Glinianaia S V, Tennant P W G, Crowder D, Nayar R, Bell R
Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
Diabet Med. 2014 Sep;31(9):1104-13. doi: 10.1111/dme.12460. Epub 2014 Apr 21.
To investigate trends in indicators of preparation for pregnancy in women with Type 1 and Type 2 diabetes and explore their predictors.
Data on 2293 pregnancies delivered during 1996-2010 by women with Type 1 (n = 1753) and Type 2 (n = 540) diabetes were obtained from the Northern Diabetes in Pregnancy Survey. Multiple logistic regression was used to analyse the relationship between potential predictors and three indicators of inadequate pregnancy preparation: non-attendance for pre-conception care; no pre-conception folate consumption; and peri-conception HbA(1c) ≥ 53 mmol/mol (≥ 7%).
Overall, 40.3% of women with diabetes attended pre-conception care, 37.4% reported pre-conception folate consumption, and 28.2% had adequate peri-conception HbA1c . For all patients, pre-conception folate consumption improved over time, while peri-conception glucose control did not. Attendance for pre-conception care for women with Type 1 diabetes significantly declined. Residence in deprived areas, smoking and younger maternal age (for women aged < 35 years) were independently associated with all three indicators of inadequate preparation for pregnancy. Additional predictors of inadequate peri-conception HbA(1c) were: Type 1 diabetes (adjusted odds ratio 5.51, 95% CI 2.71-11.22), longer diabetes history (adjusted odds ratio 1.16, 95% CI 1.09-1.23 per year increase for those with < 15 years' diabetes duration), non-white ethnicity (adjusted odds ratio 3.13, 95% CI 1.23-7.97) and higher BMI (adjusted odds ratio 1.05, 95% CI 1.01-1.09 per 1-kg/m(2) increase). Non-attendance for pre-conception care was additionally associated with Type 2 diabetes (P = 0.003) and multiparity (P < 0.0001).
There are socio-demographic inequalities in preparation for pregnancy among women with diabetes. Women with Type 2 diabetes were less likely to attend pre-conception care. Pre-conception services need to be designed to maximize uptake in all groups.
调查1型和2型糖尿病女性的孕前准备指标趋势，并探究其预测因素。
从《北方妊娠期糖尿病调查》中获取了1996 - 2010年间1型糖尿病女性（n = 1753）和2型糖尿病女性（n = 540）分娩的2293例妊娠的数据。采用多因素逻辑回归分析潜在预测因素与孕前准备不足的三个指标之间的关系：未参加孕前保健；未摄入孕前叶酸；妊娠早期糖化血红蛋白（HbA1c）≥53 mmol/mol（≥7%）。
总体而言，40.3%的糖尿病女性参加了孕前保健，37.4%的女性报告摄入了孕前叶酸，28.2%的女性妊娠早期糖化血红蛋白控制良好。对于所有患者，孕前叶酸摄入量随时间有所改善，而妊娠早期血糖控制情况未改善。1型糖尿病女性参加孕前保健的比例显著下降。居住在贫困地区、吸烟以及产妇年龄较小（年龄<35岁的女性）与孕前准备不足的所有三个指标均独立相关。妊娠早期糖化血红蛋白（HbA1c）控制不佳的其他预测因素包括：1型糖尿病（调整后的比值比为5.51，95%置信区间为2.71 - 11.22）、糖尿病病程较长（糖尿病病程<15年者，每年增加的调整后比值比为1.16，95%置信区间为1.09 - 1.23）、非白人种族（调整后的比值比为3.13，95%置信区间为1.23 - 7.97）以及较高的体重指数（BMI）（每增加1 kg/m²，调整后的比值比为1.05，95%置信区间为1.01 - 1.09）。未参加孕前保健还与2型糖尿病（P = 0.003）和多胎妊娠（P < 0.0001）相关。
糖尿病女性在孕前准备方面存在社会人口统计学不平等。2型糖尿病女性参加孕前保健的可能性较小。需要设计孕前服务以提高所有群体的参与率。
