Carr Darcy B, Koontz Gretchen L, Gardella Carolyn, Holing Emily V, Brateng Debra A, Brown Zane A, Easterling Thomas R
Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington 98195-6460, USA.
Am J Hypertens. 2006 May;19(5):513-9. doi: 10.1016/j.amjhyper.2005.12.010.
Nephropathy complicates 5% to 10% of pregnancies in women with diabetes and is associated with adverse outcomes. Given the importance of blood pressure (BP) control in reducing cardiovascular and renal complications outside of pregnancy, we hypothesized that poorly controlled hypertension in early pregnancy among women with diabetic nephropathy would be associated with adverse outcomes.
To examine the impact of hypertensive control in early pregnancy on perinatal outcomes, we performed a retrospective cohort study of pregnancies complicated by diabetic nephropathy with "Above Target" mean arterial pressure (> or = 100 mm Hg; N = 21) and "Below Target" mean arterial pressure (< 100 mm Hg; N = 22), which approximates the American Diabetes Association and the Seventh Report of the Joint National Committee recommended target of 130/80 mm Hg, measured at < 20 weeks' gestation.
There were no differences in maternal age (mean +/- SEM: 27.2 +/- 1.2 v 29.5 +/- 1.0 years), duration of diabetes (median, range: 17.5, 13 to 24 v 16, 1 to 25 years), or glucose control (glycosylated hemoglobin [HbA1c] 8.0% +/- 0.3% v 8.1% +/- 0.4%) between the Above and Below Target groups. The Above Target group had more proteinuria (4.69 +/- 1.08 v 1.65 +/- 0.43 g/24 h; P = .007) and higher serum creatinine levels (1.23 +/- 0.17 v 0.85 +/- 0.06 mg/dL; P = .02). The Above Target group was more likely to deliver at < 32 weeks' gestation (38.1% v 4.6%; P = .007). The increased risk of preterm delivery remained significant after adjusting for duration of diabetes and glucose control.
Suboptimal control of hypertension in early pregnancy in women with diabetic nephropathy is associated with a significant risk of preterm delivery. Improved preconceptional control of hypertension may reduce adverse perinatal outcomes in women with diabetic nephropathy.
糖尿病女性妊娠中有5%至10%会并发肾病，并伴有不良结局。鉴于血压控制对于降低非孕期心血管和肾脏并发症的重要性，我们推测糖尿病肾病女性在妊娠早期血压控制不佳会与不良结局相关。
为研究妊娠早期高血压控制对围产期结局的影响，我们对妊娠合并糖尿病肾病且平均动脉压“高于目标值”（≥100 mmHg；n = 21）和“低于目标值”（< 100 mmHg；n = 22）的孕妇进行了一项回顾性队列研究，平均动脉压在妊娠20周前测量，接近美国糖尿病协会和美国国家联合委员会第七次报告推荐的130/80 mmHg目标值。
“高于目标值”组和“低于目标值”组在产妇年龄（平均±标准误：27.2±1.2岁对29.5±1.0岁）、糖尿病病程（中位数，范围：17.5，13至24年对16，1至25年）或血糖控制（糖化血红蛋白[HbA1c] 8.0%±0.3%对
