Rackham Oliver, Paize Fauzia, Weindling A Michael
Wirral University Teaching Hospital, NHS Foundation Trust, Wirral, United Kingdom.
Postgrad Med. 2009 Jul;121(4):26-32. doi: 10.3810/pgm.2009.07.2026.
Perinatal mortality remains high among infants of mothers with type 1 and type 2 diabetes mellitus. Although high glucose levels have been implicated, the mechanism is not well understood.
The case notes of women with type 1 and type 2 diabetes mellitus who had a stillbirth or neonatal death were identified and examined by 2 reviewers independently.
Ninety-three perinatal deaths were identified (59 women with type 1 diabetes; 34 women with type 2 diabetes). There were 73 stillbirths, 12 were early neonatal deaths, and 8 were late neonatal deaths. Eighteen deaths were attributed to congenital anomalies, 64 to antepartum asphyxia, 4 to intrapartum asphyxia, 3 to postnatal hyaline membrane disease, 2 to postnatal infection, 1 was unclassifiable, and 1 case had no details available. Median postmenstrual age at death was 34 weeks for both women with type 1 and type 2 diabetes. Congenital anomalies were less common in women with type 1 diabetes than those with type 2 diabetes (rate ratio, 0.37 [95% confidence interval, 0.15-0.95]). The relationship between preconceptional and maximal maternal glycosylated hemoglobin (HbA1c) concentrations and birth weight was curvilinear: at low HbA1c levels, the fetal weight was normal; when HbA1c levels were moderately raised, there was macrosomia; very high HbA1c levels were associated with severe intrauterine growth restriction.
We describe a relationship between HbA1c and fetal weight. We consider that this provides evidence that hyperglycemia not only causes fetal macrosomia but also an angiopathy affecting the utero-placental blood vessels and consequent fetal hypoxia. These observations provide further evidence that good pre- and periconceptional glycemic control is likely to be of great importance in improving the outcome of pregnancies of women with diabetes.
1型和2型糖尿病母亲所生婴儿的围产期死亡率仍然很高。尽管高血糖水平被认为与此有关，但其机制尚不清楚。
1）确定1型和2型糖尿病女性所生婴儿死产和新生儿死亡的原因；2）确定1型和2型糖尿病女性围产期死亡原因是否相同；3）确定围产期死亡率与母亲血糖控制之间的关系。
确定1型和2型糖尿病并有死产或新生儿死亡的女性的病历，并由两名审阅者独立检查。
共确定93例围产期死亡（1型糖尿病女性59例；2型糖尿病女性34例）。其中死产73例，早期新生儿死亡12例，晚期新生儿死亡8例。18例死亡归因于先天性异常，64例归因于产前窒息，4例归因于产时窒息，3例归因于产后透明膜病，2例归因于产后感染，1例无法分类，1例无详细信息。1型和2型糖尿病女性死亡时的经月经龄中位数均为34周。1型糖尿病女性的先天性异常比2型糖尿病女性少见（率比，0.37[95%置信区间，0.15 - 0.95]）。孕前和母亲糖化血红蛋白（HbA1c）最高浓度与出生体重之间的关系呈曲线：在低HbA1c水平时，胎儿体重正常；当HbA1c水平适度升高时，出现巨大儿；非常高的HbA1c水平与严重的宫内生长受限有关。
我们描述了HbA1c与胎儿体重之间的关系。我们认为这提供了证据，证明高血糖不仅导致胎儿巨大儿，还导致影响子宫 - 胎盘血管的血管病变以及随之而来的胎儿缺氧。这些观察结果进一步证明，孕前和孕早期良好的血糖控制对于改善糖尿病女性的妊娠结局可能非常重要。
