Ray J G, O'Brien T E, Chan W S
Division of Obstetrical Medicine, Department of Medicine, Women's College Campus, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
QJM. 2001 Aug;94(8):435-44. doi: 10.1093/qjmed/94.8.435.
Offspring of women with pregestational diabetes mellitus are at increased risk for congenital malformations, largely attributable to poor periconceptional glycaemic control. We assessed the effect of preconception care in reducing congenital malformations, in a meta-analysis of published studies of preconception care in women with diabetes mellitus. Articles were retrieved from Medline (1970 to June 2000) and Embase (1980 to June 2000), and data abstracted by two independent reviewers. The rates and relative risks (RR) for major and minor congenital malformations were pooled from all eligible studies using a random effects model, as were early first-trimester glycosylated haemoglobin values. In 14 cohort studies, major congenital malformations were assessed among 1192 offspring of mothers who had received preconception care, and 1459 offspring of women who had not. The pooled rate of major anomalies was lower among preconception care recipients (2.1%) than non-recipients (6.5%) (RR 0.36, 95%CI 0.22-0.59). In nine studies, the risk for major and minor anomalies was also lower among women who received preconception care (RR 0.32, 95%CI 0.17-0.59), as were the early first-trimester mean glycosylated haemoglobin values (pooled mean difference: 2.3%, 95%CI 2.1-2.4). Women who received preconception care were, on average, 1.8 years older than non-recipients, and fewer smoked (19.6% vs. 30.2%). Only one study described the routine use of periconception folic acid. Out-patient preconception care probably reduces the risk of major congenital anomalies among the offspring of women with pregestational diabetes mellitus. Because many women with diabetes neither plan their pregnancy nor achieve adequate glycaemic control before conception, strategies are needed to improve access to these programs, and to maximize those interventions associated with improved pregnancy outcome, such as smoking cessation and folic acid use.
孕前糖尿病女性的后代患先天性畸形的风险增加，这在很大程度上归因于受孕前血糖控制不佳。我们在一项对已发表的糖尿病女性孕前护理研究的荟萃分析中，评估了孕前护理在降低先天性畸形方面的效果。文章从Medline（1970年至2000年6月）和Embase（1980年至2000年6月）中检索，并由两名独立的审阅者提取数据。使用随机效应模型汇总所有符合条件的研究中主要和次要先天性畸形的发生率及相对风险（RR），以及孕早期糖化血红蛋白值。在14项队列研究中，对1192名接受孕前护理母亲的后代和1459名未接受孕前护理女性的后代进行了主要先天性畸形评估。接受孕前护理者的主要异常合并发生率（2.1%）低于未接受者（6.5%）（RR 0.36，95%CI 0.22 - 0.59）。在9项研究中，接受孕前护理的女性发生主要和次要异常的风险也较低（RR 0.32，95%CI 0.17 - 0.59），孕早期糖化血红蛋白均值也较低（合并均值差异：2.3%，95%CI 2.1 - 2.4）。接受孕前护理的女性平均比未接受者大1.8岁，且吸烟的较少（19.6%对30.2%）。只有一项研究描述了受孕前叶酸的常规使用情况。门诊孕前护理可能会降低孕前糖尿病女性后代患主要先天性异常的风险。由于许多糖尿病女性既不计划怀孕，也未在受孕前实现充分的血糖控制，因此需要采取策略来改善这些项目的可及性，并最大限度地发挥与改善妊娠结局相关的干预措施，如戒烟和使用叶酸。
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