Time and mode of delivery in diabetic pregnancy: a review

Preterm delivery and maternal obesity remain common complications in pregnancies with type 1 diabetes-A nationwide study in Sweden

AIM

A primary goal of obstetric care of women with type 1 diabetes (T1D) is to reduce the risks of preterm birth (PTB). Besides hyperglycaemia, maternal obesity is an important risk factor for PTB in T1D. However, it's unclear if public health efforts decreased risks of maternal obesity and PTB in pregnancies with T1D. We examined time-trends over the last 20 years in the distribution of gestational ages at birth (GA) in offspring of women with T1D in Sweden, and in maternal BMI in the same mothers.

METHODS

Population-based cohort study, using data from national registries in Sweden. To capture differences not only in the median values, we used quantile regression models to compare the whole distributions of GA's and early pregnancy BMI between deliveries in 1998-2007 (P1) and 2008-2016 (P2). Multivariable models were adjusted for differences in maternal age, smoking and education between periods 1 and 2.

RESULTS

The study included 7639 offspring of women with T1D between 1998 and 2016. The 10% percentile GA, increased with 0.09 days (95% CI: -0.11 to 0.35) between P1 and P2. The 90% percentile for BMI was 1.20 kg/m2 higher (95% CI: 0.57 to 1.83) in P2. Risks of PTB remained stable over time also when adjusting for maternal BMI.

CONCLUSION

Despite modern diabetes management, the distribution of GA, and consequently the risk of PTB in T1D, remained unchanged from 1998 to 2016. During the same time, maternal BMI increased, particularly in the already obese.

Gestational diabetes mellitus: The optimal time of delivery

Gestational diabetes mellitus (GDM) is a common pregnancy complication strongly associated with poor maternal-fetal outcomes. Its incidence and prevalence have been increasing in recent years. Women with GDM typically give birth through either vaginal delivery or cesarean section, and the maternal-fetal outcomes are related to several factors such as cervical level, fetal lung maturity, the level of glycemic control still present, and the mode of treatment for the condition. We categorized women with GDM based on the latter two factors. GDM that is managed without medication when it is responsive to nutrition- and exercise-based therapy is considered diet- and exercise-controlled GDM, or class A1 GDM, and GDM managed with medication to achieve adequate glycemic control is considered class A2 GDM. The remaining cases in which neither medical nor nutritional treatment can control glucose levels or patients who do not control their blood sugar are categorized as class A3 GDM. We investigated the optimal time of delivery for women with GDM according to the classification of the condition. This review aimed to address the benefits and harms of giving birth at different weeks of gestation for women with different classes of GDM and attempted to provide an analytical framework and clearer advice on the optimal time for labor.

Application of Color Ultrasound in the Diagnosis of Gynecological Endocrine Disorders and Study of Ultrasonic Image Characteristics

In order to study gynecological endocrine disorders, color ultrasound and image examination were used for in-depth study. After examining the clinical significance, research methods, strengthening treatment measures, and adjusting physical and mental health, the research and examination of endocrine disorders under ultrasound and ultrasound images are successfully analyzed. Endocrine is like a woman’s umbrella. When it is in harmony with the body, it will make women as beautiful as flowers. Once it becomes an endocrine disorder, it will cause a lot of trouble to women. According to the statistics of a magazine, the incidence of facial chloasma in young and middle-aged women is 28.2%; breast cancer in women over 30 years old has a breast mass of 38.8–49.3%, of which 1–2% may be converted to breast cancer. For the treatment of patients with gynecological endocrine disorders, we mainly use simple western medicine, but the curative effect is not ideal. The rehabilitation speed of patients is relatively slow, which has certain treatment limitations. After the ultrasound research on endocrine disorders, the ultrasound can not only determine the female endocrine function but also diagnose diseases related to endocrine disorders, which basically meets the general understanding of clinicians on the screening of endocrine disorders and physiological functions.