Мать и дитя в Кузбассе (Nov 2023)
RISK OF ADVERSE OUTCOMES IN GESTATIONAL DIABETES MELLITUS
Abstract
Aim – to assess the risk of adverse outcomes for the newborn in women with gestational diabetes mellitus. Design – сohort retrospective study. Materials and methods. The course of pregnancy, childbirth and perinatal outcomes were studied in 53 women with verified gestational diabetes mellitus, who gave birth to a child in the period from 2022 to 2023 at the Kaluga Regional Clinical Hospital of the Perinatal Center. Depending on the number of perinatal factors, low, medium and high risk – groups were distinguished. During childbirth, intranatal risk factors were additionally assessed with the calculation of intranatal growth. The neonatal complications index was used to evaluate the effect of perinatal factors on the condition of newborns. Results. The influence of perinatal risk factors on the outcome of childbirth for newborns was evaluated. The structure of the factors of intranatal growth was dominated by labor disorders 15 (28.3 %), prenatal outpouring of amniotic fluid – 5 (9.4 %), induction of labor activity – 5 (9.4 %). The intranatal increase in 7 (13.2 %) patients was more than 30 points, which led to a change in the tactics of childbirth in the form of an emergency caesarean section. Due to the presence of a scar on the uterus, 6 (11.3 %) pregnant women were delivered by Caesarean section as planned. In 25 (47.2 %) newborns, the early neonatal period proceeded without complications (the index of neonatal complications was 0 points). In 28 (62.8 %) newborns, the index of intranatal complications varied from 1 to 9 points (an average of 8.7 ± 2.31 points), of which 8 children were transferred to the second stage of nursing. In the early neonatal period, complications in 6 (11.3 %) newborns are associated with an incorrect position in utero, in 14 (26.4 %) – placental insufficiency and tight cord entanglement around the neck and/or trunk, and in 8 (15.1 %) are due to complications of childbirth (weakness of labor, clinically narrow pelvis). Conclusion. In this study, it was revealed that the risk of adverse outcomes for a newborn in women with gestational diabetes mellitus is directly dependent on the sum of the points of perinatal risk and intranatal growth. Timely identification of intranatal risk factors and calculation of intranatal growth allows to revise obstetric tactics and reduce perinatal morbidity and mortality in women with gestational diabetes.
