Cypryk Katarzyna, Bartyzel Lukasz, Zurawska-Klis Monika, Mlynarski Wojciech, Szadkowska Agnieszka, Wilczynski Jan, Nowakowska Dorota, Wozniak Lucyna A, Fendler Wojciech
1 Department of Diabetology and Metabolic Diseases, Medical University of Lodz , Poland .
2 Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz , Poland .
Diabetes Technol Ther. 2015 Sep;17(9):619-24. doi: 10.1089/dia.2014.0255. Epub 2015 Apr 30.
Much evidence has shown that pregnancies in women with preexisting diabetes are affected by an increased risk of maternal and fetal adverse outcomes, probably linked to poor glycemic control. Despite great progress in medical care, the rate of stillbirths remains much higher in diabetes patients than in the general population. Recent technological advances in the field of glucose monitoring and noninvasive fetal heart rate monitoring made it possible to observe the fetal-maternal dependencies in a continuous manner.
Fourteen type 1 diabetes patients were involved into the study and fitted with a blinded continuous glucose monitoring (CGM) recorder. Fetal electrocardiogram data were recorded using the Monica AN24™ device (Monica Healthcare Ltd., Nottingham, United Kingdom), the recordings of which were matched with CGM data. Statistical analysis was performed using a generalized mixed-effect logistic regression to account for individual factors.
The mean number of paired data points per patient was 254±106, representing an observation period of 21.2±8.8 h. Mean glycemia equaled 5.64±0.68 mmol/L, and mean fetal heart rate was 135±6 beats/min. Higher glycemia correlated with fetal heart rate (R=0.32; P<0.0001) and was associated with higher odds of the fetus developing small accelerations (odds ratio=1.05; 95% confidence interval, 1.00-1.10; P=0.04).
Elevated maternal glycemia of mothers with diabetes is associated with accelerations of fetal heart rate.
大量证据表明，患有糖尿病的女性怀孕时，母婴不良结局风险增加，这可能与血糖控制不佳有关。尽管医疗护理取得了巨大进展，但糖尿病患者的死产率仍远高于普通人群。葡萄糖监测和无创胎儿心率监测领域的最新技术进展使得能够持续观察胎儿与母体之间的依存关系。
14例1型糖尿病患者参与本研究，佩戴了盲法连续血糖监测（CGM）记录仪。使用Monica AN24™设备（英国诺丁汉的Monica Healthcare Ltd.）记录胎儿心电图数据，并将记录与CGM数据匹配。采用广义混合效应逻辑回归进行统计分析，以考虑个体因素。
每位患者配对数据点的平均数为254±106，代表观察期为21.2±8.8小时。平均血糖为5.64±0.68 mmol/L，平均胎儿心率为135±6次/分钟。较高的血糖水平与胎儿心率相关（R = 0.32；P < 0.0001），并且与胎儿出现小加速的几率较高有关（优势比 = 1.05；95%置信区间，1.00 - 1.10；P = 0.04）。
糖尿病母亲的母体血糖升高与胎儿心率加速有关。
