Nielsen L R, Müller C, Damm P, Mathiesen E R
Clinic of Endocrinology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
Diabet Med. 2006 Apr;23(4):426-31. doi: 10.1111/j.1464-5491.2006.01831.x.
In normotensive women with Type 1 diabetes and microalbuminuria we previously found preterm delivery (< 34 weeks) in 23% of the pregnancies. Antihypertensive treatment was initiated in late pregnancy when preeclampsia was diagnosed and diastolic blood pressure > 90 mmHg. From April 2000 our routine was changed and early antihypertensive treatment with methyldopa was initiated if antihypertensive treatment was given prior to pregnancy, if urinary albumin excretion (UAE) was > 2 g/24 h, or blood pressure > 140/90 mmHg. The present study describes the impact of this more aggressive antiypertensive treatment in the prevalence of preterm delivery.
The old cohort (1995-1999) consisted of 26 and the new cohort (2000-2003) of 20 pregnant women with Type 1 diabetes and microalbuminuria. All were referred before gestational week 17.
The cohorts were comparable with regard to age, diabetes duration, prepregnancy body mass index, HbA1c, blood pressure 121 (13)/71 (8) vs. 121 (14)/73 (8) mmHg [mean (sd)] and early UAE 69 (16-278) vs. 74 (30-287) mg/24 h (geometric mean and range). Antihypertensive treatment was initiated in the old cohort at 29 (20-33) weeks, n = 9, and in the new at 13 (0-34) weeks, n = 10. The prevalence of preterm delivery before 34 weeks was reduced from 23% to zero (P = 0.02), preterm delivery before 37 weeks from 62% to 40% (P = 0.15) and preeclampsia from 42% to 20% (P = 0.11). Perinatal mortality occurred in 4% vs. 0%. Birth weight was 3124 (767) g vs. 3279 (663) g.
Introduction of early antihypertensive treatment with methyldopa in normotensive pregnant women with Type 1 diabetes and microalbuminuria resulted in a significant reduction in preterm delivery before gestational week 34.
在血压正常的1型糖尿病合并微量白蛋白尿的女性中，我们之前发现23%的妊娠发生早产（<34周）。当诊断为子痫前期且舒张压>90 mmHg时，在妊娠晚期开始抗高血压治疗。从2000年4月起，我们改变了常规做法，如果在妊娠前已进行抗高血压治疗、尿白蛋白排泄量（UAE）>2 g/24小时或血压>140/90 mmHg，则开始用甲基多巴进行早期抗高血压治疗。本研究描述了这种更积极的抗高血压治疗对早产发生率的影响。
旧队列（1995 - 1999年）由26名患有1型糖尿病合并微量白蛋白尿的孕妇组成，新队列（2000 - 2003年）由20名此类孕妇组成。所有孕妇均在妊娠第17周前转诊。
两组在年龄、糖尿病病程、孕前体重指数、糖化血红蛋白、血压[均值（标准差），分别为121（13）/71（8）mmHg与121（14）/73（8）mmHg]以及早期UAE[几何均值及范围，分别为69（16 - 278）mg/24小时与74（30 - 287）mg/24小时]方面具有可比性。旧队列在妊娠29（20 - 33）周时开始抗高血压治疗的有9例，新队列在妊娠13（0 - 34）周时开始抗高血压治疗的有10例。34周前早产的发生率从23%降至零（P = 0.02），37周前早产的发生率从62%降至40%（P = 0.15），子痫前期的发生率从42%降至20%（P = 0.11）。围产期死亡率分别为4%和0%。出生体重分别为3124（767）g和3279（663）g。
在血压正常的1型糖尿病合并微量白蛋白尿的孕妇中引入甲基多巴早期抗高血压治疗，可使妊娠第34周前的早产率显著降低。
