PDF(Pubmed)
Abstract：
Background: Preterm birth (PTB) is a significant challenge in contemporary obstetrics, affecting over one in ten infants worldwide and accounting for 75% of perinatal mortality. Short cervical length during mid-trimester is well known to be associated with an increased risk of spontaneous preterm birth (sPTB). Ultrasound-indicated cerclage (UIC) is recommended to prevent sPTB in women with a short cervix at mid-trimester and a history of sPTB. Objectives: This retrospective observational study aimed to examine the impact of diabetes and obesity on the occurrence of sPTB in women who underwent UIC due to mid-trimester cervical shortening. Methods/Results: The analysis revealed that cervical length at the time of operation, preoperative erythrocyte sedimentation rate levels, and diabetes were independent risk factors for sPTB. Additionally, the presence of diabetes, particularly when combined with obesity, significantly elevated the risk of sPTB. Women with pregestational diabetes or those requiring insulin treatment had a higher propensity for preterm delivery compared to those with gestational diabetes managed through diet control alone. Conclusions: These findings emphasize the importance of considering maternal metabolic factors, such as diabetes and obesity, in women with a short cervix when planning for UIC and highlight the crucial role of optimizing maternal glucose control and weight management in reducing the risk of sPTB.
摘要：
背景：早产（PTB）是当代产科的重大挑战，影响全球十分之一的婴儿，占围产期死亡率的75％。众所周知，中期宫颈长度短与自发性早产（sPTB）的风险增加有关。建议在妊娠中期宫颈短且有sPTB病史的女性中使用超声指示环扎（UIC）预防sPTB。目的：这项回顾性观察性研究旨在研究糖尿病和肥胖对因中期宫颈缩短而接受UIC的女性sPTB发生的影响。方法/结果：分析显示手术时宫颈长度，术前红细胞沉降率水平，糖尿病是sPTB的独立危险因素。此外,糖尿病的存在，特别是当与肥胖结合时，显著升高sPTB的风险。与仅通过饮食控制管理的妊娠糖尿病患者相比，患有孕前糖尿病或需要胰岛素治疗的女性早产的倾向更高。结论：这些发现强调了考虑母体代谢因素的重要性，比如糖尿病和肥胖症，在计划进行UIC时，宫颈短的女性中，并强调了优化母体血糖控制和体重管理在降低sPTB风险中的关键作用。
