Objective: The study aims to compare alterations of glucose fluctuations across individuals with different kinds of diabetes in pregnancy and investigate influencing factors that may react with glucose variations (GV). Design：A retrospective cohort study was conducted from May 2018 and May 2021. Setting：Shanghai General Hospital. Population: A total of 776 pregnant women who were diagnosed diabetes was obtained. We grouped participants who were exposed to gestational hyperglycemia into 5 sub-groups [Type 1 diabetes (T1DM), Type 2 diabetes (T2DM), Overt diabetes, Gestational diabetes (GDM) 1 and GDM2). Methods: Logistic regression models, one way Analysis of Variance (ANOVA) method and the chi-squared test were utilized. Main Outcome Measures: Demographic variables and GV parameters were compared among 5 groups through ANOVA-test and Chi-square test. We estimated odd ratios (ORs) for the association between glucose coefficient of variation (CV) and possible influencing variables. Results: T1DM group performed greatest glucose fluctuations with a CV value 35.02% whereas the number in all the other groups was no more than 22.82%. On multivariate logistic regression analysis of possible factors influencing CV, only body mass index (BMI) (OR: 0.754, P=0.029), HOMA- β (OR:0.969, P=0.037) and fasting plasma glucose (FPG) (OR: 1.832, P=0.008) reached statistical significance. Conclusions: A greater GV in pregnant women with pre-pregnancy diabetes than that in GDM controls, and the former had a worse glucose profile than the other two groups while ODM group coming second. BMI, HOMA-β and FPG remain as an independent risk factors for unstable GV.

Abstract Background Perineal trauma refers to damage to the genitalia during the birthing process and can occur spontaneously or as a result of an episiotomy or female genital mutilation (FGM). Objective To perform a systematic review and network meta-analysis investigating the effectiveness of different PFMT relevant strategies in the prevention of perineal trauma. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, CNKI, CBM, WANFANG DATABASE, and ClinicalTrials.gov were searched for citations published in any language from inception to 1 July 2021. Selection criteria Randomised controlled trials (RCTs) of PFMT relevant prevention strategy to prevent perineal trauma in pregnant women. Data collection and analysis Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA). Main results Of 12632 citations screened, 21 RCTs were included. Comparing with usual care, “PFMT combine with perineal massage” and PFMT alone showed more superiority in intact perineum (RR=5.37, 95%CI: 3.79 to 7.60, moderate certainty; RR=2.58, 95%CI: 1.34 to 4.97, moderate certainty), episiotomy (RR=0.26, 95%CI: 0.14 to 0.49, very low certainty; RR=0.63, 95%CI: 0.45 to 0.90, very low certainty), and OASIS (RR=0.35, 95%CI: 0.16 to 0.78, moderate certainty; RR=0.49, 95%CI: 0.28 to 0.85, high certainty). “PFMT combine with perineal massage” show superiority in reducing perineal tear (RR=0.41, 95%CI: 0.20 to 0.85, moderate certainty). Conclusion In this systematic review, the finding on the perineal trauma indicated that “PFMT combine with perineal massage” and PFMT showed more superiority to prevent perineal trauma.

Background Different techniques have been reported to prevent perineal lacerations, but the effects of the use of lubricant have been unclear and is still subject of debate. Objective To assess the effect of lubricants on reducing perineal trauma during vaginal delivery. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang databases, ClinicalTrials.gov in 25 June 2021. Selection criteria Randomized controlled trials published in English or Chinese that compared the vaginal application of lubricant with standard care in women with cephalic presentation at vaginal delivery were included . Data collection and analysis Two independent reviewers selected eligible trials and extracted data on perineal trauma, duration of the second-stage labor, postpartum hemorrhage and Apgar score for meta-analysis. Main results Nineteen trials enrolling 5445 pregnant women were included. Compared with standard care, women using lubricants had a lower incidence of perineal trauma (RR 0.84, 95%CI 0.76 to 0.93), second-degree perineal laceration (RR 0.72, 95%CI 0.64 to 0.82) and episiotomy (RR 0.77, 95%CI 0.62 to 0.96), had a shorter duration of the second-stage labor (MD -13.72 minutes, 95%CI -22.68 to -4.77). Subgroup analysis indicated that women with obstetric gel had a shorter duration of the second-stage (MD -16.9 minutes, 95%CI -27.03 to -6.78 vs MD -8.38 minutes, 95%CI -11.11 to -5.65; P interaction=0.02) when compared with liquid wax. Conclusions Compared with standard care, lubricants could reduce the incidence of perineal trauma, especially second-degree perineal laceration, and shorten the duration of the second-stage labor.