Chaturvedi N, Stephenson J M, Fuller J H
Department of Epidemiology and Public Health, University College, London, UK.
Diabet Med. 1995 Jun;12(6):494-9. doi: 10.1111/j.1464-5491.1995.tb00530.x.
Pregnancy is believed to exacerbate diabetes complications, although the degree to which this occurs, and the advice that should be given to women contemplating pregnancy is unclear. We examined 776 nulliparous and 582 parous women with Type 1 diabetes from a cross-sectional study performed in 31 European centres. Glycaemic control was better in parous women. Age and duration adjusted prevalence of microalbuminuria was similar in parous and nulliparous women, but macroalbuminuria was lower in parous women (6% versus 10%, p < 0.0001). Prevalence of all retinopathy was lower in parous women (34% in women who had two or more pregnancies, 45% in women who had one), compared with 48% in nulliparous women (chi 2 for trend = 47.1, p < 0.0001). Proliferative retinopathy was lower in parous (8% and 7%, respectively) compared with nulliparous women (16%, chi 2 for trend = 52.2, p < 0.0001). These differences persisted when adjusted for glycaemic control. Excluding referrals for pregnancy, parous women were more likely to have been referred to the diabetes clinic with complications than nulliparous women (p = 0.001). It is unlikely that our findings can be explained by women with complications being advised against pregnancy, or by the better glycaemic control in parous women. Equivalent levels of microalbuminuria and background retinopathy in parous and nulliparous women suggests that pregnancy may not exacerbate these early complications.
尽管孕期糖尿病并发症恶化的程度以及对于考虑怀孕的女性应给予何种建议尚不清楚，但普遍认为怀孕会加剧糖尿病并发症。我们在一项由31个欧洲中心开展的横断面研究中，对776名未生育和582名已生育的1型糖尿病女性进行了检查。已生育女性的血糖控制更佳。在年龄和病程调整后，已生育和未生育女性的微量白蛋白尿患病率相似，但已生育女性的大量白蛋白尿患病率较低（6% 对10%，p < 0.0001）。与未生育女性的48%相比，已生育女性中所有视网膜病变的患病率较低（有两次或更多次怀孕的女性为34%，有一次怀孕的女性为45%，趋势检验卡方值 = 47.1，p < 0.0001）。与未生育女性（16%）相比，已生育女性的增殖性视网膜病变患病率较低（分别为8%和7%，趋势检验卡方值 = 52.2，p < 0.0001）。在对血糖控制进行调整后，这些差异依然存在。排除因怀孕而转诊的情况后，已生育女性因并发症被转诊至糖尿病诊所的可能性高于未生育女性（p = 0.001）。我们的研究结果不太可能是由于患有并发症的女性被建议不要怀孕，或者是由于已生育女性的血糖控制更好。已生育和未生育女性微量白蛋白尿和背景性视网膜病变水平相当，这表明怀孕可能不会加剧这些早期并发症。
