School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK.
Diabetes Care. 2011 Aug;34(8):1683-8. doi: 10.2337/dc11-0244. Epub 2011 Jun 2.
To assess the relationship between glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes.
Pregnancy outcome (pre-eclampsia or gestational hypertension) was assessed prospectively in 749 women from the randomized controlled Diabetes and Pre-eclampsia Intervention Trial (DAPIT). HbA(1c) (A1C) values were available up to 6 months before pregnancy (n = 542), at the first antenatal visit (median 9 weeks) (n = 721), at 26 weeks' gestation (n = 592), and at 34 weeks' gestation (n = 519) and were categorized as optimal (<6.1%: referent), good (6.1-6.9%), moderate (7.0-7.9%), and poor (≥8.0%) glycemic control, respectively.
Pre-eclampsia and gestational hypertension developed in 17 and 11% of pregnancies, respectively. Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy compared with women who did not develop pre-eclampsia (P < 0.05, respectively). In early pregnancy, A1C ≥ 8.0% was associated with a significantly increased risk of pre-eclampsia (odds ratio 3.68 [95% CI 1.17-11.6]) compared with optimal control. At 26 weeks' gestation, A1C values ≥ 6.1% (good: 2.09 [1.03-4.21]; moderate: 3.20 [1.47-7.00]; and poor: 3.81 [1.30-11.1]) and at 34 weeks' gestation A1C values ≥ 7.0% (moderate: 3.27 [1.31-8.20] and poor: 8.01 [2.04-31.5]) significantly increased the risk of pre-eclampsia compared with optimal control. The adjusted odds ratios for pre-eclampsia for each 1% decrement in A1C before pregnancy, at the first antenatal visit, at 26 weeks' gestation, and at 34 weeks' gestation were 0.88 (0.75-1.03), 0.75 (0.64-0.88), 0.57 (0.42-0.78), and 0.47 (0.31-0.70), respectively. Glycemic control was not significantly associated with gestational hypertension.
Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy. These data suggest that optimal glycemic control both early and throughout pregnancy may reduce the risk of pre-eclampsia in women with type 1 diabetes.
评估 1 型糖尿病女性的血糖控制、先兆子痫和妊娠期高血压之间的关系。
前瞻性评估了随机对照糖尿病与先兆子痫干预试验（DAPIT）中的 749 名女性的妊娠结局（先兆子痫或妊娠期高血压）。HbA1c（A1C）值在妊娠前 6 个月（n=542）、第一次产前检查（中位数 9 周）（n=721）、26 周妊娠（n=592）和 34 周妊娠（n=519）时可用，并分别归类为最佳（<6.1%：参照）、良好（6.1-6.9%）、中度（7.0-7.9%）和较差（≥8.0%）血糖控制。
先兆子痫和妊娠期高血压的发生率分别为 17%和 11%。与未发生先兆子痫的女性相比，发生先兆子痫的女性在妊娠前和妊娠期间的 A1C 值明显更高（分别为 P<0.05）。在孕早期，A1C≥8.0%与先兆子痫的风险显著增加相关（优势比 3.68 [95%CI 1.17-11.6]），与最佳控制相比。在 26 周妊娠时，A1C 值≥6.1%（良好：2.09 [1.03-4.21]；中度：3.20 [1.47-7.00]；较差：3.81 [1.30-11.1]）和在 34 周妊娠时 A1C 值≥7.0%（中度：3.27 [1.31-8.20]和较差：8.01 [2.04-31.5]）与最佳控制相比，显著增加了先兆子痫的风险。妊娠前、第一次产前检查、26 周妊娠和 34 周妊娠时，A1C 每降低 1%，先兆子痫的调整优势比分别为 0.88（0.75-1.03）、0.75（0.64-0.88）、0.57（0.42-0.78）和 0.47（0.31-0.70）。血糖控制与妊娠期高血压无显著相关性。
发生先兆子痫的女性在妊娠前和妊娠期间的 A1C 值明显更高。这些数据表明，1 型糖尿病女性在妊娠早期和整个妊娠期间实现最佳血糖控制可能会降低先兆子痫的风险。
