Gladman G, McCrindle B W, Boutin C, Smallhorn J F
Fetal Assessment Unit, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Am J Perinatol. 1997 Feb;14(2):59-62. doi: 10.1055/s-2007-994098.
This study sought to assess pregnant diabetic women for the presence of fetal cardiac anomalies and to determine whether better diabetic control was associated with a reduced risk to the fetus. Between 1988 and 1995, pregnant type I and II diabetic women routinely underwent fetal echocardiography. Hemoglobin A1c values were used as an indicator of maternal diabetic control and any relation between congenital heart disease in the fetus and maternal hemoglobin A1c levels was sought. Cardiac defects were identified in 7 of 328 pregnancies assessed, for an incidence of congenital heart disease of 2.1% (95% confidence interval: 0.6-3.6%). A review of the postnatal cardiac database did not reveal any undetected major malformations. The mean hemoglobin A1c level was 7.6% +/- 2.0% obtained at a mean gestational age of 12 +/- 7 weeks. Hemoglobin A1c levels of mothers carrying a fetus with congenital heart disease did not significantly differ from those with a normal fetus: 8.1% +/- 3.4% versus 7.6% +/- 1.9% (p = 0.48). Mothers with an affected fetus demonstrated a wide range of HbA1c levels (4.1 to 13.7%). Thus, the incidence of significant fetal cardiac abnormalities is low and not significantly related to maternal diabetic control.
本研究旨在评估妊娠糖尿病妇女胎儿心脏异常的情况，并确定更好的血糖控制是否与降低胎儿风险相关。1988年至1995年间，I型和II型糖尿病孕妇常规接受胎儿超声心动图检查。糖化血红蛋白（HbA1c）值用作母亲血糖控制的指标，并探寻胎儿先天性心脏病与母亲HbA1c水平之间的任何关系。在评估的328例妊娠中，有7例发现心脏缺陷，先天性心脏病的发生率为2.1%（95%置信区间：0.6 - 3.6%）。对产后心脏数据库的审查未发现任何未被检测到的重大畸形。平均HbA1c水平为7.6%±2.0%，平均孕周为12±7周。怀有先天性心脏病胎儿的母亲的HbA1c水平与怀有正常胎儿的母亲相比，无显著差异：分别为8.1%±3.4%和7.6%±1.9%（p = 0.48）。怀有患病胎儿的母亲的HbA1c水平范围较广（4.1%至13.7%）。因此，严重胎儿心脏异常的发生率较低，且与母亲血糖控制无显著关系。
