血糖控制和 1 型糖尿病女性在连续皮下胰岛素输注和多次皮下注射治疗下的选定妊娠结局：妊娠计划的意义。
Glycemic control and selected pregnancy outcomes in type 1 diabetes women on continuous subcutaneous insulin infusion and multiple daily injections: the significance of pregnancy planning.
机构信息
Department of Metabolic Diseases, Jagiellonian University Medical College, 31-511 Krakow, Poland.
出版信息
Diabetes Technol Ther. 2010 Jan;12(1):41-7. doi: 10.1089/dia.2009.0081.
BACKGROUND
Two regimens are used to achieve excellent glycemic control during pregnancy in type 1 diabetes mellitus (T1DM): continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI). We assessed their efficacy and safety and the effect of pregnancy planning.
METHODS
We examined 269 pregnant T1DM women: 157 treated with MDI (MDI group), 42 with CSII (CSII group), and 70 who switched from MDI to CSII in the first trimester (MDI/CSII group). There were 116 women who planned pregnancy: 58 in the MDI group, 38 in the CSII group, and 20 in the MDI/CSII group. The estimated differences in glycemic control and maternal and fetal outcomes were adjusted for baseline characteristics.
RESULTS
Mean glycated A1c (HbA1c) in the first trimester in the whole group was 6.9%, and the women differed depending on whether they planned pregnancy or not (P < 0.0001). A multiple regression model showed an average difference of about 0.9% in favor of pregnancy planning, with no interaction between the planning and treatments. In the second trimester, HbA1c decreased to a mean value of 5.8%, with improvement of HbA1c across all treatments: by 1.5% in not-planning and 0.9% in planning women. Despite greater improvement, not-planning women still had a higher HbA1c (by 0.3%, P = 0.05). In the third trimester, there was no further significant changes; nevertheless, women who planned pregnancy still had a lower HbA1c (by 0.5%, P = 0.02). There were 14 malformations, stillbirths, and perinatal infant deaths in the not-planning versus five in the planning group (P = 0.07). Patients in the CSII group had a 2 kg greater weight gain compared to the MDI group (15.0 kg vs. 13.0 kg; P = 0.005).
CONCLUSIONS
In pregnancy with T1DM, both MDI and CSII can provide excellent glycemic control. Pregnancy planning has a beneficial effect on glycemic control, independent from the therapy model. CSII seems to predispose to a larger weight gain in mothers.
背景
在 1 型糖尿病（T1DM）患者中，有两种方案可实现妊娠期间的血糖良好控制：持续皮下胰岛素输注（CSII）和多次皮下注射（MDI）。我们评估了这两种方案的疗效和安全性以及妊娠计划的影响。
方法
我们对 269 名妊娠 T1DM 女性进行了研究：157 名接受 MDI 治疗（MDI 组），42 名接受 CSII 治疗（CSII 组），70 名在妊娠早期从 MDI 转为 CSII（MDI/CSII 组）。有 116 名计划妊娠的女性：MDI 组 58 名，CSII 组 38 名，MDI/CSII 组 20 名。根据基线特征调整了血糖控制和母婴结局的估计差异。
结果
整个研究组在妊娠早期的平均糖化血红蛋白（HbA1c）为 6.9%，根据是否计划妊娠，女性之间存在差异（P<0.0001）。多因素回归模型显示，计划妊娠的平均差异约为 0.9%，且计划和治疗之间无交互作用。在妊娠中期，HbA1c 降至平均 5.8%，所有治疗方案的 HbA1c 均有所改善：未计划妊娠的女性改善 1.5%，计划妊娠的女性改善 0.9%。尽管改善程度更大，但未计划妊娠的女性 HbA1c 仍较高（高 0.3%，P=0.05）。在妊娠晚期，HbA1c 无进一步显著变化；然而，计划妊娠的女性 HbA1c 仍较低（低 0.5%，P=0.02）。未计划妊娠的女性有 14 例畸形、死胎和围生儿死亡，而计划妊娠的女性有 5 例（P=0.07）。CSII 组与 MDI 组相比，体重增加了 2 公斤（15.0 公斤 vs. 13.0 公斤；P=0.005）。
结论
在 T1DM 妊娠中，MDI 和 CSII 均可提供良好的血糖控制。妊娠计划对血糖控制有有益影响，与治疗模式无关。CSII 似乎会使母亲体重增加更多。
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