Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: A population-based study in Alberta, Canada, 2005-11

• Published in: Journal of diabetes 2016-01, Vol.8 (1), p.45-55
• Main Authors: Lai, Florence Y., Johnson, Jeffrey A., Dover, Doug, Kaul, Padma
• Format: Article
• Language: English
• Subjects: Adult; Alberta - epidemiology; Birth Weight; Cohort Studies; Diabetes Complications; Diabetes, Gestational - epidemiology; epidemiology; Female; gestatational diabetes; Humans; Infant, Newborn; multiple pregnancies; Odds Ratio; pre-existing diabetes; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics - epidemiology; Pregnancy Outcome; Pregnancy, Twin - statistics & numerical data; Prevalence; Retrospective Studies; Young Adult; 多胎妊娠; 妊娠前存在的糖尿病; 妊娠糖尿病; 流行病学
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12255

Background We assessed the prevalence and pregnancy outcomes of pre‐existing diabetes mellitus (pre‐DM) and gestational diabetes mellitus (GDM) in Alberta, Canada, 2005–11. Methods 327 198 singleton and 5552 twin pregnancies resulting in live births or stillbirths were included. The odds ratios of adverse outcomes were evaluated comparing pre‐DM with no diabetes and GDM with no diabetes, controlling for maternal characteristics. Results Diabetes complicated 6.3% of pregnancies, with 88% being GDM. In singleton pregnancies, pre‐DM and GDM were associated with increased risks of pre‐eclampsia (adjusted odds ratio [aOR] = 3.38 and 1.83, respectively), cesarean delivery (aOR 2.53, 1.55), spontaneous preterm (aOR 4.20, 1.71), and labor‐induced preterm (aOR 3.82, 2.00) in the mother, and macrosomia (aOR 2.11, 1.30), shoulder dystocia (aOR 1.54, 1.32), congenital anomalies (aOR 1.61, 1.20), and neonatal intensive care unit (NICU) admissions (aOR 3.81, 1.60) in the infants. In addition, pre‐DM was associated with an increased likelihood of stillbirth (aOR 3.73) and neonatal death (aOR 2.00) compared with non‐diabetic pregnancies. In twin pregnancies, pre‐DM was associated with increased risks of spontaneous (aOR 3.54) and labor‐induced (aOR 3.57) preterm births, large for gestational age (LGA) infants (aOR 3.73), congenital anomalies (aOR 3.05) and NICU admissions (aOR 2.91); GDM was associated with an increased risk of pre‐eclampsia (aOR 1.54), cesarean delivery (aOR 1.57), and LGA infants (aOR 1.63). Conclusions Pre‐existing diabetes confers higher risks than GDM. Diabetes is associated with adverse outcomes in singleton and twin pregnancies, and the increased risks are generally similar or less in twins, probably due to their higher “baseline” risks and closer clinical monitoring. 摘要 背景 我们评估了2005‐11年加拿大亚伯达省妊娠前存在的糖尿病(preexisting diabetes mellitus,pre‐DM)与妊娠糖尿病(GDM)的患病率以及妊娠结局。 方法 研究纳入了327198名单胎妊娠以及5552名双胎妊娠并且最终分娩活胎或者死胎的孕妇。将pre‐DM与非糖尿病孕妇相比,GDM与非糖尿病孕妇相比,评估了她们的不良结局优势比,并且按照母亲的特征进行了校正。 结果 妊娠合并糖尿病的比例为6.3%,合并GDM的比例为88%。在单胎妊娠中,pre‐DM以及GDM都与孕妇发生先兆子痫(校正后的优势比[aOR]分别为3.38、1.83)、剖宫产(aOR分别为2.53、1.55)、自发性早产(aOR分别为4.20、1.71)以及劳动诱发早产(aOR分别为3.82、2.00)的风险增加有关,并且都与婴儿出现巨大儿(aOR分别为2.11、1.30)、肩难产(aOR分别为1.54、1.32)、先天异常(aOR分别为1.61、1.20)以及入住新生儿重症监护治疗病房(aOR分别为3.81、1.60)的风险增加有关。另外,与非糖尿病孕妇相比较,pre‐DM还与死胎(aOR为3.73)以及新生儿死亡(aOR为2.00)的可能性增加有关。在双胎妊娠中,pre‐DM与自发性早产(aOR为3.54)、劳动诱发早产(aOR为3.57)、过期妊娠胎儿(aOR为3.73)、先天异常(aOR为3.05)以及入住新生儿重症监护治疗病房(aOR为2.91)的风险增加有关;GDM与先兆子痫(aOR为1.54)、剖宫产(aOR为1.57)以及过期妊娠胎儿(aOR为1