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[Premature delivery in diabetes: etiology and risk factors]
A Beigelman1, A Wiznitzer, I Shoham-Vardi
1Dept. of Obstetrics and Gynecology, Soroka Medical Center, Beer Sheba.
Insights
Diabetes mellitus (DM) significantly increases the risk of preterm birth. Risk factors for preterm delivery differ between diabetic and non-diabetic pregnancies, particularly concerning amniotic fluid levels.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Endocrinology
Context:
- Preterm birth is a leading cause of perinatal complications.
- Diabetes mellitus (DM), both gestational and pregestational, is associated with increased perinatal risks.
- Understanding DM's independent impact on preterm birth is crucial for improved maternal and neonatal outcomes.
Purpose:
- To investigate if DM is an independent risk factor for preterm birth.
- To determine if risk factors for preterm birth differ between diabetic and non-diabetic pregnancies.
- To analyze the specific roles of polyhydramnios and oligohydramnios in preterm delivery among different DM subgroups.
Summary:
- This study analyzed singleton deliveries from 1990-1997, comparing preterm birth rates in non-diabetic, gestational DM, and pregestational DM groups.
- Multivariate analysis confirmed DM as an independent risk factor for spontaneous preterm delivery, with higher odds ratios for pregestational DM.
- Amniotic fluid volume emerged as a key differentiator: polyhydramnios was linked to preterm birth in non-diabetics and pregestational DM, while oligohydramnios increased risk in gestational DM.
Impact:
- Gestational and pregestational diabetes are confirmed independent risk factors for spontaneous preterm delivery.
- The study highlights distinct roles for polyhydramnios and oligohydramnios in preterm birth risk stratification for diabetic pregnancies.
- Findings can inform targeted interventions and risk assessment strategies for pregnant individuals with diabetes.
Abstract:
Preterm birth is the leading cause of perinatal morbidity and mortality, while preterm labor and delivery in diabetes mellitus (DM) carries an increased risk of perinatal complications. We investigated the hypothesis that DM (gestational and pregestational) is an independent risk factor for preterm birth and evaluated the hypothesis that the risk factors for preterm birth in diabetics are different from those in non-diabetics. The study population consisted of all singleton deliveries at this hospital between 1990-1997. Excluded were those of mothers who had not had prenatal care, or who had only partial care or multiple gestations. There were 3 subgroups: 834 women with pregestational DM, 3,841 with gestational DM, and 66,253 non-diabetics. The combined spontaneous and induced preterm delivery rate was determined in each subgroup. Potential risk factors for spontaneous preterm deliveries were assessed by a univariate model. A logistic regression model was used to assess the unique contribution of DM (gestational and pregestational) to preterm delivery in the presence of the other risk factors, and to compare risk factors for preterm delivery between subgroups. The prevalence of spontaneous preterm delivery was: 7.1% in non-diabetics, 10.0% in those with gestational DM and 25.5% in those with pregestational DM. When adjusted by a multivariate model for other risk factors for preterm delivery, DM still remained an independent risk factor for spontaneous preterm delivery (gestational DM: odds ratio 1.28, 95% CI: 1.1-1.48; pregestational diabetes: odds ratio 3.4, 95% CI: 2.65-4.36). The main difference in risk factors for preterm birth between the 3 subgroups was the amount of amniotic fluid. Polyhydramnios was an independent risk factor for preterm delivery in non-diabetics and in pregestational DM, but not in gestational DM. On the other hand, oligohydramnios was associated with a higher risk for preterm delivery only in gestational DM compared to non-diabetics. DM (gestational and pregestational) is an independent risk factor for spontaneous preterm delivery. Polyhydramnios is an independent risk factor for preterm delivery in pregestational but not in gestational DM. Oligohydramnios is a greater risk factor for preterm delivery in gestational DM compared to non-diabetics.