Key T C, Giuffrida R, Moore T R
Am J Obstet Gynecol. 1987 May;156(5):1096-100. doi: 10.1016/0002-9378(87)90117-7.
The influence of early pregnancy glycemic control as measured by hemoglobin A1c concentration and the incidence of congenital anomalies and spontaneous abortions were evaluated in women presenting for prenatal care with insulin-treated diabetes in a population whose glycemic control was poor. Thirty-one abnormal outcomes were seen in 83 pregnancies (37%). There were 22 spontaneous abortions and nine major congenital anomalies. No woman with an early pregnancy hemoglobin A1C value less than 9.5% had an infant with a congenital anomaly and a single woman experienced a spontaneous abortion (4%). Conversely, in women with an early pregnancy hemoglobin A1C value greater than or equal to 9.5%, congenital anomalies occurred in 24% and spontaneous abortion in 35%. Outcomes of pregnancies in type 1 and type 11 diabetic women were comparable. A strong statistical relationship between hemoglobin A1C and adverse pregnancy outcomes was demonstrated. These results strongly suggest that poor glycemic control during early pregnancy adversely influences pregnancy outcomes; the greater the degree of poor control, the greater the impact on pregnancy outcome. The data further justify the need for preconceptional control in diabetic woman and for careful evaluation of the fetus during pregnancy in the woman with insulin-treated diabetes.
在血糖控制较差的人群中，对接受胰岛素治疗的糖尿病孕妇，通过糖化血红蛋白浓度来衡量早期妊娠血糖控制情况，并评估先天性异常和自然流产的发生率。83例妊娠中有31例出现异常结局（37%）。其中有22例自然流产和9例主要先天性异常。妊娠早期糖化血红蛋白值低于9.5%的女性中，没有婴儿出现先天性异常，仅有1名女性发生自然流产（4%）。相反，妊娠早期糖化血红蛋白值大于或等于9.5%的女性中，先天性异常发生率为24%，自然流产率为35%。1型和11型糖尿病女性的妊娠结局具有可比性。糖化血红蛋白与不良妊娠结局之间存在很强的统计学关联。这些结果强烈表明，妊娠早期血糖控制不佳会对妊娠结局产生不利影响；控制不佳的程度越大，对妊娠结局的影响就越大。这些数据进一步证明了糖尿病女性孕前控制血糖以及对接受胰岛素治疗的糖尿病女性在孕期仔细评估胎儿的必要性。
