智力或发育障碍合并糖尿病孕妇的分娩不良结局

原文

BACKGROUND: Intellectual and developmental disabilities (IDD) are associated with increased risks for poor medical outcomes. However, there is limited national contemporary data on pregnancy outcomes in the setting of IDD and diabetes. OBJECTIVE: Diabetes in pregnancy (DIP) requires more intensive antenatal care including frequent glucose monitoring, medication adherence and titration, and more frequent visits. It is unclear whether IDD is an independent risk factor for adverse obstetric outcomes in this population. The purpose of this analysis was to evaluate whether IDD was associated with adverse outcomes among deliveries complicated by DIP. STUDY DESIGN: Delivery hospitalizations to patients with DIP (pregestational and gestational diabetes) aged 15 to 54 were analyzed using the 2000 to 2021 Nationwide Inpatient Sample. The primary exposure of interest was IDD. Temporal trends in the proportion of deliveries with IDD diagnosis were analyzed with join point regression to determine average annual percent change (AAPC) with 95% confidence intervals (CI). Unadjusted and adjusted survey-weighted logistic regression models (accounting for hospital, demographic, and clinical factors) were performed for adverse obstetric and diabetes-related outcomes including diabetic ketoacidosis, shoulder dystocia, gestational age at delivery, severe maternal morbidity, hypertensive disorders of pregnancy, infection, stillbirth, and cesarean and operative vaginal delivery with adjusted odds ratios (aORs) as the measure of association. RESULTS: Of 6,012,324 deliveries with DIP, 2389 (0.04%) patients had an associated IDD diagnosis. Deliveries among DIP patients with an IDD diagnosis increased from 2 per 10,000 in 2000 to 7 per 10,000 in 2021 (AAPC 7.8, 95% CI 6.4-10.3). Pregestational diabetes was more common among patients with IDD (30.2%) than among those without (13.5%). In adjusted analyses, patients with IDD had increased odds of diabetic ketoacidosis (aOR 2.66, 95% CI 1.06-6.69), preterm birth <37 weeks (aOR 1.46, 95% CI 1.10-1.92), cesarean delivery (aOR 95% CI 1.30, 1.05-1.60), nontransfusion severe maternal morbidity (aOR 2.06, 95% CI 1.26-3.32), hypertensive disorders of pregnancy (aOR 1.29, 95% CI 1.03-1.63), and stillbirth (aOR 1.94, 95% CI 1.07-3.5). Odds of shoulder dystocia did not differ significantly between deliveries with and without an IDD diagnosis. CONCLUSION: Among deliveries with DIP, the proportion of IDD increased over time. IDD is associated with increased odds of adverse outcomes among deliveries with DIP. Additional resources and surveillance may be warranted for patients with IDD and DIP to optimize outcomes.