1988 - 2011年间1型糖尿病合并糖尿病肾病患者的产科及围产期结局
Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988-2011.
作者信息
Klemetti Miira M, Laivuori Hannele, Tikkanen Minna, Nuutila Mika, Hiilesmaa Vilho, Teramo Kari
机构信息
Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, P.O. Box 140, Haartmaninkatu 2, 00029, Helsinki, Finland,
出版信息
Diabetologia. 2015 Apr;58(4):678-86. doi: 10.1007/s00125-014-3488-1. Epub 2015 Jan 10.
AIMS/HYPOTHESIS: Our aim was to analyse possible changes in the glycaemic control, BP, markers of renal function, and obstetric and perinatal outcomes of parturients with diabetic nephropathy during 1988-2011.
METHODS
The most recent childbirth of 108 consecutive type 1 diabetes patients with diabetic nephropathy and a singleton pregnancy were studied. Two periods, 1988-1999 and 2000-2011, were compared.
RESULTS
The prepregnancy and the first trimester median HbA1c values persisted at high levels (8.2% [66 mmol/mol] vs 8.5% [69 mmol/mol], p = 0.16 and 8.3% [67 mmol/mol] vs 8.4% [68 mmol/mol], p = 0.67, respectively), but decreased by mid-pregnancy (6.7% [50 mmol/mol] vs 6.9% [52 mmol/mol], p = 0.11). Antihypertensive medication usage increased before pregnancy (34% vs 65%, p = 0.002) and in the second and third trimesters of pregnancy (25% vs 47%, p = 0.02, and 36% vs 60%, p = 0.01, respectively). BP exceeded 130/80 mmHg in 62% and 61% (p = 0.87) of patients in the first trimester, and in 95% and 93% (p = 0.69) in the third trimester, respectively. No changes were observed in the markers of renal function. Pre-eclampsia (52% vs 42%, p = 0.29) and preterm birth rates before 32 and 37 gestational weeks (14% vs 21%, p = 0.33, and 71% vs 77%, p = 0.49, respectively) remained high. The elective and emergency Caesarean section rates were 71% and 45% (p = 0.01) and 29% and 48% (p = 0.05), respectively. Neonatal intensive care unit admissions increased from 26% to 49% (p = 0.02).
CONCLUSIONS/INTERPRETATION: Early pregnancy glycaemic control and hypertension management were suboptimal in both time periods. Pre-eclampsia and preterm delivery rates remained high in patients with diabetic nephropathy.
目的/假设：我们的目的是分析1988 - 2011年间糖尿病肾病产妇的血糖控制、血压、肾功能指标以及产科和围产期结局的可能变化。
方法
对108例连续的1型糖尿病合并糖尿病肾病且单胎妊娠的产妇的最近一次分娩情况进行研究。比较了两个时间段，即1988 - 1999年和2000 - 2011年。
结果
孕前和孕早期的糖化血红蛋白（HbA1c）中位数持续处于高水平（分别为8.2%[66 mmol/mol]对8.5%[69 mmol/mol]，p = 0.16；8.3%[67 mmol/mol]对8.4%[68 mmol/mol]，p = 0.67），但到孕中期有所下降（6.7%[50 mmol/mol]对6.9%[52 mmol/mol]，p = 0.11）。孕前（34%对65%，p = 0.002）以及孕中期和孕晚期（分别为25%对47%，p = 0.02；36%对60%，p = 0.01）使用降压药物的比例增加。孕早期分别有62%和61%（p = 0.87）的患者血压超过130/80 mmHg，孕晚期分别为95%和93%（p = 0.69）。肾功能指标未观察到变化。子痫前期（52%对42%，p = 0.29）以及孕32周和37周前的早产率（分别为14%对21%，p = 0.33；71%对77%，p = 0.49）仍然很高。择期和急诊剖宫产率分别为71%和45%（p = 0.01）以及29%和48%（p = 0.05）。新生儿重症监护病房收治率从26%增至49%（p = 0.02）。
结论/解读：两个时间段的孕早期血糖控制和高血压管理均未达到最佳状态。糖尿病肾病患者的子痫前期和早产率仍然很高。
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