Mills J L, Simpson J L, Driscoll S G, Jovanovic-Peterson L, Van Allen M, Aarons J H, Metzger B, Bieber F R, Knopp R H, Holmes L B
National Institute of Child Health and Human Development, Bethesda, MD 20892.
N Engl J Med. 1988 Dec 22;319(25):1617-23. doi: 10.1056/NEJM198812223192501.
Whether pregnant women with insulin-dependent diabetes mellitus have an increased risk of spontaneous abortion is controversial. To address this question, we enrolled 386 women with insulin-dependent diabetes and 432 women without diabetes before or within 21 days after conception and followed both groups prospectively. Sixty-two diabetic women (16.1 percent) and 70 control women (16.2 percent) had pregnancy losses (odds ratio, 0.99; 95 percent confidence interval, 0.67 to 1.46). After adjustment for known risk factors for spontaneous abortion, the rate was still not significantly higher in the diabetic group (odds ratio, 0.91; 95 percent confidence interval, 0.59 to 1.40). Nonetheless, among the diabetic women, most of whom had good metabolic control, those who had spontaneous abortions had higher fasting and postprandial glucose levels in the first trimester than those whose pregnancies continued to delivery (P = 0.01 for fasting glucose levels and P = 0.005 for postprandial levels). In the small subgroup of diabetic women with poor control, who had elevated values for glycosylated hemoglobin in the first trimester, each increase of 1 SD above the normal range was associated with an increase of 3.1 percent in the rate of pregnancy loss (95 percent confidence interval, 0.6 to 5.6). We conclude that diabetic women with good metabolic control are no more likely than nondiabetic women to lose a pregnancy, but that diabetic women with elevated blood glucose and glycosylated hemoglobin levels in the first trimester have a significantly increased risk of having a spontaneous abortion.
胰岛素依赖型糖尿病孕妇自然流产风险是否增加存在争议。为解决这一问题，我们纳入了386例胰岛素依赖型糖尿病女性和432例在受孕前或受孕后21天内未患糖尿病的女性，并对两组进行前瞻性随访。62例糖尿病女性（16.1%）和70例对照女性（16.2%）发生了妊娠丢失（比值比，0.99；95%置信区间，0.67至1.46）。在对已知的自然流产风险因素进行调整后，糖尿病组的发生率仍未显著升高（比值比，0.91；95%置信区间，0.59至1.40）。然而，在大多数代谢控制良好的糖尿病女性中，发生自然流产的女性在孕早期的空腹和餐后血糖水平高于妊娠持续至分娩的女性（空腹血糖水平P = 0.01，餐后血糖水平P = 0.005）。在孕早期糖化血红蛋白值升高的控制不佳的糖尿病女性小亚组中，每高于正常范围1个标准差，妊娠丢失率就增加3.1%（95%置信区间，0.6至5.6）。我们得出结论，代谢控制良好的糖尿病女性与非糖尿病女性相比，妊娠丢失的可能性并不更高，但孕早期血糖和糖化血红蛋白水平升高的糖尿病女性自然流产的风险显著增加。
