Clinical Epidemiology Unit (T2), Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
Diabetologia. 2017 Jul;60(7):1244-1251. doi: 10.1007/s00125-017-4279-2. Epub 2017 Apr 13.
AIMS/HYPOTHESIS: We aimed to compare the risks of severe asphyxia-related neonatal complications in the offspring of mothers with type 1 or type 2 diabetes, and to assess the impact of maternal overweight/obesity on these risks.
This was a population-based study of 1,343,751 live-born singleton infants in Sweden between 1997 and 2011, including 5941 and 711 infants of mothers with type 1 and type 2 diabetes, respectively. ORs with 95% CIs were calculated for low Apgar score (0-6) at 5 min after birth, hypoxic ischaemic encephalopathy and neonatal seizures.
The rates of a low Apgar score were 0.9%, 2.6% and 2.1% in the offspring of mothers without diabetes or with type 1 or type 2 diabetes, respectively. After controlling for maternal confounders (including BMI), the risk of a low Apgar score increased in the offspring of mothers with type 1 diabetes (OR 2.67, 95% CI 2.23, 3.20) but not in the offspring of mothers with type 2 diabetes (OR 1.25, 95% CI 0.66, 2.35). The ORs of hypoxic ischaemic encephalopathy or neonatal seizures were increased in the offspring of mothers with type 1 diabetes (OR 3.41, 95% CI 2.58, 4.49) and type 2 diabetes (OR 2.54, 95% CI 1.13, 5.69). Maternal overweight/obesity was a risk factor for asphyxia-related neonatal complications and low Apgar scores in the offspring of mothers with type 1 diabetes and mothers without diabetes.
CONCLUSIONS/INTERPRETATION: The risks of a low Apgar score and severe asphyxia-related neonatal complications are increased in the offspring of mothers with type 1 or type 2 diabetes. Maternal overweight/obesity is an important contributing factor.
目的/假设：我们旨在比较 1 型或 2 型糖尿病母亲所生孩子发生严重窒息相关新生儿并发症的风险，并评估母亲超重/肥胖对这些风险的影响。
这是一项基于人群的研究，共纳入了 1997 年至 2011 年间瑞典 1343751 例活产单胎婴儿，其中 5941 例和 711 例为母亲患有 1 型和 2 型糖尿病的婴儿。计算出生后 5 分钟低 Apgar 评分（0-6）、缺氧缺血性脑病和新生儿癫痫发作的比值比（OR）及其 95%置信区间（CI）。
母亲无糖尿病、1 型或 2 型糖尿病所生孩子的低 Apgar 评分发生率分别为 0.9%、2.6%和 2.1%。在控制了母亲的混杂因素（包括 BMI）后，1 型糖尿病母亲所生孩子发生低 Apgar 评分的风险增加（OR 2.67，95%CI 2.23，3.20），但 2 型糖尿病母亲所生孩子发生低 Apgar 评分的风险无显著增加（OR 1.25，95%CI 0.66，2.35）。1 型和 2 型糖尿病母亲所生孩子发生缺氧缺血性脑病或新生儿癫痫发作的 OR 均增加（OR 3.41，95%CI 2.58，4.49；OR 2.54，95%CI 1.13，5.69）。母亲超重/肥胖是 1 型糖尿病和无糖尿病母亲所生孩子发生窒息相关新生儿并发症和低 Apgar 评分的危险因素。
结论/解释：1 型或 2 型糖尿病母亲所生孩子发生低 Apgar 评分和严重窒息相关新生儿并发症的风险增加。母亲超重/肥胖是一个重要的促成因素。
