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首页> 外文期刊>American Journal of Perinatology >Timing of Medically Indicated Delivery in Diabetic Pregnancies: A Perspective on Current Evidence-Based Recommendations
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Timing of Medically Indicated Delivery in Diabetic Pregnancies: A Perspective on Current Evidence-Based Recommendations

机译：糖尿病妊娠中医学指示分娩的时机：基于当前循证医学建议的观点

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摘要

Diabetes complicates 6 to 7% of all pregnancies in the United States. Poor glycemic control is associated with multiple immediate and long-term adverse effects on both the mother and fetus. Although uniformity exists in the antenatal management of this disease, there is a paucity of evidence-based studies upon which to dictate the optimal time of delivery among affected women. The potential risks of delayed neonatal pulmonary maturation including respiratory distress syndrome and transient tachypnea of the newborn associated with early delivery must be balanced with the increased incidence of fetal demise, overgrowth, and birth injury related to diabetes in late gestations. Even among diabetic women with optimal glycemic control, the risk of stillbirth in the third trimester is considerably higher than their normal counterparts. The current paradigm of delaying delivery to 39 weeks in women with controlled and uncomplicated diabetes has been challenged by recent evidence advocating delivery by 38 weeks to improve perinatal outcomes. However, additional well-designed and adequately powered prospective studies are needed to better understand the short- and long-term implications of the optimal timing of delivery in this high-risk population. This article reviews the most current literature regarding the optimal timing of delivery in pregnancies complicated by diabetes mellitus and gestational diabetes mellitus.
机译：在美国，糖尿病使所有妊娠的6％至7％复杂化。不良的血糖控制与对母亲和胎儿的多重即时和长期不良影响有关。尽管在该疾病的产前管理中存在统一性，但仍缺乏基于证据的研究来确定受影响妇女的最佳分娩时间。新生儿肺部发育迟缓的潜在风险，包括呼吸窘迫综合征和与早期分娩相关的新生儿短暂性呼吸急促，必须与胎儿死亡，过度生长和妊娠后期糖尿病相关的出生损伤的发生率增加相平衡。即使在具有最佳血糖控制的糖尿病妇女中，妊娠中期死胎的风险也比正常人高得多。目前，控制和不合并糖尿病的妇女延迟分娩至39周的范例受到最近证据的提倡，即分娩38周以改善围产期结局的挑战。但是，还需要进行其他设计良好且功能强大的前瞻性研究，以更好地了解高危人群中最佳分娩时间的短期和长期影响。本文回顾了有关妊娠合并糖尿病和妊娠糖尿病的最佳分娩时机的最新文献。

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