目的:探讨妊娠早期糖尿病(eGDM)新生儿呼吸窘迫(NRD)的相关因素。
方法:TOBOGM试验的嵌套病例对照分析。
方法:17家医院:澳大利亚,瑞典,奥地利和印度。
方法:孕妇,<20周妊娠,单身人士,GDM危险因素。
方法:患有GDM危险因素的女性在20周前完成了口服葡萄糖耐量试验(OGTT):患有eGDM(WHO-2013标准)的女性被随机分为立即或延期GDM治疗。Logistic回归比较有/没有NRD的妊娠,在NRD怀孕时,那些有/没有高度依赖托儿所的人≤24小时,而那些人>24小时。比较根据年龄进行了调整,孕前体重指数,种族,吸烟,primigravity,教育和网站。报告了调整后的比值比(95%CI)。
方法:NRD定义:产后≥4小时的呼吸支持(补充氧气或支持通气)。呼吸窘迫综合征(RDS):支持通气和≥24小时的托儿所。
结果:793名婴儿中有99名(12.5%)患有NRD;如果早期开始GDM治疗,发病率减半(0.50,0.31-0.79)。NRD与剖腹产相关(2.31,1.42-3.76),大的胎龄(LGA)(1.83,1.09-3.08)和较短的妊娠(0.95,0.93-0.97每天更长)。在NRD婴儿中,>24小时的苗圃停留时间与较高的OGTT1小时葡萄糖(每mmol/L1.38、1.08-1.76)相关。15名(2.0%)婴儿患有RDS。
结论:识别和治疗eGDM可降低NRD风险。NRD更可能是剖腹产,LGA和较短的妊娠。需要进一步的研究来了解这种eGDM并发症背后的机制和任何长期影响。
OBJECTIVE: To identify factors associated with neonatal respiratory distress (NRD) in early Gestational diabetes mellitus (eGDM).
METHODS: Nested case-control analysis of the TOBOGM trial.
METHODS: Seventeen hospitals: Australia, Sweden, Austria and India.
METHODS: Pregnant women, <20 weeks\' gestation, singleton, GDM risk factors.
METHODS: 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.
METHODS: NRD definition: ≥4 h of respiratory support (supplemental oxygen or supported ventilation) postpartum. Respiratory distress syndrome (RDS): Supported ventilation and ≥24 h nursery stay.
RESULTS: 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.
CONCLUSIONS: 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.