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降低糖尿病怀孕的第三季度胰岛素需求和不良妊娠结果:系统性审查和元分析
Rohan D'Souza1,2,3, Rizwana Ashraf1,2,3, Shahab Sayfi1,2
1Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON L8S 4L8, Canada.
Journal of clinical medicine
|October 29, 2025
概括
第三个三个月内胰岛素需求下降与产前和新生儿呼吸困扰有关. 然而,其他不良妊娠结果的证据不太确定,仅FIR不能证明早产是合理的.
科学领域:
- 产科和妇科 产科和妇科
- 围产儿医学 围产儿医学
- 内分泌学 在内分泌学.
背景情况:
- 关于第三季度胰岛素需求 (FIR) 降低与妊娠不良结果之间的关联,存在相互矛盾的证据.
- 为了澄清这种关系,进行了系统审查和元分析.
研究的目的:
- 综合已发表的关于第三季度胰岛素需求下降与孕产妇和周围产生的结果之间的联系的证据.
- 评估这些关联的证据的确定性.
主要方法:
- 通过四个文献数据库识别的研究的系统审查和元分析.
- 使用预后研究质量 (QUIPS) 工具进行偏差风险评估.
- 使用聚合概率比率 (ORs) 和95%置信区间 (CI) 的元分析,使用推,评估,开发和评估 (GRADE) 方法对证据的确定性进行评估.
主要成果:
- 第三个三个月的FIR与孕前 (OR 3.0,高Coe) 和可能与新生儿呼吸困难 (OR 2.03,中度Coe) 相关.
- 与胎盘功能障碍 (OR 2.32,低Coe) 和早产 (OR 2.0,非常低Coe) 的关联是可能的,但确定性较低.
- 没有发现与死产,怀孕年龄较小或低Apgar分数有显著的关联.
结论:
- 证据的确定性在第三季度FIR和不良妊娠结果之间的关联方面有很大差异.
- 目前尚不确定这些关联是否具有因果关系.
- 第三季度FIR的单一发现并不意味着早产;监测应基于初级临床诊断.
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