Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
BMC Pregnancy Childbirth. 2021 Mar 22;21(1):243. doi: 10.1186/s12884-021-03702-y.
The aim of the study was a retrospective comparison of the differences in maternal-foetal outcomes between women with type 1 and type 2 diabetes mellitus (T1DM and T2DM).
A cohort of 135 patients with pregestational diabetes, 73 with T1DM (mean age 29 ± 5 years) and 62 with T2DM (mean age 33 ± 6 years), in intensive insulin treatment throughout pregnancy were evaluated. Clinical and metabolic parameters and the prevalence of maternal and foetal complications were assessed.
Women with T1DM showed lower pregestational BMI (p < 0.001), pregestational weight (p < 0.001), weight at delivery (p < 0.001), ∆_total_insulin requirement (IR) at the first, second and third trimesters (all p < 0.001) and higher weight gain during pregnancy (p < 0.001), pregestational HbA1c (p = 0.040), HbA1c in the first (p = 0.004), second (p = 0.020) and third (p = 0.010) trimesters compared to T2DM. Women with T1DM had a higher risk of macrosomia (p = 0.005) than T2DM, while women with T2DM showed higher prevalence of abortion (p = 0.037) than T1DM. At multivariate analysis, pregestational BMI and ∆_total_IR of the first trimester were independently associated with abortion in T2DM, while weight gain during pregnancy was independently associated with macrosomia in T1DM.
Women with T1DM have a higher risk of macrosomia than T2DM due to weight gain throughout pregnancy. By contrast, women with T2DM have a higher risk of spontaneous abortion than T1DM, due to pregestational BMI and ∆_total_IR in the first trimester.
本研究旨在回顾性比较 1 型糖尿病（T1DM）和 2 型糖尿病（T2DM）患者母婴结局的差异。
评估了 135 名患有孕前糖尿病的患者，其中 73 名患有 T1DM（平均年龄 29±5 岁），62 名患有 T2DM（平均年龄 33±6 岁），这些患者在整个孕期都接受强化胰岛素治疗。评估了临床和代谢参数以及母婴并发症的发生率。
T1DM 组患者的孕前 BMI（p<0.001）、孕前体重（p<0.001）、分娩体重（p<0.001）、第 1、2 和 3 孕期总胰岛素需求（IR）（均 p<0.001）和孕期体重增加（p<0.001）较低，孕前糖化血红蛋白（HbA1c）（p=0.040）、第 1 孕期（p=0.004）、第 2 孕期（p=0.020）和第 3 孕期（p=0.010）的 HbA1c 较高。与 T2DM 相比，T1DM 患者发生巨大儿的风险更高（p=0.005），而 T2DM 患者流产的发生率更高（p=0.037）。多元分析显示，T2DM 中，孕前 BMI 和第 1 孕期总 IR 是流产的独立危险因素，而 T1DM 中孕期体重增加是巨大儿的独立危险因素。
与 T2DM 相比，T1DM 患者由于整个孕期体重增加，发生巨大儿的风险更高。相比之下，由于孕前 BMI 和第 1 孕期总 IR，T2DM 患者发生自然流产的风险高于 T1DM。
