Wender-Ozegowska Ewa, Zawiejska Agnieszka, Ozegowska Katarzyna, Wroblewska-Seniuk Katarzyna, Iciek Rafal, Mantaj Urszula, Olejniczak Danuta, Brazert Jacek
Department of Obstetrics and Women Diseases, Poznan University of Medical Sciences, Poznan, Poland.
Aust N Z J Obstet Gynaecol. 2013 Apr;53(2):130-5. doi: 10.1111/ajo.12027. Epub 2013 Jan 15.
The aim was to evaluate the outcome of pregnancies with type 1 diabetes (T1DM) treated from the first trimester with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI).
In a retrospective, observational study, we matched 64 CSII patients for age, age at onset and duration of diabetes and HbA1c in the first trimester with 64 MDI pregnancies. We analysed carbohydrate metabolism, insulin requirements, development of PIH, progression of retinopathy and fetal outcome.
In CSII group, we found a significantly smaller insulin requirement both at the beginning of pregnancy and before delivery, significant decrease in HbA1c levels and significantly smaller number of hypoglycaemic episodes in the second trimester and significantly more hyperglycaemic episodes in the first trimester. In both groups, maternal, fetal and perinatal outcomes were similar and the number of hypo- and hyperglycaemic episodes decreased throughout pregnancy.
Continuous subcutaneous insulin infusion (CSII) treatment in pregnant women with type 1 diabetes is associated with a reduced number of hypoglycaemia and decreased insulin requirement. We noted no difference in perinatal outcome comparing women on multiple insulin injections with those on continuous insulin infusion.
本研究旨在评估妊娠合并1型糖尿病（T1DM）患者在孕早期接受持续皮下胰岛素输注（CSII）或多次皮下注射（MDI）治疗的结局。
在一项回顾性观察研究中，我们将64例接受CSII治疗的患者与64例接受MDI治疗的妊娠患者，按照年龄、糖尿病发病年龄、病程以及孕早期糖化血红蛋白（HbA1c）水平进行匹配。我们分析了碳水化合物代谢、胰岛素需求量、妊娠期高血压疾病（PIH）的发生情况、视网膜病变的进展以及胎儿结局。
在CSII组中，我们发现妊娠初期和分娩前的胰岛素需求量显著减少，HbA1c水平显著降低，孕中期低血糖发作次数显著减少，孕早期高血糖发作次数显著增多。两组的母婴及围产期结局相似，且低血糖和高血糖发作次数在整个孕期均减少。
妊娠合并1型糖尿病患者采用持续皮下胰岛素输注（CSII）治疗，可减少低血糖发作次数并降低胰岛素需求量。我们发现，多次胰岛素注射治疗的女性与持续胰岛素输注治疗的女性在围产期结局方面并无差异。
