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Association of types of diabetes and insulin dependency on birth outcomes

World Journal of Clinical Cases 2022年第7期10卷 2147-2158页

作者： Pamela K Xaverius Steven W Howard Deborah Kiel Jerry E Thurman Ethan Wankum Catherine Carter Clairy Fang Romi Carriere Department of Epidemiology and Biostatistics Saint Louis UniversitySt.LouisMO 63104United States Department of Health Management and Policy Saint Louis UniversitySt.LouisMO 63104United States Department of Endocrinology Diabetes and MetabolismSSM HealthSt.CharlesMO 63303United States Division of Epidemiology Institute for Health and EquityMedical College of WisconsinMilwaukeeWI 53226United States Department of Epidemiology Fielding School of Public HealthUniversity of CaliforniaLos AngelesCA 90095United States Population Health Sciences Institute Centre for Ageing and VitalityNewcastle UniversityNewcastle upon TyneEngland NE45PLUnited Kingdom

BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.AIM To investigate differences in birth outcomes(preterm birth,macrosomia,and neonatal death)by diabetes status.METHODS Cross-sectional design,using linked Missouri birth and death certificates(singleton births only),2010 to 2012(n=204057).Exposure was diabetes non-diabetic,pre-pregnancy diabetes-insulin dependent(PD-I),pre-pregnancy diabetes-non-insulin dependent(PD-NI),gestational diabetes-insulin dependent(GD-I),and gestational diabetes-non-insulin dependent(GD-NI).outcomes included preterm birth,macrosomia,and infant mortality.Confounders included demographic characteristics,adequacy of prenatal care,body mass index,smoking,hypertension,and previous preterm birth.Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.RESULTS Women with PD-I,PD-NI,and GD-I remained at a significantly increased odds for preterm birth(aOR 2.87,aOR 1.77,and aOR 1.73,respectively)and having a very large baby[macrosomia](aOR 3.01,aOR 2.12,and aOR 1.96,respectively);in reference to non-diabetic women.Women with GDNI were at a significantly increased risk for macrosomia(aOR1.53),decreased risk for their baby to die before their first birthday(aOR 0.41)and no difference in risk for preterm birth in reference to non-diabetic women.CONCLUSION Diabetes is associated with the poor birth outcomes.Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

关键词： Epidemiology Pregnancy Health care delivery birth outcomes Gestational diabetes Insulin

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Effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes among nulliparous women:randomized controlled clinical trial

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Frontiers of Nursing 2020年第3期7卷 239-248页

作者： Heba Abdel-Fatah Ibrahim Hanan Ibrahim Ibrahim Said Wafaa Taha Ibrahim Elgzar Obstetrics and Woman Health Nursing department Benha UniversityBenhaKalubia 13741Egypt Maternity and Childhood Nursing Department Nursing CollegeNajran UniversityNajran 66251Kingdom of Saudi Arabia Obstetrics and Gynecologic Nursing department Damanhour UniversityDamanhour 22511Egypt

Objective:To examine the effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes for nulliparous women.Methods:This is a randomized controlled clinical trial conducted at the delivery department of Damanhour Educational Institute,El Behira Governorate,Egypt.The study sample involved 150 parturient women equally divided into intervention and control groups using randomization block technique.The researchers used four tools for data collection:Demographic data interview schedule,World Health Organization Partograph,Apgar’s score,to evaluate neonatal outcomes,and visual analogue pain intensity scale.For the study group,the parturient women were encouraged to assume one of the upright positions or ambulating around the bed so as to maintain the pelvis in vertical plane as far as possible for 20-25 min for every 1 h.The control group received routine hospital care,which includes lying down in bed.IBM SPSS 23.0 was used to analyze the data.Results:Significant differences(P0.05)were observed between both groups in term of emergency cesarean birth rates,oxytocin use,and neonatal outcomes.Conclusions:This study proves that upright and ambulant positions significantly enhance uterine contractility,cervical dilatation,and fetal head descent and reduce the first stage duration.

关键词： birth outcomes first stage of labor lying down upright position

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