Ali Dalal S, Davern Recie, Rutter Eimear, Coveney Ciara, Devine Hilary, Walsh Jennifer M, Higgins Mary, Hatunic Mensud
Endocrinology Department, Mater Misericordiae University Hospital, Dublin, Ireland.
The National Maternity Hospital, Holles Street, Dublin, Ireland.
Diabetes Ther. 2020 Dec;11(12):2873-2885. doi: 10.1007/s13300-020-00932-9. Epub 2020 Oct 3.
Pre-gestational, type 1 and type 2 diabetes are associated with adverse neonatal outcomes and increased rates of emergency caesarean sections.
We studied pregnancy outcomes associated with pre-gestational diabetes in 174 women who attended the National Maternity Hospital in Dublin, Ireland, between 2015 and 2017.
Fifty women (28.6%) had type 2 diabetes mellitus, and 124 women (71.4%) had type 1 diabetes mellitus. Women with type 2 diabetes mellitus were older (36 vs. 34 years, p 0.02) and had a higher BMI (32.6 vs. 26.2 kg/m, p 0.00). Duration of diabetes mellitus in type 1 and type 2 was 15.7 and 5.7 years, respectively, and mean HbA1c in type 2 diabetes mellitus at booking was 44.5 mmol/mol (6.2%) and in type 1 diabetes mellitus was 56.3 mmol/mol (7.3%). Forty women (32%) with type 1 diabetes mellitus used continuous subcutaneous insulin infusion. In our cohort, 45.4% had a caesarean delivery. Offspring of patients with multiple dose injections were lighter (3.58 kg) than infants of continuous subcutaneous insulin infusion-treated patients (3.75 kg). More emergency caesarean sections were observed in the continuous subcutaneous insulin infusion group than in the group treated with multiple dose injections (37.5% vs. 28.5%), while the elective caesarean section rate was higher in the multiple dose injection group (17.8% vs. 12.5%). Women treated with continuous subcutaneous insulin infusion had a higher rate of miscarriage (25% vs. 19%) with more congenital malformations (10% vs. 2.3%).
Women in our study with pre-gestational diabetes were overweight, were older and had long-standing diabetes mellitus. Our patients with type 2 diabetes had a higher BMI, were older, had a shorter duration of diabetes mellitus and had better diabetes control compared to women with type 1 diabetes. Women treated with continuous subcutaneous insulin infusion had a higher rate of miscarriage with more congenital malformations. The initial inadequate diabetes control was significantly improved during pregnancy.
孕前1型和2型糖尿病与不良新生儿结局及急诊剖宫产率增加有关。
我们研究了2015年至2017年间在爱尔兰都柏林国家妇产医院就诊的174例孕前糖尿病患者的妊娠结局。
50例（28.6%）为2型糖尿病患者，124例（71.4%）为1型糖尿病患者。2型糖尿病患者年龄较大（36岁对34岁，p<0.02），体重指数较高（32.6对26.2kg/m²，p<0.00）。1型和2型糖尿病的病程分别为15.7年和5.7年，2型糖尿病患者孕早期糖化血红蛋白（HbA1c）均值为44.5mmol/mol（6.2%），1型糖尿病患者为56.3mmol/mol（7.3%）。1型糖尿病患者中有40例（32%）使用持续皮下胰岛素输注。在我们的队列中，45.4%进行了剖宫产。多次注射胰岛素患者的后代体重较轻（3.58kg），低于持续皮下胰岛素输注治疗患者的婴儿（3.75kg）。持续皮下胰岛素输注组的急诊剖宫产率高于多次注射胰岛素组（37.5%对28.5%），而择期剖宫产率在多次注射胰岛素组较高（17.8%对12.5%）。接受持续皮下胰岛素输注治疗的女性流产率较高（25%对19%），先天性畸形更多（10%对2.3%）。
我们研究中的孕前糖尿病女性超重、年龄较大且患有长期糖尿病。与1型糖尿病女性相比，我们的2型糖尿病患者体重指数更高、年龄更大、糖尿病病程更短且血糖控制更好。接受持续皮下胰岛素输注治疗的女性流产率更高，先天性畸形更多。孕期糖尿病最初控制不佳的情况有显著改善。
