Jensen Dorte M, Damm Peter, Moelsted-Pedersen Lars, Ovesen Per, Westergaard Jes G, Moeller Margrethe, Beck-Nielsen Henning
Department of Endocrinology, Odense University Hospital, Kløvervaenget 6 DK-5000, Odense, Denmark.
Diabetes Care. 2004 Dec;27(12):2819-23. doi: 10.2337/diacare.27.12.2819.
The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population.
This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during 1993-1999. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n=1,215) or early termination due to severe congenital malformations (n=3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry.
The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9-5.6]), and the stillbirth rate was 2.1% compared with 0.45 (4.7 [3.2-7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3-2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations. Only 34% of women performed daily home monitoring of blood glucose at conception, and 58% received preconceptional guidance. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were characterized by higher HbA1c values before and during pregnancy and a lesser degree of maternal self-care and preconceptional guidance. Women who performed daily self-monitoring of blood glucose at any time during pregnancy had lower HbA1c values than women who did not measure their daily profile. Likewise, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively.
Type 1 diabetic pregnancies are still complicated by considerably higher rates of severe perinatal complications compared with the background population, and women with poor self-care are at the highest risk. Adequate glycemic control using daily glucose monitoring before and during pregnancy is a crucial step toward reaching the goals of the St. Vincent declaration.
本研究旨在比较1型糖尿病孕妇与普通人群的妊娠结局。
这项全国性前瞻性多中心研究在丹麦的八个中心开展，这些中心于1993年至1999年期间为1型糖尿病孕妇提供治疗。共有990名女性，她们经历了1218次妊娠，其中24周后分娩的有1215例，因严重先天性畸形而早期终止妊娠的有3例。数据由每个中心的一至三名护理人员前瞻性收集，并上报至中央登记处。
1型糖尿病孕妇的围产期死亡率为3.1%，而普通人群为0.75%（相对危险度4.1 [95%可信区间2.9 - 5.6]），死产率分别为2.1%和0.45%（4.7 [3.2 - 7.0]）。研究人群的先天性畸形率为5.0%，普通人群为2.8%（1.7 [1.3 - 2.2]）。围产期死亡中有6例（16%）与先天性畸形有关。仅有34%的女性在受孕时进行每日家庭血糖监测，58%的女性接受了孕前指导。出现严重不良结局（围产期死亡和/或先天性畸形）的妊娠具有妊娠前和妊娠期间糖化血红蛋白值较高、孕产妇自我护理程度较低以及孕前指导较少的特点。在孕期任何时间进行每日自我血糖监测的女性，其糖化血红蛋白值低于未进行每日血糖监测的女性。同样，每日自我监测与严重不良结局的减少相关。剖宫产率分别为55.9%和12.6%，早产风险分别为41.7%和6.0%。
与普通人群相比，1型糖尿病孕妇的严重围产期并发症发生率仍然显著更高，自我护理不佳的女性风险最高。在妊娠前和妊娠期间通过每日血糖监测进行充分的血糖控制是实现圣文森特宣言目标的关键一步。
