Dublin Diabetes in Pregnancy Service, Mater Misericordiae University Hospital, National Maternity Hospital, Coombe Women's Hospital and Rotunda Hospitals, Dublin, Ireland.
Pediatr Diabetes. 2010 Mar;11(2):111-5. doi: 10.1111/j.1399-5448.2009.00537.x. Epub 2009 Dec 8.
Younger maternal age at delivery has been linked to adverse reproductive outcomes. Pregnancy complicated by type 1 diabetes mellitus (T1DM) is also associated with adverse pregnancy outcomes. Optimising diabetic glycaemic control prior to pregnancy is known to reduce the rate of congenital abnormalities and improve pregnancy outcomes. Teenage pregnancies are not usually planned and little data exist on teenage pregnancy complicated by T1DM. We sought to identify the glycemic control achieved in teenage pregnancy with T1DM and to clarify if there is an associated increase in adverse pregnancy outcomes compared to those seen in older women with T1DM. We compared outcomes in 18 teenagers (TG) with 582 older women with T1DM (CON) from 1995-2007. TG booked to the combined diabetes-obstetrical service at a median gestational age of 11 weeks (range 6-22) compared to 7 weeks in CON (range 4-40, p < 0.02). Glycaemic was worse in TG compared to CON at 13, 26 and 35 weeks gestation, despite higher insulin doses. First trimester miscarriage rate did not differ between groups. Major congenital anomaly rate was 6.2% (1/16) compared to 3.2% in CON. This preliminary study has demonstrated that pregnant teenage women with T1DM book later to specialised care and have worse glycaemic control in pregnancy compared to older women with T1DM. This group also appear to be more insulin resistant than older women in early pregnancy. Our data would suggest that teenagers with type 1 diabetes mellitus may constitute a high-risk group for adverse pregnancy outcomes.
年轻的产妇年龄与不良生殖结局有关。妊娠合并 1 型糖尿病（T1DM）也与不良妊娠结局相关。已知在妊娠前优化糖尿病血糖控制可降低先天性异常的发生率并改善妊娠结局。青少年妊娠通常不是计划好的，而且关于青少年妊娠合并 1 型糖尿病的数据很少。我们试图确定青少年妊娠合并 1 型糖尿病的血糖控制情况，并澄清与老年女性妊娠合并 1 型糖尿病相比，是否存在不良妊娠结局增加的情况。我们比较了 1995-2007 年期间 18 名青少年（TG）与 582 名老年女性（CON）的妊娠结局。TG 在妊娠 11 周（6-22 周）中位数时就预订了联合糖尿病-产科服务，而 CON 为 7 周（4-40 周，p<0.02）。尽管胰岛素剂量较高，但 TG 在 13、26 和 35 周妊娠时的血糖控制仍比 CON 差。尽管 TG 的妊娠早期流产率与 CON 没有差异，但主要先天性异常率为 6.2%（1/16），而 CON 为 3.2%。这项初步研究表明，患有 T1DM 的青少年妊娠女性较晚预订专业护理，且在妊娠期间的血糖控制较老年女性更差。这组在孕早期似乎比老年女性更具胰岛素抵抗性。我们的数据表明，青少年 1 型糖尿病患者可能构成不良妊娠结局的高危人群。
