Port-Royal maternity unit, DHU risks in pregnancy, Paris Descartes university, Cochin hospital, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
Port-Royal maternity unit, DHU risks in pregnancy, Paris Descartes university, Cochin hospital, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Inserm UMR 1153, obstetrical, perinatal and pediatric epidemiology research team (EPOPe), centre for epidemiology and statistics Sorbonne Paris Cité (CRESS), 75014 Paris, France.
Diabetes Metab. 2019 Apr;45(2):191-196. doi: 10.1016/j.diabet.2018.04.007. Epub 2018 May 8.
This study assessed pregnancy outcomes in women with type 1 diabetes (T1D) over the last 15 years and identified modifiable factors associated with good perinatal outcomes.
Pregnancy outcomes were prospectively assessed in this cohort study of 588 singleton pregnancies (441 women) managed by standardized care from 2000 to 2014. A good perinatal outcome was defined as the uncomplicated delivery of a normally formed, non-macrosomic, full-term infant with no neonatal morbidity. Factors associated with good perinatal outcomes were identified by logistic regression.
The rate of severe congenital malformations was 1.5%, and 0.7% for perinatal mortality. The most frequent perinatal complications were macrosomia (41%), preterm delivery (16%) and neonatal hypoglycaemia (11%). Shoulder dystocia occurred in 2.6% of cases, but without sequelae. Perinatal outcomes were good in 254 (44%) pregnancies, and were associated with lower maternal HbA values at delivery [adjusted odds ratio (aOR): 2.78, 95% CI: 2.04-3.70, for each 1% (11mmol/mol) absolute decrease], lower gestational weight gains (aOR: 1.06, 95% CI: 1.02-1.10) and absence of preeclampsia (aOR: 2.63, 95% CI: 1.09-6.25). The relationship between HbA at delivery and a good perinatal outcome was continuous, with no discrimination threshold.
In our study, rates of severe congenital malformations and perinatal mortality were similar to those of the general population. Less severe complications, mainly macrosomia and late preterm delivery, persisted. Also, our study identified modifiable risk factors that could be targeted to further improve the prognosis of pregnancy in T1D.
本研究评估了过去 15 年中 1 型糖尿病（T1D）女性的妊娠结局，并确定了与良好围产期结局相关的可改变因素。
本队列研究前瞻性评估了 2000 年至 2014 年期间接受标准化治疗的 588 例单胎妊娠（441 例女性）的妊娠结局。良好围产期结局定义为无新生儿并发症的正常形成、非巨大儿、足月分娩的正常婴儿。通过逻辑回归确定与良好围产期结局相关的因素。
严重先天性畸形的发生率为 1.5%，围产期死亡率为 0.7%。最常见的围产期并发症为巨大儿（41%）、早产（16%）和新生儿低血糖（11%）。肩难产发生率为 2.6%，但无后遗症。254 例（44%）妊娠围产期结局良好，与分娩时母亲 HbA 值较低相关[校正优势比（aOR）：2.78，95%置信区间（CI）：2.04-3.70，每降低 1%（11mmol/mol）绝对值]、较低的孕期体重增加（aOR：1.06，95%CI：1.02-1.10）和无子痫前期（aOR：2.63，95%CI：1.09-6.25）。分娩时 HbA 值与良好围产期结局的关系是连续的，没有判别阈值。
在我们的研究中，严重先天性畸形和围产期死亡率的发生率与一般人群相似。较轻的并发症，主要是巨大儿和晚期早产，仍然存在。此外，我们的研究确定了可改变的危险因素，可进一步改善 T1D 孕妇的预后。
