2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
Department of Medical Simulation, Chair of Medical Education, Poznan University of Medical Sciences, Poznan, Poland.
Front Endocrinol (Lausanne). 2023 Jul 28;14:1215407. doi: 10.3389/fendo.2023.1215407. eCollection 2023.
Double diabetes (DDiab) is defined as T1DM coexisting with insulin resistance (IR), metabolic syndrome (MetS), and/or obesity. Little evidence is available regarding how frequent DDiab is among T1DM pregnancies and whether it affects the perinatal outcome in this population.
To explore the prevalence of DDiab in early pregnancy in the cohort of pregnant women with T1DM and to examine the association between an early-pregnancy DDiab status and fetomaternal complications characteristic for T1DM in pregnancy.
A retrospective data analysis of the multicenter cohort of N=495 pregnant women in singleton pregnancy complicated with T1DM followed from early pregnancy until delivery in three tertiary referral centers. DDiab status was defined as T1DM plus pre-pregnancy obesity defined as BMI≥30 kg/m measured at the first antenatal visit (DDiabOb), or T1DM plus pre-pregnancy IR defined as eGDR (estimated Glucose Disposal Rate) below the 25 centile for the cohort measured at the first antenatal visit (DDiabIR). Proportions of the adverse pregnancy outcomes were compared between DDiabOb and Non-DDiabOb and between DDiabIR and Non-DDiabIR patients.
(data presented as mean(SD) or percentage): age: 30.0(5.1) years; age when T1DM diagnosed: 17.5(8.5) years; T1DM duration: 12.0(7,9) years; microvascular complications (White classes R,F,RF): 11.9%, pre-pregnancy counselling: 26.6%, baseline gestational age: 10.5(4.3) weeks, pre-pregnancy BMI: 23.7(4.3) kg/m; chronic hypertension: 9.1%, gestational hypertension (PIH) 10.7%, preeclampsia (PET): 3.2%; nulliparity 53.8%, smoking in pregnancy: 4.8%, eGWG: 22.4%, DDiabOB: 10.1%; DdiabIR: 25.2%; LGA: 44.0%, and NICU admission: 20.8%.
(data from the univariate analysis given as OR(95%CI)): both DDiabOB and DDiabIR status increased the risk for eGWG [23.15 (10.82; 55.59); 3.03 (1.80; 5.08), respectively]. DDiabIR status increased the risk for PET [4.79 (1.68;14.6)], preterm delivery [1.84 (1.13; 3.21)], congenital malformation [2.15 (1.07;4.25)], and NICU hospitalization [2.2 (1.20;4.01)]. Both DDiabOB and DDiabIR accurately ruled out PET (NPV 97.3%/98.3%, accuracy: 88.3%/75.6%, respectively), congenital malformation (NPV 85.6%/88.4%, accuracy: 78.9/69.8, respectively), and perinatal mortality (NPV 98.7%/99.2%, accuracy: 88.8%/74.5%, respectively).
Double diabetes became a frequent complication in T1DM pregnant population. Double diabetes diagnosed in early pregnancy allows for further stratification of the T1DM pregnant population for additional maternal risk.
双糖尿病（DDiab）定义为 1 型糖尿病（T1DM）合并胰岛素抵抗（IR）、代谢综合征（MetS）和/或肥胖。关于 T1DM 妊娠中 DDiab 的频率以及它是否会影响该人群的围产期结局，目前证据有限。
探讨 T1DM 妊娠早期 DDiab 的患病率，并研究早孕期 DDiab 状态与 T1DM 妊娠特征性胎儿-产妇并发症之间的关系。
对三家三级转诊中心的 495 名 T1DM 单胎妊娠孕妇的多中心队列进行回顾性数据分析，从早孕期开始随访至分娩。DDiab 状态定义为 T1DM 合并孕前肥胖（BMI≥30kg/m2，于首次产前检查时测量）（DDiabOb），或 T1DM 合并孕前 IR（定义为首次产前检查时估计葡萄糖处置率（eGDR）低于队列的第 25 百分位数）（DDiabIR）。比较 DDiabOb 和非 DDiabOb 以及 DDiabIR 和非 DDiabIR 患者不良妊娠结局的比例。
研究组特征（数据表示为均值（SD）或百分比）：年龄：30.0（5.1）岁；T1DM 诊断年龄：17.5（8.5）岁；T1DM 病程：12.0（7，9）年；微血管并发症（White 分级 R、F、RF）：11.9%，孕前咨询：26.6%，基线孕龄：10.5（4.3）周，孕前 BMI：23.7（4.3）kg/m2；慢性高血压：9.1%，妊娠期高血压（PIH）10.7%，子痫前期（PET）：3.2%；初产妇 53.8%，孕期吸烟：4.8%，孕期增重（eGWG）：22.4%，DDiabOb：10.1%，DDiabIR：25.2%，巨大儿（LGA）：44.0%，新生儿重症监护病房（NICU）入院：20.8%。
（单变量分析数据给出 OR（95%CI））：DDiabOb 和 DDiabIR 状态均增加了 eGWG 的风险[23.15（10.82；55.59）；3.03（1.80；5.08）]。DDiabIR 状态增加了 PET 的风险[4.79（1.68；14.6）]，早产[1.84（1.13；3.21）]，先天性畸形[2.15（1.07；4.25）]和 NICU 住院[2.2（1.20；4.01）]。DDiabOb 和 DDiabIR 均能准确排除 PET（NPV 97.3%/98.3%，准确度：88.3%/75.6%），先天性畸形（NPV 85.6%/88.4%，准确度：78.9%/69.8%）和围产儿死亡率（NPV 98.7%/99.2%，准确度：88.8%/74.5%）。
双糖尿病已成为 T1DM 妊娠人群的常见并发症。早孕期诊断的 DDiab 允许进一步对 T1DM 妊娠人群进行分层，以增加产妇的风险。
