2型糖尿病患者的妊娠结局：来自荷兰的一项回顾性分析
Pregnancy outcome in type 2 diabetes mellitus: a retrospective analysis from the Netherlands.
作者信息
de Valk Harold W, van Nieuwaal Nancy H G, Visser Gerard H A
机构信息
Department of Internal Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
出版信息
Rev Diabet Stud. 2006 Fall;3(3):134-42. doi: 10.1900/RDS.2006.3.134. Epub 2006 Nov 10.
MAIN OBJECTIVES
The objective was to describe pre-gestational history and the maternal, fetal and neonatal outcome in pregnancies in women with pre-gestational type 2 diabetes during the period between 1992 and 2006 from one center in the Netherlands.
METHODS
Patients attending the obstetric-diabetology outpatient clinic of a tertiary referral center were studied. This center also has a regular diabetes clinic and a community midwifery service. Patients were identified from the database. Maternal outcome (pre-eclampsia, pre-term delivery, Caesarean section) and fetal and neonatal outcome (macrosomia, congenital malformations, perinatal mortality, neonatal hypoglycemia) were analyzed as well HbA1c levels, planning of pregnancy, gestational age at first antenatal visit and ethnic background.
RESULTS
Sixty-six singleton pregnancies from 48 women were analyzed. Their age was 34 +/- 5 yr, the BMI 31.7 +/- 7.4 and the median duration of diabetes was 3 yr. 52% were Caucasian and 35% were of Moroccan descent. 49% did not complete secondary school. Moroccan descent was associated with a lower educational level and a BMI comparable with the whole study group. The proportion of planned pregnancies was approximately 70%. The mean HbA1c in the first trimester was 6.4 +/- 1.1% and the gestational age at first visit was 10 +/- 5 wk, in one-quarter before 6 wk. The prevalences of variables related to maternal and neonatal outcome were as follows: spontaneous abortion 13.6%, pre-eclampsia 8.9%, pre-term delivery 21.4%, spontaneous labor 25.0%, induced labor 48.2%, Caesarean section 42.9%, macrosomia (>/=90th percentile) 41.1%, severe hypoglycemia 41.5% and major congenital malformations 5.1%.
CONCLUSIONS
Pre-gestational type 2 diabetes is associated with an increased incidence of adverse pregnancy outcome despite reasonable mean HbA1c level and despite a high frequency of planned pregnancies. Many women report relatively late. Improvement in the outcome requires more active peri-gestational specialist care and a tailored approach is required towards migrant communities.
主要目标
目的是描述1992年至2006年期间荷兰一家中心孕前2型糖尿病女性妊娠的孕前病史以及母婴和新生儿结局。
方法
对一家三级转诊中心产科糖尿病门诊的患者进行研究。该中心还有一个常规糖尿病诊所和社区助产服务。从数据库中识别患者。分析了母婴结局（子痫前期、早产、剖宫产）以及胎儿和新生儿结局（巨大儿、先天性畸形、围产期死亡率、新生儿低血糖），以及糖化血红蛋白水平、妊娠计划、首次产前检查时的孕周和种族背景。
结果
分析了48名女性的66例单胎妊娠。她们的年龄为34±5岁，体重指数为31.7±7.4，糖尿病病程中位数为3年。52%为白种人，35%为摩洛哥裔。49%未完成中学学业。摩洛哥裔与较低的教育水平和与整个研究组相当的体重指数相关。计划妊娠的比例约为70%。孕早期糖化血红蛋白的平均值为6.4±1.1%，首次就诊时的孕周为10±5周，四分之一的患者在6周前就诊。与母婴和新生儿结局相关变量的患病率如下：自然流产13.6%，子痫前期8.9%，早产21.4%，自然分娩25.0%，引产48.2%，剖宫产42.9%，巨大儿（≥第90百分位数）41.1%，严重低血糖41.5%，主要先天性畸形5.1%。
结论
尽管糖化血红蛋白平均水平合理且计划妊娠频率较高，但孕前2型糖尿病与不良妊娠结局的发生率增加相关。许多女性就诊相对较晚。改善结局需要更积极的围孕期专科护理，并且需要针对移民社区采取量身定制的方法。
Zotero 插件