Graduation Program in Medicine, Universidade Federal de São Paulo, Rua Botucatu, n° 740, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil.
Department of Medicine, Discipline of Endocrinology, Universidade Federal de São Paulo, Rua Sena Madureira, n° 1500, Vila Clementino, São Paulo, SP, CEP 04021-001, Brazil.
Arch Gynecol Obstet. 2023 Oct;308(4):1229-1238. doi: 10.1007/s00404-022-06806-8. Epub 2022 Oct 11.
To assess the intention of actual pregnancy and its influence on glycated hemoglobin (HbA1c) profile before and during the pregnancy of women with previous diabetes mellitus (DM).
Prospective cohort study included pregnant women with previous DM assisted from October/2018 to October/2019. Data were collected with standardized questionnaire and from medical records. Comparisons of variables of interest (Student's t test, Mann-Whitney or chi-square test) were performed between the group of women who did or denied report having interest to become pregnant. And a logistic regression analysis were performed considering prematurity or fetal/neonatal complication as dependent variables.
Sixty patients were included, with HbA1c mean of pre-pregnancy, first and third trimesters of 9.3, 8.1 and 6.8%, respectively. 7.7% women had HbA1c ≤ 6.5% in pre-pregnancy and 16.7% in first trimester. 83.3% reported having received guidance on the importance of glucose control and contraception before their current pregnancy. Although 28.3% reported the intention to become pregnant, only 28.3% reported regular use of any contraceptive method before it, none of which had HbA1c in the recommended goal for pregnancy. Glycemic control did not differ between groups intending or not to become pregnant. Women with adequate glycemic control in first trimester had a lower frequency of prematurity (p = 0.015) and fetal complications (p = 0.001), and better control at the end of pregnancy.
Although most of these women reported having had information about the importance of a planned pregnancy, adequate glycemic control of women with diabetes before and during the pregnancy is still not a reality nowadays. It might be necessary to improve medical communication in pregnancy planning.
评估既往患有糖尿病（DM）的女性在妊娠前和妊娠期间的实际妊娠意愿及其对糖化血红蛋白（HbA1c）谱的影响。
前瞻性队列研究纳入了 2018 年 10 月至 2019 年 10 月期间接受辅助治疗的既往 DM 妊娠妇女。通过标准化问卷和病历收集数据。对有（或否认）妊娠意愿的两组女性的感兴趣变量（Student's t 检验、Mann-Whitney 检验或卡方检验）进行比较。并考虑早产或胎儿/新生儿并发症作为因变量进行逻辑回归分析。
共纳入 60 例患者，妊娠前、妊娠第 1 个月和第 3 个月的 HbA1c 均值分别为 9.3%、8.1%和 6.8%。7.7%的患者妊娠前 HbA1c≤6.5%，妊娠第 1 个月时为 16.7%。83.3%的患者报告在当前妊娠前接受过关于血糖控制和避孕重要性的指导。尽管 28.3%的患者报告有妊娠意愿，但只有 28.3%的患者在这之前报告使用过任何避孕方法，且她们的 HbA1c 均未达到妊娠推荐目标。有或无妊娠意愿的两组患者血糖控制情况无差异。妊娠第 1 个月血糖控制良好的女性早产率较低（p=0.015）、胎儿并发症发生率较低（p=0.001），且妊娠末期血糖控制更好。
尽管这些女性大多数都报告说已经了解了计划妊娠的重要性，但糖尿病女性在妊娠前和妊娠期间血糖的充分控制目前仍未实现。可能需要改进妊娠计划中的医疗沟通。
