早産女性における糖尿病：ブラジルの多施設研究の結果

Diabetes among women with preterm births: outcomes of a Brazilian multicenter study.

抄録

目的:

ブラジルの早産女性コホートにおいて、糖尿病の有無による母体および周産期の特徴と転帰を比較することである。

OBJECTIVE: The objective was to compare the maternal and perinatal characteristics and outcomes between women with and without diabetes in a Brazilian cohort of women with preterm births.

方法:

本解析はBrazilian Multicenter Study on Preterm Birthの補助的解析であり、4,150例の早産を対象とした。この解析では、早産を糖尿病の有無によって2群に分け、妊娠前乳糖病と妊娠糖尿病は同じ糖尿病群に分類した。両群間の差はχ2検定またはStudentのt検定を用いて評価した。

METHODS: This was an ancillary analysis of the Brazilian Multicenter Study on Preterm Birth, which included 4,150 preterm births. This analysis divided preterm births into two groups according to the presence of diabetes; pregestational and gestational diabetes were clustered in the same Diabetes Group. Differences between both groups were assessed using χ 2 or Student's t tests.

結果:

糖尿病の有無にかかわらず、それぞれ133例および4,017例の早産女性が対象となった。糖尿病の有病率は3.2％であった。糖尿病群では35歳以上の妊婦が多かった（それぞれ31.6％ vs 非糖尿病群14.0％）。糖尿病患者の帝王切開率は68.2％、非糖尿病患者は52.3％）、出生時の妊娠週数は34週から36週が78.9％、対照群は62.1％であった。妊娠週数に対する出生児の大きさは糖尿病群で7倍多かった。

RESULTS: Preterm births of 133 and 4,017 women with and without diabetes, respectively, were included. The prevalence of diabetes was 3.2%. Pregnant women aged ≥35 years were more common in the Diabetes Group (31.6% versus 14.0% non-diabetic women, respectively). The rate of cesarean section among patients with diabetes was 68.2% versus 52.3% in non-diabetic cases), with a gestational age at birth between 34 and 36 weeks in 78.9% of the cases and 62.1% of the controls. Large-for-gestational-age babies were 7 times more common in the Diabetes Group.

結論:

ブラジルの糖尿病女性における早産の有病率は2倍以上であった。これらの女性は高齢であり、通常帝王切開による晩期早産が常態化していた。また、奇形や多乳房症などの胎児病変の頻度が高く、妊娠週数に対して大きい新生児や巨大児の割合が高かった。

CONCLUSION: Preterm birth among Brazilian women with diabetes was more than twice as prevalent; these women were older and had regular late preterm deliveries, usually by cesarean section. They also had a greater frequency of fetal morbidities, such as malformations and polyhydramnios, and a higher proportion of large-for-gestational-age and macrosomic neonates.