Goldman J A, Dicker D, Feldberg D, Yeshaya A, Samuel N, Karp M
Am J Obstet Gynecol. 1986 Aug;155(2):293-7. doi: 10.1016/0002-9378(86)90812-4.
Forty-four of 75 pregnant women with juvenile-onset insulin-dependent diabetes, who attended a preconceptional clinic, were seen regularly by a diabetologic team. Glycemic control was obtained by intensified insulin therapy and monitored by blood glucose self-monitoring. When these patients were compared with a group of 31 nonattenders of the preconceptional clinic, in the former normoglycemia and normal hemoglobin A1 values were achieved before conception, whereas in the latter good control was reached by the second trimester. This group had also more maternal complications, such as preeclampsia, and higher cesarean section rates. Congenital anomalies were 9.6% among offspring of nonattenders, while none occurred in those with preconceptional counseling. We confirm the evidence accumulated in the recent literature that congenital malformations in pregnancy complicated by diabetes may be linked to disturbances in maternal metabolism during the period of embryogenesis. Consequently we concur with the recommendation that tight diabetic control is required before the patient attempts to conceive.
75名患有青少年期胰岛素依赖型糖尿病的孕妇前往孕前诊所就诊，其中44人由糖尿病治疗团队定期诊治。通过强化胰岛素治疗实现血糖控制，并通过自我血糖监测进行监测。将这些患者与31名未前往孕前诊所就诊的患者进行比较，结果发现，前者在受孕前实现了血糖正常和糖化血红蛋白A1值正常，而后者在孕中期才实现良好控制。该组孕妇还出现了更多的母体并发症，如先兆子痫，剖宫产率也更高。未就诊者的后代先天性异常发生率为9.6%，而接受孕前咨询者的后代未出现先天性异常。我们证实了近期文献中积累的证据，即糖尿病合并妊娠时的先天性畸形可能与胚胎发育期间母体代谢紊乱有关。因此，我们赞同在患者尝试受孕前需要严格控制糖尿病的建议。
