Gonzalez-Gonzalez Nieves Luisa, Ramirez Octavio, Mozas Juan, Melchor Juan, Armas Honorio, Garcia-Hernandez Jose Angel, Caballero Agueda, Hernandez Marta, Diaz-Gomez Marta Nieves, Jimenez Alejandro, Parache Javier, Bartha Jose Luis
Department of Obstetrics and Gynecology, University Hospital of the Canary Islands, Tenerife, Spain.
Acta Obstet Gynecol Scand. 2008;87(1):43-9. doi: 10.1080/00016340701778732.
To compare pregnancy outcome and factors related to adverse perinatal outcome in women with type 1 versus type 2 diabetes mellitus (DM).
Multicentre retrospective study. Some 404 women were studied, 257 with type 1 DM and 147 with type 2 DM. Main outcome measures were rates of prematurity, macrosomia, instrumental deliveries, congenital malformations, need for neonatal intensive care unit (NICU), and perinatal mortality.
There were no significant differences in pregnancy outcome between women with type 1 and type 2 DM, except for an increased rate of instrumental deliveries in women with type 1 DM. In these women, duration of diabetes was a significant predictor of caesarean delivery (OR =1.06 (1.01-1.12); p=0.02). Chronic hypertension was positively related to prematurity (p=0.02), and proved to be a significant predictor of birth weight lower than 2,500 g (OR =3.54 (1.4-12.49); p=0.043) and perinatal mortality (OR =10.6 (1.15-117.6); p=0.04). In women with type 2 DM, third trimester higher glycosylated haemoglobin was related to both prematurity (OR 4.9 (1.7-14.4; p=0.004) and low birth weight. Macrosomia was a significant risk factor for caesarean section. First trimester glycosylated haemoglobin was related to congenital malformations and proved to be a significant predictor of perinatal mortality (OR =2.4 (1.02-5.74); p=0.04).
Duration of DM and chronic hypertension were the most influential factors related to adverse perinatal outcomes in women with type 1 DM, and poor metabolic control and macrosomia in women with type 2 DM.
比较1型糖尿病与2型糖尿病（DM）女性的妊娠结局及围产期不良结局相关因素。
多中心回顾性研究。共研究了约404名女性，其中257名患有1型糖尿病，147名患有2型糖尿病。主要结局指标包括早产率、巨大儿、器械助产、先天性畸形、新生儿重症监护病房（NICU）需求及围产期死亡率。
1型糖尿病与2型糖尿病女性的妊娠结局无显著差异，只是1型糖尿病女性器械助产率有所增加。在这些女性中，糖尿病病程是剖宫产的显著预测因素（OR =1.06（1.01 - 1.12）；p = 0.02）。慢性高血压与早产呈正相关（p = 0.02），且被证明是出生体重低于2500g（OR =3.54（1.4 - 12.49）；p = 0.043）及围产期死亡率（OR =10.6（1.15 - 117.6）；p = 0.04）的显著预测因素。在2型糖尿病女性中，孕晚期较高的糖化血红蛋白与早产（OR 4.9（1.7 - 14.4；p = 0.004））及低出生体重均有关。巨大儿是剖宫产的显著危险因素。孕早期糖化血红蛋白与先天性畸形有关，且被证明是围产期死亡率的显著预测因素（OR =2.4（1.02 - 5.74）；p = 0.04）。
糖尿病病程和慢性高血压是1型糖尿病女性围产期不良结局的最有影响因素，而代谢控制不佳和巨大儿是2型糖尿病女性围产期不良结局的最有影响因素。
