PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：患有妊娠糖尿病（DIP）的澳大利亚原住民和托雷斯海峡岛民妇女更有可能出现高于目标范围的血糖水平，因此，他们的婴儿胎儿过度生长的风险更高。肩难产,定义为在需要产科操作的头部出生后胎儿肩自然出生失败，是与DIP和胎儿大小密切相关的产科急诊。这项研究的目的是调查DIP母亲所生的原住民婴儿的肩难产的流行病学。
方法：按原住民身份分层，比较了有和没有DIP的妇女并发肩难产的出生特征，并描述了肩难产的发生率和时间趋势。比较了DIP女性对旨在预防肩难产的指南的依从性。使用逻辑回归估计来计算与DIP相关的肩难产的人口归因分数（PAF），并估计出生体重>3kg的DIP母亲所生的婴儿的肩难产概率。
结果：患有DIP的母亲所生的土著婴儿阴道分娩的肩难产率是非土著婴儿的两倍（6.3％vs3.2％，p<0.001)，随着时间的推移没有改善。妊娠合并肩难产的糖尿病土著母亲更有可能有肩难产史（13.1％vs6.3％，p=0.032)。在糖尿病和出生体重>4.5kg的孕妇中，指南推荐的选择性剖腹产率在土著妇女中更低(28.6%vs43.1%,p=0.004)。PAFs表明，土著妇女中13.4％（95％CI：9.7％-16.9％）的肩难产病例（非土著妇女中为2.7％（95％CI：2.1％-3.4％））归因于DIP。出生体重>3kg时，患有DIP的土著母亲所生的婴儿的肩难产概率更高。
结论：患有DIP的土著母亲患肩难产的风险更高，出生体重与肩难产之间的关联更强。许多病例反复出现。在临床实践中和咨询妇女时应考虑这些因素。
方法：按原住民身份分层，比较了有和没有DIP的妇女并发肩难产的出生特征，并描述了肩难产的发生率和时间趋势。比较了DIP女性对旨在预防肩难产的指南的依从性。使用逻辑回归估计来计算与DIP相关的肩难产的人口归因分数（PAF），并估计出生体重>3kg的DIP母亲所生的婴儿的肩难产概率。
结果：患有DIP的母亲所生的土著婴儿阴道分娩的肩难产率是非土著婴儿的两倍（6.3％vs3.2％，p<0.001)，随着时间的推移没有改善。妊娠合并肩难产的糖尿病土著母亲更有可能有肩难产史（13.1％vs6.3％，p=0.032)。在糖尿病和出生体重>4.5kg的孕妇中，指南推荐的选择性剖腹产率在土著妇女中更低(28.6%vs43.1%,p=0.004)。PAFs表明，土著妇女中13.4％（95％CI：9.7％-16.9％）的肩难产病例（非土著妇女中为2.7％（95％CI：2.1％-3.4％））归因于DIP。出生体重>3kg时，患有DIP的土著母亲所生的婴儿的肩难产概率更高。
结论：患有DIP的土著母亲患肩难产的风险更高，出生体重与肩难产之间的关联更强。许多病例反复出现。在临床实践中和咨询妇女时应考虑这些因素。
