抗高血压治疗对患有糖尿病的孕妇胎儿生长及血流动力学的影响——一项探索性研究。

The impact of anti-hypertensive treatment on foetal growth and haemodynamics in pregnant women with pre-existing diabetes - An explorative study.

作者信息

Vestgaard Marianne, Al-Saudi Elaf, Ásbjörnsdóttir Björg, Nørgaard Lone N, Pedersen Berit Woetman, Ekelund Charlotte Kvist, Ringholm Lene, Andersen Lise Lotte T, Jensen Dorte M, Tabor Ann, Damm Peter, Mathiesen Elisabeth R

机构信息

Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

出版信息

Diabet Med. 2022 Apr;39(4):e14722. doi: 10.1111/dme.14722. Epub 2021 Oct 30.

DOI:10.1111/dme.14722

PMID:34653280

Abstract

OBJECTIVES

To explore the impact of anti-hypertensive treatment of pregnancy-induced hypertension on foetal growth and hemodynamics in women with pre-existing diabetes.

METHODS

A prospective cohort study of 247 consecutive pregnant women with pre-existing diabetes (152 type 1 diabetes; 95 type 2 diabetes), where tight anti-hypertensive treatment was initiated and intensified (mainly with methyldopa) when office blood pressure (BP) ≥135/85 mmHg and home BP ≥130/80 mmHg. Foetal growth was assessed by ultrasound at 27, 33 and 36 weeks and foetal hemodynamics were assessed by ultrasound Doppler before and 1-2 weeks after initiation of anti-hypertensive treatment.

RESULTS

In 215 initially normotensive women, anti-hypertensive treatment for pregnancy-induced hypertensive disorders was initiated in 42 (20%), whilst 173 were left untreated. Chronic hypertension was present in 32 (13%). Anti-hypertensive treatment for pregnancy-induced hypertensive disorders was not associated with foetal growth deviation (linear mixed model, p = 0.681). At 27 weeks, mainly before initiation of anti-hypertensive treatment, the prevalence of small foetuses with an estimated foetal weight <10th percentile was 12% in women initiating anti-hypertensive treatment compared with 4% in untreated women (p = 0.054). These numbers were close to the prevalence of birth weight ≤10th percentile (small for gestational age (SGA)) (17% vs. 4%, p = 0.003). Pulsatility index in the umbilical and middle cerebral artery remained stable after the onset of anti-hypertensive treatment in a representative subgroup (n = 12, p = 0.941 and p = 0.799, respectively).

CONCLUSION

There is no clear indication that antihypertensive treatment causes harm in this particular at-high-risk group of pregnant women with diabetes, such that a larger well-designed study to determine the value of tight antihypertensive control would be worthwhile.

摘要

目的

探讨妊娠高血压疾病的降压治疗对患有糖尿病的孕妇胎儿生长及血流动力学的影响。

方法

对247例患有糖尿病的连续孕妇进行前瞻性队列研究（152例1型糖尿病；95例2型糖尿病），当诊室血压（BP）≥135/85 mmHg且家庭血压≥130/80 mmHg时，启动并强化严格的降压治疗（主要使用甲基多巴）。在孕27、33和36周时通过超声评估胎儿生长情况，并在开始降压治疗前及治疗后1 - 2周通过超声多普勒评估胎儿血流动力学。

结果

在215例最初血压正常的女性中，42例（20%）因妊娠高血压疾病接受了降压治疗，173例未接受治疗。32例（13%）存在慢性高血压。妊娠高血压疾病的降压治疗与胎儿生长偏差无关（线性混合模型，p = 0.681）。在孕27周时，主要是在开始降压治疗之前，接受降压治疗的女性中估计胎儿体重低于第10百分位数的小胎儿患病率为12%，未治疗女性为4%（p = 0.054）。这些数字接近出生体重≤第10百分位数（小于胎龄（SGA））的患病率（17%对4%，p = 0.003）。在一个代表性亚组（n = 12）中，降压治疗开始后脐动脉和大脑中动脉的搏动指数保持稳定（分别为p = 0.941和p = 0.799）。