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首页> 外文期刊>The journal of maternal-fetal & neonatal medicine >Management of diabetic women with threatened preterm birth: a survey of Maternal-Fetal Medicine providers
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Management of diabetic women with threatened preterm birth: a survey of Maternal-Fetal Medicine providers

机译：患有威胁早产的糖尿病女性的管理：母形医学提供者的调查

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Objective:To evaluate variation in management of diabetic women with threatened preterm birth (PTB). Study design:Thirty-two-question electronic maternal-fetal medicine (MFM) provider survey advertised on the Society for MFM website, newsletter, and Facebook page with questions about antenatal steroid use in diabetic women and glycemic management strategy after steroid administration. Descriptive statistics were used to summarize respondent characteristics, practice patterns, and satisfaction with current practice. Multivariable logistic regression was performed to determine if there were any factors independently associated with provider-reported satisfaction. Result:We obtained 159 completed surveys: 69% from board-certified MFM providers and 31% from MFM fellows. Almost half (48%) of respondents reported caring for diabetic women with threatened PTB at least weekly. Overall, 74% were concerned about the risk of maternal hyperglycemia after steroids, but 86% believed the neonatal benefit outweighed maternal risk. More than half (64%) agreed or strongly agreed that steroids for diabetic pregnant women were "evidence-based," and as such, the majority answered that they administer steroids always or most of the time, ranging from 92% for women with uncontrolled type 1 diabetes to 100% for women with diet-controlled gestational diabetes. The frequency of hospitalization and management approach to obtain glycemic control varied by diabetes type and degree of antepartum glycemic control. Two-thirds of MFM providers reported being satisfied with their current practice in caring for these women. Use of a standard protocol for glycemic management was also associated with increased odds of satisfaction (aOR 4.5, 95% CI 1.3-16.1) whereas use of a continuous insulin infusion for all women with insulin-dependent diabetes was associated with decreased odds of satisfaction (aOR 0.3, 95% CI 0.1-0.8). There was no significant association observed between number of years in practice or frequency of care for diabetic women with threatened PTB and provider satisfaction. Overall, 49% of respondents desired a protocol to guide glycemic management, and 74% believed more research is needed to optimize care of diabetic women receiving steroids for threatened PTB. Conclusion:While there are no prospective studies examining the neonatal benefit of antenatal steroids in diabetic women, MFM respondents believe steroid use in this context is evidence-based and report they are administering steroids almost universally in this population. Variation exists in the glycemic management strategy used after steroid administration. While use of a standard protocol for glycemic control was associated with practice satisfaction, routine use of a continuous insulin infusion for all women with insulin-dependent diabetes was associated with lower odds of satisfaction. More research is needed to optimize care of diabetic women receiving steroids for threatened PTB as maternal and neonatal outcomes related to these practices remain unknown.
机译：目的：评价威胁早产的糖尿病女性管理的变化（PTB）。研究设计：三十二个问题电子孕产妇医学（MFM）提供的提供商调查，用于MFM网站，时事通讯和Facebook页面，具有关于糖尿病女性和类固醇管理后的糖尿病女性和血糖管理策略的疑问。描述性统计数据用于总结受访者的特征，实践模式和对当前实践的满意度。进行多变量逻辑回归，以确定是否有与提供者报告的满意相关的任何因素。结果：我们获得了159次完成的调查：借助于MFM研究员的董事会认证的MFM提供商69％，31​​％。近一半（48％）的受访者报告了至少每周至少每周有威胁PTB的糖尿病妇女。总体而言，74％涉及类固醇后孕产妇高血糖的风险，但86％相信新生儿益处超过产妇风险。一半以上（64％）同意或强烈同意糖尿病患者的类固醇是“基于证据”，因此大多数人答案，他们始终或大部分时间施用类固醇，为不受控制的女性提供92％的妇女患有饮食控制的妊娠期糖尿病的女性1型糖尿病至100％。从糖尿病型糖尿病型和血糖血糖对照的血糖控制变化的住院治疗和管理方法的频率。报告的三分之二的MFM提供商对他们目前的照顾这些女性的做法感到满意。对血糖管理的标准方案也与满意度的可能性增加有关（AOR 4.5,95％CI 1.3-16.1），而使用胰岛素依赖性糖尿病的所有妇女的连续胰岛素输注与降低的满意度降低有关（ AOR 0.3,95％CI 0.1-0.8）。在实践中的数年间或糖尿病妇女受到威胁的PTB和提供者满意度的患者频率之间没有显着的关联。总体而言，49％的受访者期望指导血糖管理的议定书，74％相信需要更多研究以优化接受威胁PTB的类固醇的糖尿病女性的护理。结论：虽然在糖尿病女性中的产前类固醇中没有未来的研究，但MFM受访者认为，在这种情况下，对类固醇使用是基于证据，并报告他们几乎普遍普遍存在这个人口中。类固醇给药后使用的血糖管理策略存在变异。虽然使用标准血糖控制方案与实践满意有关，但常规使用连续胰岛素输注的所有患有胰岛素依赖性糖尿病的妇女与较低的满意度有关。需要更多的研究来优化接受威胁PTB的类固醇的糖尿病女性的护理，因为与这些做法有关的母亲和新生儿结果仍然未知。

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