Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Diabetes Metab Res Rev. 2024 Mar;40(3):e3741. doi: 10.1002/dmrr.3741. Epub 2023 Oct 24.
To explore the relationship between preconception severe hypoglycemia (PSH) and pregnancy outcomes in pregnancies complicated with type 1 diabetes mellitus (T1DM).
In this multicenter prospective cohort study, women with pregestational T1DM were stratified by episodes of severe hypoglycemia within 1 year before conception: No PSH, sporadic PSH (1-6 times/year), and recurrent PSH (>6 times/year). We analysed the predictive ability of PSH for maternal and neonatal outcomes using log-binomial regression models and receiver operating characteristic (ROC) curve.
Of the 124 women studied, 37.1% experienced at least one episode of severe hypoglycemia preconception. In the multiple adjusted regression models, recurrent PSH was significantly associated with increased incidence of preeclampsia (RR 17.59, 95% CI: 2.89-150.62, p for trend = 0.007), preterm birth (RR 6.34, 95% CI: 1.22-40.63, p for trend = 0.027), neonatal hypoglycemia (RR 4.52, 95% CI: 1.14-17.16, p for trend = 0.017), neonatal hyperbilirubinemia (RR 4.12, 95% CI: 1.11-15.56, p for trend = 0.004), and composite neonatal outcome (RR 3.85, 95% CI: 1.01-19.61, p for trend = 0.003). In the ROC analysis, PSH predicted preeclampsia, preterm birth, neonatal hypoglycemia, neonatal hyperbilirubinemia, and composite neonatal outcome with areas under the ROC curve all ≥0.6.
Recurrent preconception severe hypoglycemia is associated with increased risks of adverse outcomes in pregnant women with T1DM.
探讨 1 型糖尿病（T1DM）患者妊娠前严重低血糖（PSH）与妊娠结局的关系。
在这项多中心前瞻性队列研究中，根据妊娠前 1 年内严重低血糖发作情况，将孕前 T1DM 女性分为无 PSH、偶发性 PSH（1-6 次/年）和复发性 PSH（>6 次/年）。我们使用对数二项式回归模型和受试者工作特征（ROC）曲线分析 PSH 对母婴结局的预测能力。
在 124 名研究女性中，37.1%至少发生过一次妊娠前严重低血糖事件。在多因素调整回归模型中，复发性 PSH 与子痫前期（RR 17.59，95%CI：2.89-150.62，趋势检验 p 值=0.007）、早产（RR 6.34，95%CI：1.22-40.63，趋势检验 p 值=0.027）、新生儿低血糖（RR 4.52，95%CI：1.14-17.16，趋势检验 p 值=0.017）、新生儿高胆红素血症（RR 4.12，95%CI：1.11-15.56，趋势检验 p 值=0.004）和复合新生儿结局（RR 3.85，95%CI：1.01-19.61，趋势检验 p 值=0.003）的发生率增加显著相关。在 ROC 分析中，PSH 预测子痫前期、早产、新生儿低血糖、新生儿高胆红素血症和复合新生儿结局的曲线下面积均≥0.6。
复发性妊娠前严重低血糖与 T1DM 孕妇不良结局风险增加相关。
