妊娠期糖尿病对双胎妊娠孕妇母婴结局的影响:Meta分析

Effects of gestational diabetes mellitus status on maternal and fetal outcomes among women with twin pregnancy:a Meta-analysis

目的评价妊娠期糖尿病(GDM)对双胎妊娠孕妇母婴围产期结局的影响。方法检索PubMed、Embase、Web of Science、Cochrane、中国知网、万方数据库、维普数据库、中国生物医学文献数据库(SinoMed),自2000年1月1日至2019年5月31日所有双胎妊娠孕妇中比较GDM和非GDM母婴结局的观察性研究。采用RevMan 5.3软件进行数据分析。结果共纳入18项研究。与非GDM组相比,GDM组高血压相关疾病(妊娠期高血压和子痫前期)、早产(<37周)、剖宫产、子代入住新生儿重症监护室(NICU)及呼吸窘迫综合征(RDS)发生风险均升高(分别为OR=1.78,95%CI:1.53~2.07;OR=1.22,95%CI:1.11~1.34;OR=1.34,95%CI:1.21~1.48;OR=1.29,95%CI:1.05~1.59;OR=1.45,95%CI:1.05~2.01);子代小于胎龄儿(SGA)及Apgar评分(5 min<7分)发生风险降低(分别为OR=0.87,95%CI:0.80~0.93和OR=0.65,95%CI:0.52~0.81)。依据国际糖尿病与妊娠研究组(IADPSG)标准诊断GDM的亚组分析显示,GDM未增加双胎妊娠孕妇高血压相关疾病、新生儿入住NICU及RDS发生风险(分别为OR=1.05,95%CI:0.69~1.60;OR=1.12,95%CI:0.77~1.61;OR=0.82,95%CI:0.39~1.74)。结论现有研究显示GDM增加双胎妊娠孕妇高血压相关疾病、早产(<37周)、剖宫产、子代入住NICU及RDS发生风险,结果与单胎一致;降低SGA及Apgar评分(5 min<7分)发生风险。对双胎妊娠孕妇GDM的诊断标准和治疗需要更多的研究。

Objective To evaluate the effects of gestational diabetes mellitus (GDM) on the perinatal outcomes among women with twin pregnancy.Methods PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang database, Weipu database and SinoMed were searched for twin pregnancy observational studies comparing the maternal and fetal outcomes from January 1, 2000 to May 31, 2019. RevMan 5.3 software was used for data analysis.Results A total of 18 cohort studies were included in the analysis. Compared with the non-GDM group, the risks of hypertensive-related diseases (gestational hypertension and preeclampsia), premature delivery (<37 weeks), neonatal intensive care unit (NICU) admission, and respiratory distress syndrome (RDS) were all increased (OR=1.78,95%CI:1.53-2.07;OR=1.22,95%CI:1.11-1.34;OR=1.34,95%CI:1.21-1.48;OR=1.29,95%CI:1.05-1.59;OR=1.45,95%CI:1.05-2.01, respectively);the risks of SGA and 5-minute-Apgar scores<7 were decreased in GDM group (OR=0.87, 95%CI:0.80-0.93 and OR=0.65,95%CI:0.52-0.81, respectively). Cohort studies using international diabetes and pregnancy research group (IADPSG) criteria were investigated as subgroup analysis, however, GDM did not increase the risks of hypertensive-related diseases, NICU admission or RDS (OR=1.05, 95%CI:0.69-1.60;OR=1.12,95%CI:0.77-1.61;OR=0.82,95%CI:0.39-1.74, respectively).Conclusions GDM may increase the risks of hypertensive-related diseases (gestational hypertension and preeclampsia), preterm delivery, cesarean section, NICU admission and RDS in women with twin pregnancies while the risk of SGA and 5-minute-Apgar scores<7 were decreased. More studies are required for the diagnosis and treatment of GDM in women with twin pregnancies.