Department of Endocrinology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
Gynecol Endocrinol. 2020 Oct;36(10):879-884. doi: 10.1080/09513590.2020.1727432. Epub 2020 Feb 19.
The aim of this study was to explore the risk of perinatal outcomes in pre-gestational type 1 diabetes mellitus (T1DM) compared to gestational diabetes mellitus (GDM) and pregnancy without diabetes and to examine the association of glycemic level of third-trimester gestation with perinatal outcomes in T1DM. We included 69 pre-gestational T1DM, 1398 cases of GDM, and 1304 control pregnancies and collected data regarding demographics, obstetric, and perinatal outcomes from the hospital discharge database. Relative to the pregnancies without diabetes, women with T1DM encountered increasing risk of polyhydramnios, preterm delivery, and cesarean section. These adverse outcomes were also common in GDM, although with relatively lower adjusted ORs. The weights of babies delivered by women with T1DM were more intend to be large for gestational age, as well as to be less than 2.5 kg relative to those without diabetes. Poorly controlled hemoglobin A1c in late pregnancy was significantly associated with an increased risk of preterm birth in T1DM (adjusted odds ratio 2.01, 95%confidence interval 1.1-3.6). Women with T1DM have considerably increased risks of adverse perinatal outcomes, which appear more prevalent than the perinatal outcomes in women with GDM. Thus, a specific routine is required for pregnancy in T1DM to improve the glycemic control and obstetric care.
本研究旨在探讨与妊娠期糖尿病（GDM）和无糖尿病妊娠相比，孕前 1 型糖尿病（T1DM）患者围产期结局的风险，并研究 T1DM 患者孕晚期血糖水平与围产期结局的关系。我们纳入了 69 例孕前 T1DM、1398 例 GDM 和 1304 例对照妊娠病例，并从医院出院数据库中收集了人口统计学、产科和围产期结局的数据。与无糖尿病妊娠相比，T1DM 患者发生羊水过多、早产和剖宫产的风险增加。这些不良结局在 GDM 中也很常见，尽管调整后的 OR 相对较低。与无糖尿病妊娠相比，T1DM 患者分娩的婴儿体重更倾向于大于胎龄，也更倾向于小于 2.5kg。孕晚期糖化血红蛋白控制不佳与 T1DM 早产风险增加显著相关（调整后的优势比 2.01，95%置信区间 1.1-3.6）。T1DM 患者的围产期不良结局风险显著增加，似乎比 GDM 患者的围产期不良结局更为普遍。因此，需要针对 T1DM 妊娠制定特定的常规方案，以改善血糖控制和产科护理。
