D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductive Medicine, 3 Mendeleevskaya Line, St. Petersburg, 199034, Russia.
Arch Gynecol Obstet. 2024 Jun;309(6):2643-2651. doi: 10.1007/s00404-023-07187-2. Epub 2023 Aug 18.
The aim of our study was to investigate to what degree clinical characteristics can contribute to incidence and structure of pregnancy and childbirth complications in women with diabetes, and to reveal key risk factors for adverse outcomes.
We conducted a retrospective single-center cohort study from January 2008 through December 2017, including 3069 singleton pregnancies, affected by type 1 diabetes (T1D, n = 498), type 2 diabetes (T2D, n = 214), and gestational diabetes mellitus (GDM, n = 2357).
More than 10 years duration of T1D associated with increased risk for preterm birth (RR 2.03, 95% CI 1.28-3.20) and preeclampsia (RR 1.57, 95% CI 1.09-2.26). Diabetic nephropathy, same as diabetic proliferative retinopathy, was associated with increased risk of C-section, preeclampsia development, SGA delivery. In patients with T1D who received CSII (12%), we do not report superior outcomes compared to MDI. Pre-pregnancy HbA1c level less than 6.5% reduced the risk of preeclampsia for T1D (RR 0.28, 95% CI 0.19-0.67) and risk of LGA birth for T2D (RR 0.43, 95% CI 0.19-0.92). Achieving glycemic target values by full-term pregnancy reduced the risk of excessive fetal adiposity (RR 0.81 for T1D, RR 0.39 for T2D). For T2D and GDM, the leading risk factors were obesity and chronic hypertension. For patients with GDM, insulin administration and early diagnosis of GDM were the significant risk factors for adverse outcomes.
Diabetes during pregnancy is challenging for the clinician, but optimizing glycemic control, treatment regimens, and close attention to comorbidities can help to reduce the risks and ensure appropriate quality diabetes management.
本研究旨在探讨临床特征在多大程度上可导致糖尿病女性妊娠和分娩并发症的发生和结构，并揭示不良结局的关键危险因素。
我们进行了一项回顾性单中心队列研究，纳入了 2008 年 1 月至 2017 年 12 月期间的 3069 例单胎妊娠，包括 498 例 1 型糖尿病（T1D）、214 例 2 型糖尿病（T2D）和 2357 例妊娠期糖尿病（GDM）患者。
T1D 病程超过 10 年与早产（RR 2.03，95%CI 1.28-3.20）和子痫前期（RR 1.57，95%CI 1.09-2.26）的风险增加相关。糖尿病肾病和糖尿病增殖性视网膜病变与剖宫产、子痫前期发展和 SGA 分娩的风险增加相关。在接受胰岛素连续皮下输注（CSII）（12%）的 T1D 患者中，我们未报告 CSII 相较于多次皮下胰岛素注射（MDI）有更好的结局。T1D 患者孕前 HbA1c 水平<6.5%可降低子痫前期风险（RR 0.28，95%CI 0.19-0.67）和 T2D 巨大儿出生风险（RR 0.43，95%CI 0.19-0.92）。T1D 患者实现整个孕期血糖目标值可降低胎儿过度肥胖风险（RR 0.81），T2D 患者可降低胎儿过度肥胖风险（RR 0.39）。对于 T2D 和 GDM，主要危险因素是肥胖和慢性高血压。对于 GDM 患者，胰岛素治疗和 GDM 的早期诊断是不良结局的显著危险因素。
妊娠期间的糖尿病对临床医生具有挑战性，但优化血糖控制、治疗方案和密切关注合并症有助于降低风险并确保适当的高质量糖尿病管理。
