Hiéronimus S, Cupelli C, Durand-Réville M, Bongain A, Fénichel P
Service d'endocrinologie-médecine de la reproduction, hôpital de l'Archet, CHU de Nice, BP 3079, 06202 Nice 3, France.
Gynecol Obstet Fertil. 2004 Jan;32(1):23-7. doi: 10.1016/j.gyobfe.2003.10.023.
The rise in the prevalence of type 2 diabetes in women of childbearing age leads to an increasing number of pregnant women with type 2 diabetes. But published data on fetal outcome are scarce.
In a prospective study from 1999 to 2002, we assessed fetal outcome (preterm delivery, perinatal mortality, congenital malformations) in 20 pregnancies associated with type 2 diabetes and compared the outcome to 40 pregnancies associated with type 1 diabetes.
Women with type 2 diabetes are older (32 +/- 5 vs. 27 +/- 5, P = 0.003), more obese (body mass index: 28.3 +/- 4.8 vs. 22.8 +/- 5.5, P < 0.001) than women with type 1 diabetes. Their pregnancy usually is not planned (10% vs. 55%, P < 0.001). HbA1c during organogenesis is above 8% in 46.6% of type 2 vs. 26.4% of type 1 (P < 0.001). Compared with data obtained in the general population, a fivefold increase in preterm delivery (26.3% vs. 4.7%), a sevenfold increase in perinatal mortality (5% vs. 0.7%) and congenital malformations (15.8% vs. 2.2%) are observed. These results are similar to those obtained in type 1. In planned pregnancy, HbA1c during organogenesis is under 7% with no perinatal death and no major congenital malformation.
Pregnancy complicated by type 2 diabetes is a high-risk one, as much as in type 1 diabetes. Efficient pre-pregnancy care needs to be strongly encouraged in women with type 2 diabetes who also display many risk factors for adverse fetal outcome.
育龄期女性2型糖尿病患病率上升，导致患2型糖尿病的孕妇数量不断增加。但关于胎儿结局的已发表数据很少。
在一项1999年至2002年的前瞻性研究中，我们评估了20例与2型糖尿病相关妊娠的胎儿结局（早产、围产期死亡率、先天性畸形），并将结果与40例与1型糖尿病相关妊娠的结果进行比较。
2型糖尿病女性比1型糖尿病女性年龄更大（32±5岁 vs. 27±5岁，P = 0.003），更肥胖（体重指数：28.3±4.8 vs. 22.8±5.5，P < 0.001）。她们的妊娠通常是意外妊娠（10% vs. 55%，P < 0.001）。在器官形成期，46.6%的2型糖尿病患者糖化血红蛋白（HbA1c）高于8%，而1型糖尿病患者为26.4%（P < 0.001）。与普通人群的数据相比，观察到早产增加了五倍（26.3% vs. 4.7%），围产期死亡率增加了七倍（5% vs. 0.7%），先天性畸形增加了七倍（15.8% vs. 2.2%）。这些结果与1型糖尿病的结果相似。在计划妊娠中，器官形成期的HbA1c低于7%，无围产期死亡和严重先天性畸形。
妊娠合并2型糖尿病是高危妊娠，与1型糖尿病一样。对于存在许多不良胎儿结局风险因素的2型糖尿病女性，应大力鼓励进行有效的孕前护理。
