Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3B 3P4, Canada.
Curr Diabetes Rev. 2023;19(2):e010222200742. doi: 10.2174/1573399818666220201111200.
There is an increasing awareness that in those who develop early-onset (18-39 years) adult type 2 diabetes, an increase in insulin resistance, deterioration in beta-cell, and clustering of cardiovascular risk factors are particularly pronounced. Pregnant women with type 2 diabetes have additional risk factors for serious adverse pregnancy outcomes as well as added barriers regarding healthcare access before, during, and after pregnancy. Compared to pregnant women with type 1 diabetes, those with type 2 diabetes are older, have higher body mass index (BMI), with more metabolic comorbidities and concomitant medications, are more likely to belong to minority ethnic groups, and live in the highest areas of socio-economic deprivation. Approximately, one in seven pregnant women with type 2 diabetes (median age 34 years) are taking ACE-inhibitors, statins (13%), and/or other potentially harmful diabetes therapies (7%). Fewer than one in four are taking a high dose of folic acid before pregnancy, which may suggest that planning for pregnancy is not a priority for women themselves, their healthcare professionals, or the healthcare system. Knowledge of the epidemiology, pathophysiology, and unique management considerations of early-onset type 2 diabetes is essential to providing evidence-based care to pregnant women with type 2 diabetes. This narrative review will discuss contemporary data regarding type 2 diabetes pregnancy outcomes and the increasing recognition that different types of diabetes may require different treatment strategies before, during, and after pregnancy.
人们越来越意识到，在那些患有早发性（18-39 岁）成人 2 型糖尿病的人群中，胰岛素抵抗增加、β细胞功能恶化和心血管危险因素聚集的情况尤为明显。患有 2 型糖尿病的孕妇除了存在严重不良妊娠结局的额外风险因素外，在妊娠前、妊娠期间和妊娠后获得医疗保健的机会也受到更多限制。与 1 型糖尿病孕妇相比，2 型糖尿病孕妇年龄更大、体重指数（BMI）更高，合并更多代谢合并症和伴随用药，更有可能属于少数族裔，生活在社会经济剥夺程度最高的地区。大约每 7 名患有 2 型糖尿病的孕妇（中位数年龄 34 岁）中有 1 人正在服用 ACE 抑制剂、他汀类药物（13%）和/或其他潜在有害的糖尿病治疗药物（7%）。不到四分之一的人在妊娠前服用高剂量叶酸，这可能表明，对于女性自身、其医疗保健专业人员或医疗保健系统而言，计划妊娠并不是优先事项。了解早发性 2 型糖尿病的流行病学、病理生理学和独特的管理注意事项，对于为患有 2 型糖尿病的孕妇提供循证护理至关重要。本叙述性综述将讨论有关 2 型糖尿病妊娠结局的当代数据，并日益认识到不同类型的糖尿病可能需要在妊娠前、妊娠期间和妊娠后采用不同的治疗策略。
