妊娠合并显性和孕前2型糖尿病的先天性异常：来自巴西一个队列的灰色描述。

Congenital anomalies in pregnancies with overt and pregestational type 2 diabetes: a gray portrayal from a cohort in Brazil.

作者信息

Campos Maria Amélia A, Oppermann Maria Lúcia R, Sanseverino Maria Teresa V, Guerra Giulia L, Hirakata Vânia N, Reichelt Angela J

机构信息

Serviço de Endocrinologia, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.

Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

出版信息

Diabetol Metab Syndr. 2024 Jul 11;16(1):157. doi: 10.1186/s13098-024-01376-y.

DOI:10.1186/s13098-024-01376-y

PMID:38992793

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11238503/

Abstract

OBJECTIVE

To describe the frequency and types of congenital anomalies and associated risk factors in Brazilian women with type 2 diabetes.

METHODS

In this retrospective cohort study between 2005 and 2021, we included all pregnant participants with type 2 diabetes from the two major public hospitals in southern Brazil. We collected data from the electronic hospital records. Congenital anomalies were classified by the 10 revised International Classification of Diseases, Q chapter, enhanced by the EUROCAT registry classification, and categorized by type and gravity. We used multiple Poisson regression with robust estimates to estimate risks.

RESULTS

Among 648 participants, we excluded 19, and 62 were lost to follow-up; therefore, we included 567 participants. Overt diabetes arose in 191 participants (33.7%, 95% CI 30.0% - 38.0%). Less than 20% of the participants supplemented folate. Congenital anomalies occurred in 78 neonates (13.8%, CI 11.0 - 16.9%), 73 babies (93.6%) presented major anomalies, and 20 (10.5%) cases occurred in participants with overt diabetes. Cardiac anomalies were the most frequent (43 isolated and 12 combined). Pre-eclampsia was associated with an increased risk in the analyses including all women (adjusted RR 1.87 (95% CI 1.23-2.85), p = 0.003), but not in analyses including only women with an HbA1c measured up to the 14 gestational age. HbA1c, either measured at any time in pregnancy (adjusted RR 1.21 (95% CI 1.10-1.33), p < 0.001) or up to the first 14 weeks (adjusted RR 1.22, 95% CI 1.10-1.35, p < 0.001) was the only sustained risk factor. Risk factors such as maternal age, obesity, diabetes diagnosis, or use of antidiabetic medications were not associated with congenital anomalies.

CONCLUSION

We found a high frequency of congenital anomalies associated with poor maternal glycemic control and revealed an almost universal lack of preconception care. An urgent call to action is mandatory for the reversal of this gray scenario.

摘要

目的

描述巴西2型糖尿病女性中先天性异常的频率、类型及相关危险因素。

方法

在这项2005年至2021年的回顾性队列研究中，我们纳入了巴西南部两家主要公立医院所有患有2型糖尿病的孕妇参与者。我们从电子医院记录中收集数据。先天性异常按照修订后的第10版《国际疾病分类》Q章进行分类，并由EUROCAT登记处分类进行补充，然后按类型和严重程度进行归类。我们使用具有稳健估计的多重泊松回归来估计风险。

结果

在648名参与者中，我们排除了19名，62名失访；因此，我们纳入了567名参与者。191名参与者（33.7%，95%置信区间30.0% - 38.0%）出现显性糖尿病。不到20%的参与者补充了叶酸。78名新生儿（13.8%，置信区间11.0 - 16.9%）出现先天性异常，73名婴儿（93.6%）存在主要异常，20例（10.5%）发生在显性糖尿病参与者中。心脏异常最为常见（43例孤立性和12例合并性）。在纳入所有女性的分析中，子痫前期与风险增加相关（调整后相对风险1.87（95%置信区间1.23 - 2.85），p = 0.003），但在仅纳入妊娠14周前测量糖化血红蛋白的女性的分析中并非如此。在孕期任何时间测量的糖化血红蛋白（调整后相对风险1.21（95%置信区间1.10 - 1.33），p < 0.001）或妊娠前14周测量的糖化血红蛋白（调整后相对风险1.22，95%置信区间1.10 - 1.35，p < 0.001）是唯一持续存在的危险因素。诸如产妇年龄、肥胖、糖尿病诊断或使用抗糖尿病药物等危险因素与先天性异常无关。