Galindo Alberto, Burguillo Antonio Garcia, Azriel Sharona, Fuente Pedro de la
Department of Obstetrics and Gynecology, Hospital Universitario,"12 de Octubre", Madrid, Spain.
J Perinat Med. 2006;34(4):323-31. doi: 10.1515/JPM.2006.062.
To investigate the effects of pregestational diabetes on pregnancy outcome.
Data of 126 women with pregestational diabetes prospectively collected and controlled in a single tertiary center. HbA(1C) levels at early pregnancy were registered. Adverse pregnancy outcome was defined as spontaneous abortion, congenital defect, stillbirth, or neonatal death.
There were 10 spontaneous abortions (7.9%) and 17 fetuses with congenital anomalies (13.4%), including 8 major malformations (6.3%). Compared with pregnancies with a favorable outcome, a higher HbA(1C) concentration in early pregnancy was observed in pregnancies with adverse perinatal outcome [mean (SD): 6.3 (1.6) vs. 7.2 (1.7), P=0.001]. A positive correlation between increased maternal HbA(1C) levels and the rate of fetal malformations was observed, and the group of women with poor metabolic control (early maternal HbA(1c) concentration >7%) showed a 3 to 5-fold increase in the major malformation rate. Cardiovascular and genitourinary defects accounted for 58.8% of the anomalies, and the ultrasound examinations detected seven of them (41.2%). For major malformations, the detection rate was 50% (4/8). Perinatal mortality rate was 26 per thousand (3/116). There was almost 5-fold increase in the total pregnancy loss rate in the poor control group compared with the group with fair control [22.2% vs. 5.3%, OR (95% CI): 5.1 (1.4-17.1)]. Only 11.9% of mothers used a preconception care program.
Pregestational diabetes mellitus is a significant risk factor for the developing fetus. Spontaneous abortions and congenital defects are more common when a poor metabolic control is present in early pregnancy. It is most important to improve access to preconception care programs for achieving a good metabolic control in early pregnancy. Ultrasound examinations have a low performance for detecting congenital defects in diabetic pregnancies.
探讨孕前糖尿病对妊娠结局的影响。
前瞻性收集并在单一三级中心对126例孕前糖尿病女性的数据进行对照研究。记录孕早期的糖化血红蛋白（HbA1C）水平。不良妊娠结局定义为自然流产、先天性缺陷、死产或新生儿死亡。
有10例自然流产（7.9%）和17例胎儿有先天性异常（13.4%），其中8例为严重畸形（6.3%）。与妊娠结局良好的妊娠相比，围产期不良结局的妊娠在孕早期观察到更高的糖化血红蛋白（HbA1C）浓度[均值（标准差）：6.3（1.6）对7.2（1.7），P = 0.001]。观察到母体糖化血红蛋白（HbA1C）水平升高与胎儿畸形率之间呈正相关，代谢控制不佳的女性组（孕早期母体糖化血红蛋白（HbA1c）浓度>7%）严重畸形率增加3至5倍。心血管和泌尿生殖系统缺陷占异常的58.8%，超声检查检测出其中7例（41.2%）。对于严重畸形，检出率为50%（4/8）。围产儿死亡率为千分之26（3/116）。与控制良好组相比，控制不佳组的总妊娠丢失率几乎增加了5倍[22.2%对5.3%，比值比（95%可信区间）：5.1（1.4 - 17.1）]。只有11.9%的母亲使用了孕前保健计划。
孕前糖尿病是发育中胎儿的一个重要危险因素。孕早期代谢控制不佳时，自然流产和先天性缺陷更为常见。改善孕前保健计划的可及性对于孕早期实现良好的代谢控制最为重要。超声检查在检测糖尿病妊娠中的先天性缺陷方面表现不佳。
