Purpose: Diabetic women appear to have adverse pregnancy outcomes. Although there were two meta-analyzes that examined the association between health care and adverse pregnancy outcomes, their results were limited because they only included congenital anomaly and perinatal mortality, and they did not clarify the detailed situations of diabetes and health care. This meta-analysis aims to completely evaluate the effects of health care in improving adverse pregnancy outcomes among diabetic mothers.
Methods: CNKI, EMBASE, Web of Science, and PubMed databases were searched for eligible studies up to December 2017, without any restrictions. Relevant cohort studies characterizing the relationship between health care and adverse pregnancy outcomes were selected for inclusion in the meta-analysis. We also screened the reference list of relevant studies. The fixed-effect models or random-effect models were used to calculate the risk estimates. The potential sources of heterogeneity were explored by stratified and sensitivity analyzes.
Results: Twenty-one studies with 6685 cases were included in our analysis. Health care was associated with significantly decreased risk of congenital anomaly (RR 0.237; 95% CI 0.166-0.338), perinatal death (RR 0.457; 95% CI 0.294-0.712), large for gestational age (LGA) (RR 0.794; 95% CI 0.640-0.986), and neonatal hypoglycemia (RR 0.672; 95% CI 0.486-0.929). Publication bias was not found in most results, with the exception of congenital anomaly and small for gestational age (SGA).
Conclusion: Health care is associated with decreased risk of congenital anomaly, perinatal death, LGA, neonatal hypoglycemia.
Keywords: Adverse outcomes; Diabetes; Health care; Meta-analysis.