Rosenn B, Miodovnik M, Combs C A, Khoury J, Siddiqi T A
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Ohio.
Obstet Gynecol. 1994 Oct;84(4):515-20.
To test the hypothesis that women with insulin-dependent (type I) diabetes have a threshold of glycemic control in early pregnancy for increased risks of spontaneous abortion and congenital malformations.
Receiver-operating characteristic (ROC) curves were formed for the occurrence of abortion and malformations as a function of the median first-trimester preprandial blood glucose concentration and the first measured glycohemoglobin concentration in pregnant women with type I diabetes.
Fifty-two of the 215 women (24%) who enrolled before 9 weeks' gestation had spontaneous abortions. Six percent of the women enrolled before 14 weeks had infants with major congenital malformations. Thresholds for an increased risk of abortion and malformations were a median first-trimester blood glucose concentration of 120-130 mg/dL or an initial glycohemoglobin concentration of 12-13% (6.2-7.5 standard deviations above the normal mean).
Type I diabetic women with initial glycohemoglobin concentrations in pregnancy above 12% or median first-trimester preprandial glucose concentrations above 120 mg/dL have an increased risk of abortion and malformations. Below these glycemic thresholds, the risks are comparable to those in nondiabetic women.
检验胰岛素依赖型（I型）糖尿病女性在妊娠早期存在血糖控制阈值，超过此阈值会增加自然流产和先天性畸形风险这一假设。
以妊娠早期餐前血糖浓度中位数及首次测得的糖化血红蛋白浓度为函数，绘制I型糖尿病孕妇流产和畸形发生情况的受试者工作特征（ROC）曲线。
在妊娠9周前入组的215名女性中，有52名（24%）发生自然流产。在妊娠14周前入组的女性中，6%的婴儿患有严重先天性畸形。流产和畸形风险增加的阈值为妊娠早期血糖浓度中位数120 - 130 mg/dL或初始糖化血红蛋白浓度12% - 13%（比正常均值高6.2 - 7.5个标准差）。
妊娠初期糖化血红蛋白浓度高于12%或妊娠早期餐前血糖浓度中位数高于120 mg/dL的I型糖尿病女性，流产和畸形风险增加。低于这些血糖阈值时，风险与非糖尿病女性相当。
