Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, PO Box 140, Haartmaninku 2, 00029 Helsinki, Finland.
Diabetologia. 2012 Sep;55(9):2327-34. doi: 10.1007/s00125-012-2627-9. Epub 2012 Jul 3.
AIMS/HYPOTHESIS: Our objective was to examine the trends in prepregnancy BMI and glycaemic control among Finnish type 1 diabetic patients and their relation to delivery mode and perinatal outcome.
We analysed the obstetric records of 881 type 1 diabetic women with a singleton childbirth during 1989-2008. Maternal prepregnancy weight and height were obtained from the maternity cards, where they are recorded as reported by the mother.
Maternal BMI increased significantly during 1989-2008 (p < 0.001). The mean HbA(1c) in the first trimester remained unchanged, but the midpregnancy and the last HbA(1c) before delivery increased (p = 0.009 and 0.005, respectively). Elective Caesarean sections (CS) decreased (p for trend <0.001), while emergency CS increased (p for trend <0.001). The mean umbilical artery (UA) pH decreased in vaginal deliveries (p for trend <0.001). The frequency of UA pH <7.15 and <7.05 increased (p for trend <0.001 and 0.008, respectively). The macrosomia rate remained at 32-40%. Neonatal intensive care unit (NICU) admissions increased (p for trend 0.03) and neonatal hypoglycaemia frequency decreased (p for trend 0.001). In multiple logistic regression analysis, maternal BMI was associated with macrosomia and NICU admission. The last HbA(1c) value before delivery was associated with delivery before 37 weeks' gestation, UA pH <7.15, 1 min Apgar score <7, macrosomia, NICU admission and neonatal hypoglycaemia.
CONCLUSIONS/INTERPRETATION: Self-reported pregestational BMI has increased and glycaemic control during the second half of pregnancy has deteriorated. Poor glycaemic control seems to be associated with the observed increases in adverse obstetric and perinatal outcomes.
目的/假设：我们的目的是研究芬兰 1 型糖尿病患者孕前 BMI 和血糖控制的趋势及其与分娩方式和围产儿结局的关系。
我们分析了 1989 年至 2008 年间 881 名单胎分娩的 1 型糖尿病女性的产科记录。产妇孕前体重和身高从母婴保健卡中获得，记录值为产妇报告值。
1989 年至 2008 年间，母体 BMI 显著增加（p<0.001）。第一个三个月的平均 HbA1c 保持不变，但中期和分娩前最后一个 HbA1c 增加（p=0.009 和 0.005）。选择性剖宫产（CS）减少（趋势 p<0.001），而急诊 CS 增加（趋势 p<0.001）。阴道分娩时脐动脉（UA）pH 值下降（趋势 p<0.001）。UA pH 值<7.15 和<7.05 的频率增加（趋势 p<0.001 和 0.008）。巨大儿率保持在 32-40%。新生儿重症监护病房（NICU）入院人数增加（趋势 p=0.03），新生儿低血糖频率降低（趋势 p=0.001）。在多因素逻辑回归分析中，母体 BMI 与巨大儿和 NICU 入院有关。分娩前最后一个 HbA1c 值与 37 周前分娩、UA pH 值<7.15、1 分钟 Apgar 评分<7、巨大儿、NICU 入院和新生儿低血糖有关。
结论/解释：自我报告的孕前 BMI 增加，妊娠后半期血糖控制恶化。血糖控制不佳似乎与观察到的不良产科和围产儿结局增加有关。
