy complications. The findings contribute to a more comprehensive understanding of the adverse outcomes of pregnancy related to gestational diabetes mellitus. Future primary studies should routinely consider adjusting for a more complete set of prognostic factors.

DOI: 10.1136/bmj-2021-067946

Source: https://www.bmj.com/content/377/bmj-2021-067946

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj