Pedersen Berit Woetmann, Ringholm Lene, Damm Peter, Tabor Ann, Søgaard Kirsten, Hellmuth Ellinor, Mathiesen Elisabeth R
a Center for Pregnant Women with Diabetes, University of Copenhagen , Copenhagen , Denmark .
b Department of Obstetrics .
J Matern Fetal Neonatal Med. 2016;29(4):550-3. doi: 10.3109/14767058.2015.1010198. Epub 2015 Feb 6.
To evaluate whether initiation of anti-hypertensive treatment with methyldopa affects fetal hemodynamics in women with pregestational diabetes.
Prospective study of unselected singleton pregnant women with diabetes (seven type 1 and two type 2 diabetes), normal blood pressure and kidney function at pregnancy booking. Methyldopa treatment was initiated at blood pressure >135/85 mmHg and/or urinary albumin excretion (UAE) >300 mg/g creatinine. Pulsatility indices (PI) of the uterine, umbilical, middle cerebral arteries before and 1 week after initiation of methyldopa treatment (250 mg three times daily) was performed and the cerebro-placental ratio (CPR) was calculated.
Methyldopa treatment was initiated at median 249 (range 192-260) gestational days, mainly due to gestational hypertension (n = 7). Blood pressure declined from 142 (112-156)/92 (76-103) mmHg before to 129 (108-144)/82 (75-90) mmHg after initiation of methyldopa treatment (p = 0.11 and 0.04 for systolic and diastolic blood pressure, respectively). There were no significant changes in the umbilical artery PI (0.82 (0.72-1.40) versus 0.87 (0.64-0.95), p = 0.62) or CPR (1.94 (0.96-2.33) versus 1.78 (1.44-2.76), (p = 0.73). Gestational age was 265 (240-270) d. Apgar scores were normal.
Stable Doppler flow velocity waveforms were documented after initiation of methyldopa treatment for pregnancy-induced hypertensive disorders in this cohort of pregnant women with pregestational diabetes.
评估甲基多巴起始抗高血压治疗对孕前糖尿病女性胎儿血流动力学的影响。
对妊娠登记时血压和肾功能正常的未选择的单胎糖尿病孕妇（7例1型糖尿病和2例2型糖尿病）进行前瞻性研究。当血压>135/85 mmHg和/或尿白蛋白排泄率（UAE）>300 mg/g肌酐时开始甲基多巴治疗。在开始甲基多巴治疗（每日3次，每次250 mg）前及治疗1周后测量子宫动脉、脐动脉、大脑中动脉的搏动指数（PI），并计算脑胎盘比率（CPR）。
甲基多巴治疗始于妊娠中位数249（范围192 - 260）天，主要原因是妊娠期高血压（n = 7）。甲基多巴治疗开始前收缩压为142（112 - 156）/舒张压为92（76 - 103）mmHg，治疗后收缩压降至129（108 - 144）/舒张压降至82（75 - 90）mmHg（收缩压和舒张压p值分别为0.11和0.04）。脐动脉PI无显著变化（0.82（0.72 - 1.40）对0.87（0.64 - 0.95），p = 0.62），CPR也无显著变化（1.94（0.96 - 2.33）对1.78（1.44 - 2.76），p = 0.73）。孕周为265（240 - 270）天。阿氏评分正常。
在这组孕前糖尿病孕妇中，甲基多巴治疗妊娠高血压疾病后记录到稳定的多普勒流速波形。
