引产时机对非药物治疗妊娠期糖尿病母婴结局的影响

Effect of Different Timing of Labor Induction on Maternal and Infant Pregnancy Outcomes of Non Drug Treated Gestational Diabetes Mellitus

目的探讨不同引产时机对非药物治疗妊娠期糖尿病(GDM)母婴妊娠结局的影响。方法选取2021年1月-12月本院规律产检并住院分娩的GDM孕产妇191例为研究对象,根据其是否在39~39+6周引产分为39周引产组(n=81,39~39+6周引产)、39周期待妊娠组(n=110,39^(+6)周后引产);进一步将39周期待妊娠组分为40周引产组(n=59,40~40^(+6)周引产)、40周期待妊娠组(n=51,40^(+6)周后引产)。比较引产组与期待妊娠组妊娠结局、新生儿结局、剖宫产指征。结果(1)39周组中引产组剖宫产率高于期待妊娠组(P<0.05),而两组总产程、肩难产率及产后出血量比较,差异无统计学意义(P>0.05);40周组中引产组与期待妊娠组剖宫产率、总产程、肩难产及产后出血量比较,差异无统计学意义(P>0.05);(2)39周组中期待妊娠组巨大儿发生率高于引产组(P<0.05),而两组胎儿窘迫、新生儿窒息、新生儿低血糖及病理性黄疸发生率比较,差异无统计学意义(P>0.05);40周组中期待妊娠组巨大儿发生率高于引产组(P<0.05),而两组胎儿窘迫、新生儿窒息、新生儿低血糖及病理性黄疸发生率比较,差异无统计学意义(P>0.05);(3)39周组中引产组因社会因素行剖宫产者人数高于期待妊娠组(P<0.05),因其余指征行剖宫产人数比较,差异无统计学意义(P>0.05)。40周组中引产组及期待妊娠组不同指征行剖宫产人数比较,差异均无统计学意义(P>0.05)。结论对于非药物治疗血糖控制良好的GDM孕妇,若无其他合并症,孕40~40^(+6)周引产在提高引产成功率的同时也能在一定程度上减少不良母婴结局的发生率。

Objective To explore and evaluate the effect of different timing of labor induction on maternal and infant pregnancy outcomes of non drug treated gestational diabetes mellitus(GDM).Methods From January to December 2021,191 pregnant women with GDM who underwent regular prenatal examination and were hospitalized for delivery in our hospital were selected as the research objects.According to whether they had induced labor at 39-39^(+6) weeks,they were divided into 39 weeks induced labor group(n=81,39-39^(+6) weeks induced labor)and 39 weeks expectant pregnancy(n=110,39^(+6) weeks induced labor).The 39 weeks expectant pregnancy group was further divided into 40 weeks induction group(n=59,40-40^(+6) weeks induced labor)and 40 weeks expectant pregnancy group(n=51,40^(+6) weeks induced labor).The pregnancy outcome,neonatal outcome and cesarean section indications were compared between the induced labor group and the expected pregnancy group.Results①In the 39 week group,the cesarean section rate in the induced labor group was higher than that in the expectant pregnancy group(P<0.05),while there was no significant difference in total labor,shoulder dystocia rate and postpartum hemorrhage between the two groups(P>0.05);in the 40 week group,there was no significant difference in cesarean section rate,total labor,shoulder dystocia and postpartum hemorrhage between the induction group and the expectant pregnancy group(P>0.05);②In the 39 week group,the incidence of macrosomia in expectant pregnancy group was higher than that in induced labor group(P<0.05),while there was no significant difference in the incidence of fetal distress,neonatal asphyxia,neonatal hypoglycemia and pathological jaundice between the two groups(P>0.05);in the 40 week group,the incidence of macrosomia in expectant pregnancy group was higher than that in induced labor group(P<0.05),while there was no significant difference in the incidence of fetal distress,neonatal asphyxia,neonatal hypoglycemia and pathological jaundice between the two groups(P>0.05);③In the 39 week group,the number of cesarean section due to social factors in the induced labor group was higher than that in the expected pregnancy group(P<0.05),while there was no significant difference in the number of cesarean section due to other indications(P>0.05);in the 40 week group,there was no significant difference in the number of cesarean section between the induction group and the expectant pregnancy group(P>0.05).Conclusion For GDM pregnant women with non drug treatment and good blood glucose control,if there are no other complications,induction of labor at 40-40^(+6) weeks of gestation can not only improve the success rate of induction of labor,but also reduce the incidence of adverse maternal and infant outcomes to a certain extent.