预先存在的糖尿病和死胎或围产期死亡率:系统性审查和元分析
Anna R Blankstein1, Sarah M Sigurdson, Levi Frehlich
1Department of Medicine, the Department of Obstetrics, Gynecology and Reproductive Sciences, and the Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, the Department of Community Health Sciences, the Department of Medicine, the Department of Obstetrics and Gynecology, the Alberta Children's Hospital Research Institute, the O'Brien Institute for Public Health, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, and the Department of Medicine, Université Laval, Quebec City, Quebec, Canada; and Stanford Lifestyle Medicine, Stanford University, Redwood City, California.
先前存在的糖尿病显著增加了死胎和产前死亡的风险超过三倍. 母亲2型糖尿病的风险高于1型糖尿病.
科学领域:
- 产科和妇科 产科和妇科
- 内分泌学 在内分泌学.
- 围产儿医学 围产儿医学
背景情况:
- 已经认识到,先前存在的糖尿病与不良周产期结果 (如死胎和周产期死亡率) 之间的关联.
- 然而,关于不同人群中这种关联的确切强度,仍然存在重大知识差距.
- 本研究通过量化风险和确定有助于因素来解决这些差距.
研究的目的:
- 系统地审查和对现有文献进行元分析,以量化先前存在的糖尿病与死产或围产死亡率之间的关联.
- 确定预测先前存在糖尿病的个体中死胎和产前死亡率的关键风险因素.
- 为了比较与妊娠期间1型糖尿病和2型糖尿病相关的风险.
主要方法:
- 一个全面的系统审查和对队列研究和随机对照试验的元分析.
- 从开始到2022年4月,主要数据库 (MEDLINE,EMBASE,Cochrane) 进行了搜索.
- 数据提取,偏差风险评估和使用随机效应模型的元分析由重复审查者进行.
主要成果:
- 包括91项涉及7,777个引用的研究.
- 先前存在的糖尿病显示,死亡出生率 (OR 3.74) 和围产死亡率 (OR 3.22) 的几率增加了超过3倍.
- 与1型糖尿病相比,母亲的2型糖尿病与较高的死胎和产前死亡率有关;然而,产前和孕前糖尿病护理显著降低了这些风险.
结论:
- 先前存在的糖尿病显著增加了死胎和围产期死亡的风险.
- 孕产妇的2型糖尿病比1型糖尿病具有更大的不良周产期结果风险.
- 获得高质量的产前护理和妊娠前糖尿病管理是关键的保护因素.
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