1 Barbara Davis Center for Diabetes , Aurora, Colorado.
2 Jaeb Center for Health Research , Tampa, Florida.
Diabetes Technol Ther. 2018 Aug;20(8):517-523. doi: 10.1089/dia.2018.0033. Epub 2018 Jul 10.
Gestational tight glycemic control is critical for women with type 1 diabetes (T1D). Limited data exist on the adoption and retention of diabetes technologies among women in different parity strata.
We compared T1D management between T1D Exchange clinic registry participants (mean age 28 ± 9 years, 84% white non-Hispanic, and median T1D duration 13 years) who were pregnant at enrollment or year 1 follow-up ("recently pregnant" between 2010 and 2013, n = 214), ever (but not recently) pregnant (n = 1540), and never pregnant (n = 2586). We examined self-reported maternal and fetal outcomes in 130 women who delivered a baby within the last year.
Recently pregnant women had the lowest hemoglobin A1c (6.5% pregnant vs. 7.8% ever pregnant vs. 8.0% never pregnant, P < 0.001). Recently pregnant women reported the highest use of continuous subcutaneous insulin infusion (74% vs. 60% vs. 58%, adjusted P < 0.001) and continuous glucose monitor (CGM) (36% vs.17% vs. 12%, adjusted P < 0.001) therapies compared with ever or never pregnant women, respectively, after adjusting for age, diabetes duration, and socioeconomic status. Among women 18-25 years old, CGM use was highest among recently pregnant women (adjusted P = 0.0022). Never pregnant women 26-45 years old had a higher use of CGM compared with younger counterparts (adjusted P < 0.001). Adverse maternal and fetal outcomes were common.
Despite high uptake levels of advanced diabetes technologies among pregnant women, rates of adverse maternal and fetal outcomes remain high. More studies are needed to determine how these technologies could be best used in pregnancy and postpartum to improve health outcomes among women with T1D.
对于 1 型糖尿病（T1D）女性患者，妊娠期严格控制血糖至关重要。关于不同生育阶段女性采用和坚持使用糖尿病技术的数据有限。
我们比较了 T1D 交换诊所注册参与者的 T1D 管理情况，这些参与者在入组或第 1 年随访时怀孕（2010 年至 2013 年期间“最近怀孕”，n=214）、曾怀孕（n=1540）和从未怀孕（n=2586）。我们检查了最近一年内分娩的 130 名女性的母婴结局。
最近怀孕的女性糖化血红蛋白（HbA1c）最低（6.5%，怀孕 vs. 7.8%，曾怀孕 vs. 8.0%，从未怀孕，P<0.001）。与曾怀孕或从未怀孕的女性相比，最近怀孕的女性报告使用连续皮下胰岛素输注（74% vs. 60% vs. 58%，调整 P<0.001）和连续血糖监测（CGM）（36% vs. 17% vs. 12%，调整 P<0.001）的比例更高，调整因素包括年龄、糖尿病病程和社会经济地位。在 18-25 岁的女性中，最近怀孕的女性 CGM 使用比例最高（调整 P=0.0022）。26-45 岁从未怀孕的女性与年轻女性相比，CGM 使用率更高（调整 P<0.001）。不良母婴结局较为常见。
尽管妊娠期采用先进糖尿病技术的比例较高，但不良母婴结局的发生率仍然很高。需要进一步研究如何在妊娠期和产后更好地使用这些技术，以改善 T1D 女性的健康结局。
