Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital NHS Trust, UK.
Best Pract Res Clin Obstet Gynaecol. 2011 Feb;25(1):3-14. doi: 10.1016/j.bpobgyn.2010.10.001. Epub 2010 Nov 19.
The association between hyperglycaemia and congenital malformations was first recognised over 40 years ago and was followed by the development of preconception clinics for women with diabetes. A fresh look at preconception care is needed as many studies were conducted during the late 1970s and early 1980s, before the introduction of regular home blood glucose monitoring and glycosylated haemoglobin assays, and when many patients with diabetes had microvascular complications. Recent observational studies and a meta-analysis suggest preconception care is effective with an approximately threefold reduction in the risk of malformations. There is now a worldwide epidemic of type 2 diabetes, but only few studies of preconception care have included women with type 2 diabetes. Furthermore, few studies have addressed the relationship between preconception care and perinatal morbidity. This article will review the evidence for preconception care in women with diabetes, evaluate different models of preconception care and discuss future strategies.
高血糖与先天畸形之间的关联早在 40 多年前就已被认识到，此后，为糖尿病女性设立了孕前诊所。随着越来越多的糖尿病患者出现微血管并发症，以及在引入定期家庭血糖监测和糖化血红蛋白检测之前，许多研究都是在 20 世纪 70 年代末和 80 年代初进行的，因此需要对孕前保健进行重新审视。最近的观察性研究和荟萃分析表明，孕前保健是有效的，可以将畸形风险降低约三倍。目前，2 型糖尿病在全球范围内呈流行趋势，但只有少数关于孕前保健的研究纳入了 2 型糖尿病女性。此外，很少有研究探讨孕前保健与围产期发病率之间的关系。本文将综述糖尿病女性孕前保健的证据，评估不同的孕前保健模式，并讨论未来的策略。
