BACKGROUND: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications. METHODS: We randomly assigned women between ...BACKGROUND: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications. METHODS: We randomly assigned women between 24 and 34 weeks’ gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. RESULTS: The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P < 0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women’ s mood and quality of life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group. CONCLUSIONS: Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman’ s health-related quality of life.展开更多
To compare the neonatal outcome of vaginally delivered (VD) to that of abdomin ally delivered (CS) vertex-nonvertex (Vx/NVx)-twins. Vx/NVx live nonanomalous twin gestations ≥25 weeks delivered from 1984 to 2000 were ...To compare the neonatal outcome of vaginally delivered (VD) to that of abdomin ally delivered (CS) vertex-nonvertex (Vx/NVx)-twins. Vx/NVx live nonanomalous twin gestations ≥25 weeks delivered from 1984 to 2000 were divided into two gro ups: VD (N=138), and CS (N=79). The outcome of the second twin was compared. The vaginal delivery rate for the Vx/NVx twins was 63.6%. The median Apgar scores at 1 and 5 min, respectively, were significantly lower in VD [7 (0-9) and 9 (1 -10)] compared to CS [8 (2-10) and 9 (2-10)]. The neonatal mortality was also higher in VD (109/1000 vs. 38/1000, p=0.040). Differences in the 1-min Apgar s cores persisted when infants <1500 g were excluded. All other neonatal outcome v ariables studied including respiratory distress syndrome, necrotizing enterocoli tis, intraventricular hemorrhage, trauma, seizures, and length of nursery stay w ere similar. On logistic regression analysis, vaginal delivery of Vx/NVx twins m arginally increased low 5-min Apgar scores and neonatal deaths. Vaginal deliver y in vertex-nonvertex twins was achieved in 63.6%of cases at the expense of a higher incidence of low 1-and 5-min Apgar scores and neonatal death.展开更多
文摘BACKGROUND: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications. METHODS: We randomly assigned women between 24 and 34 weeks’ gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. RESULTS: The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P < 0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women’ s mood and quality of life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group. CONCLUSIONS: Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman’ s health-related quality of life.
文摘To compare the neonatal outcome of vaginally delivered (VD) to that of abdomin ally delivered (CS) vertex-nonvertex (Vx/NVx)-twins. Vx/NVx live nonanomalous twin gestations ≥25 weeks delivered from 1984 to 2000 were divided into two gro ups: VD (N=138), and CS (N=79). The outcome of the second twin was compared. The vaginal delivery rate for the Vx/NVx twins was 63.6%. The median Apgar scores at 1 and 5 min, respectively, were significantly lower in VD [7 (0-9) and 9 (1 -10)] compared to CS [8 (2-10) and 9 (2-10)]. The neonatal mortality was also higher in VD (109/1000 vs. 38/1000, p=0.040). Differences in the 1-min Apgar s cores persisted when infants <1500 g were excluded. All other neonatal outcome v ariables studied including respiratory distress syndrome, necrotizing enterocoli tis, intraventricular hemorrhage, trauma, seizures, and length of nursery stay w ere similar. On logistic regression analysis, vaginal delivery of Vx/NVx twins m arginally increased low 5-min Apgar scores and neonatal deaths. Vaginal deliver y in vertex-nonvertex twins was achieved in 63.6%of cases at the expense of a higher incidence of low 1-and 5-min Apgar scores and neonatal death.
