Gibbons Anthea, Flatley Christopher, Kumar Sailesh
Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia.
Eur J Obstet Gynecol Reprod Biol. 2017 Apr;211:56-61. doi: 10.1016/j.ejogrb.2017.02.001. Epub 2017 Feb 3.
This study aimed to assess the relationship between the cerebro-placental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by pre-existing insulin dependent diabetes (pT1DM) mellitus, pre-existing non-insulin dependent diabetes mellitus (pT2DM) and gestational diabetes mellitus (GDM).
This was a retrospective cohort study of 1281 women with diabetes mellitus birthing at the Mater Mothers' Hospital in Brisbane between 2007 and 2015. The CPR in non-anomalous singleton fetuses was measured between 34+0 and 36+6 weeks gestation and compared between types of DM treatment groups and correlated with intrapartum and perinatal outcomes.
Of the study cohort, 9.7% (124/1281) had pT1DM, 5.3% (68/1281) had pT2DM and 85.0% (1089/1281) had GDM. Of women with pT2DM and GDM, 61.8% (42/68) and 28.9% (315/1089) respectively, required insulin during pregnancy. Women with pT1DM had an increased odds of having a CPR <5th centile (OR 3.73, 95%CI: 1.90-6.96, p=0.0001) or a CPR <10th centile (OR 3.01, 95% CI: 1.80-4.91, p<0.0001) respectively. The odds of a UA PI >90th centile (OR 2.69, 95% CI: 1.60-4.39, p=0.0001) was higher in the pT1DM cohort. There was however no significant difference in the mean MCA PI between the three groups. Stratification by CPR centiles (<10th centile vs. ≥10th centile) demonstrated a lower birth weight in the CPR <10th centile cohort for all DM categories. The proportion of neonates with birth weights <10th centile were higher in the CPR <10th centile cohort with the GDM cohort having an odds ratio of 8.28 (95% CI 4.22-16.13, p<0.0001) of this complication. The CPR <10th centile cohort also had a greater proportion of adverse composite neonatal outcome regardless of type of DM.
Regardless of the type of DM, a low CPR was associated with poorer neonatal outcomes. Women with pT1DM also had the highest mean UA PI and lowest mean CPR despite no difference in the mean MCA PI between the three groups.
本研究旨在评估脑胎盘比率（CPR）与患有孕前胰岛素依赖型糖尿病（pT1DM）、孕前非胰岛素依赖型糖尿病（pT2DM）和妊娠期糖尿病（GDM）的孕妇的产时及围产期结局之间的关系。
这是一项对2007年至2015年间在布里斯班马特母亲医院分娩的1281例糖尿病女性进行的回顾性队列研究。在妊娠34 + 0至36 + 6周之间测量非畸形单胎胎儿的CPR，并在不同类型的糖尿病治疗组之间进行比较，并与产时及围产期结局相关联。
在研究队列中，9.7%（124/1281）患有pT1DM，5.3%（68/1281）患有pT2DM，85.0%（1089/1281）患有GDM。患有pT2DM和GDM的女性中，分别有61.8%（42/68）和28.9%（315/1089）在孕期需要胰岛素治疗。患有pT1DM的女性CPR＜第5百分位数（比值比3.73，95%置信区间：1.90 - 6.96，p = （此处原文有误，应为p = 0.0001））或CPR＜第10百分位数（比值比3.01，95%置信区间：1.80 - 4.91，p＜0.000（此处原文有误，应为p＜0.0001））的几率分别增加。pT1DM队列中脐动脉搏动指数（UA PI）＞第90百分位数（比值比2.69，95%置信区间：1.60 - 4.39，p = 0.0001）的几率更高。然而，三组之间大脑中动脉搏动指数（MCA PI）的平均值没有显著差异。按CPR百分位数分层（＜第10百分位数与≥第10百分位数）显示，所有糖尿病类别中，CPR＜第10百分位数队列的出生体重较低。CPR＜第10百分位数队列中出生体重＜第10百分位数的新生儿比例更高，GDM队列发生这种并发症的比值比为8.28（95%置信区间4.22 - 16.13，p＜0.0001）。无论糖尿病类型如何，CPR＜第10百分位数队列中不良复合新生儿结局的比例也更高。
无论糖尿病类型如何，低CPR与较差的新生儿结局相关。尽管三组之间MCA PI的平均值没有差异，但pT1DM女性的平均UA PI最高，平均CPR最低。
