妊娠期糖尿病与新生儿不良结局关系的meta分析

Association of gestational diabetes mellitus with adverse neonatal outcomes: a meta-analysis

关键词:  妊娠期糖尿病  队列研究  新生儿结局  meta分析

Key words:  gestational diabetes mellitus  cohort study  neonatal outcomes  meta-analysis

摘要:

目的 评价妊娠期糖尿病(gestational diabetes mellitus, GDM)与新生儿不良结局的关系及其影响程度。方法 通过搜索PubMed、Web of Science、Ovid、Elsevier和Cochrane数据库,收集1970—2013年所有公开发表的关于GDM对妊娠结局影响的队列研究文献。两名相关专业人员采用Newcastle-Ottawa Scale文献质量评价量表,独立对纳入文献进行质量评价,应用RR值比较分析其合并效应,异质性高时采用随机效应模型,反之采用固定效应模型。结果 最终纳入文献15篇,13项研究评分＞7分。GDM组新生儿3129名,非GDM组27674名。GDM孕妇发生巨大儿、大于胎龄儿、新生儿低血糖、新生儿黄疸、肩难产和先天性畸形的风险均比非GDM孕妇高,其RR(95%CI)分别为: 2.81(1.88~4.22)、1.87(1.20~2.90)、2.28(1.60~3.23)、1.46(1.11~1.92)、3.41(1.85~6.27)和1.65(1.17~2.35),差异有统计学意义。结论 GDM与肩难产、巨大儿、低血糖、大于胎龄儿、先天畸形和新生儿黄疸6种新生儿不良结局密切相关,发生肩难产的风险最高。

Abstract:

Objective To assess the relationship between gestational diabetes mellitus (GDM) and adverse neonatal outcomes. Methods The electronic database PubMed, Web of Science, Ovid, Elsevier and Cochrane were used to search English-language cohort studies published from 1970—2013, the quality of included studies was independently assessed by two reviewers using the New-Castle-Ottawa Scale (NOS). If heterogeneity was high, the relative risk (RR) was pooled using random effect model; otherwise, fixed effect model was applied. Results Fifteen studies were included, comprising 3129 newborns in GDM group and 27674 newborns in Non-GDM group. The quality score of 13 studies was＞7 assessing by NOS. Six adverse neonatal outcomes were associated with GDM: macrosomia (RR=2.81,5%CI: 1.88-4.22), Large for gestational age (RR=1.87,5%CI: 1.20-2.90), hypoglycemia (RR=2.28,5%CI: 1.60-3.23), neonatal jaundice (RR=1.46,5%CI: 1.11-1.92), shoulder dystocia (RR=3.41,5%CI: 1.85-6.27), and congenital malformations (RR=1.65,5%CI: 1.17-2.35). Conclusion GDM is closely associated with six adverse neonatal outcomes in our study. According to risk stratification of adverse neonatal outcomes, the descending order is: shoulder dystocia, macrosomia, hypoglycemia, large for gestational age, congenital malformations and neonatal jaundice.