Rosenn B, Miodovnik M, Combs C A, Khoury J, Siddiqi T A
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Ohio.
Obstet Gynecol. 1991 Jun;77(6):846-9.
Poor glycemic control in early pregnancy in insulin-dependent diabetes is associated with an increased risk for spontaneous abortions and congenital malformations. Strict glycemic control from the initial stages of embryogenesis is one of the major goals of management in these pregnancies. We hypothesized that insulin-dependent diabetic patients attending a pre-conception program would have improved glycemic control compared with insulin-dependent diabetic patients who enrolled after conception and would have better pregnancy outcome, with fewer spontaneous abortions and fewer major malformations. Ninety-nine pregnant insulin-dependent diabetic patients were recruited before reaching 9 weeks' gestation and were followed prospectively throughout pregnancy. Twenty-eight had attended a pre-conception clinic to optimize glycemic control (study group) and 71 had enrolled after conception (control group). Early glycemic control was significantly better in the study group: Glycohemoglobin values at the first prenatal visit and at 9 and 14 weeks' gestation were significantly lower than in the control group. The rate of spontaneous abortion was significantly lower in the study group (7%) than in the controls (24%). There was one major malformation in the control group and none in the study group. We conclude that patients with insulin-dependent diabetes attending a pre-conception program have a decreased rate of early pregnancy loss compared with those receiving prenatal care early in pregnancy.
胰岛素依赖型糖尿病患者在妊娠早期血糖控制不佳与自然流产和先天性畸形的风险增加有关。从胚胎发育初始阶段就进行严格的血糖控制是这类妊娠管理的主要目标之一。我们假设，参加孕前计划的胰岛素依赖型糖尿病患者与妊娠后才登记的胰岛素依赖型糖尿病患者相比，血糖控制会得到改善，妊娠结局会更好，自然流产和严重畸形会更少。99名妊娠的胰岛素依赖型糖尿病患者在妊娠9周前被招募，并在整个孕期接受前瞻性随访。28名患者参加了孕前门诊以优化血糖控制（研究组），71名患者在妊娠后登记（对照组）。研究组的早期血糖控制明显更好：首次产前检查时以及妊娠9周和14周时的糖化血红蛋白值明显低于对照组。研究组的自然流产率（7%）明显低于对照组（24%）。对照组有1例严重畸形，研究组无严重畸形。我们得出结论，与在妊娠早期接受产前护理的患者相比，参加孕前计划的胰岛素依赖型糖尿病患者早期妊娠丢失率降低。
