von Kries R, Kimmerle R, Schmidt J E, Hachmeister A, Böhm O, Wolf H G
Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University, Munich, Germany.
Eur J Pediatr. 1997 Dec;156(12):963-7. doi: 10.1007/s004310050752.
The purpose of this study was to estimate the proportion of pregnancies with pregestational diabetes in Germany, to compare the outcome of these pregnancies to pregnancies in nondiabetic mothers and to identify risk factors for poor pregnancy outcomes in mothers with pregestational diabetes. Data of the "Perinatalerhebung Nordrhine" from 1988-1993 were analysed. The Perinatalerhebung is an ongoing quality assurance programme of prenatal and perinatal care in the region of North Rhine (South Western part of North Rhine-Westphalia). During the observation period a proportion of 93%-100% of the annual births in the region (n = approximately 100000) were included in the study. Their data had been documented by the obstetricians in a standard multiple choice questionnaire. The outcome parameters perinatal mortality, macrosomia, prematurity, and malformations were analysed in relation to several defined explanatory variables. There were 2,402 births in mothers with pregestational diabetes (0.4% of all births). The proportions of poor pregnancy outcomes in women with pregestational diabetes were 2.8% for perinatal mortality, 27.6% for macrosomia, 21.1% for prematurity and 2.1% for malformations . The respective relative risks compared to the non diabetic mothers were 4.3 (95% CI 3.4-5.5) for perinatal mortality, 3.1 (95% CI 2.9-3.3) for macrosomia, 2.7 (95% CI 2.5-2.9) for prematurity and 1.7 (95% CI 1.3-2.3) for malformations . The main risk factor for perinatal mortality in children of diabetic mothers after adjustment for maternal smoking, ethnicity, parents' professional achievement, type of obstetric hospital, and maternal age was substandard use of prenatal care.
The prevalence of births from mothers with pregestational diabetes and their pregnancy outcomes were similar to those in other Western countries. The standard for non-diabetic mothers has not been reached yet. Further improvements may be achieved if all diabetic women are convinced to use the standard prenatal care facilities throughout pregnancy.
本研究旨在估算德国孕前糖尿病孕妇的比例，比较这些孕妇与非糖尿病孕妇的妊娠结局，并确定孕前糖尿病孕妇不良妊娠结局的风险因素。分析了1988 - 1993年“北莱茵围产期调查”的数据。“北莱茵围产期调查”是北莱茵地区（北莱茵 - 威斯特法伦州西南部）正在进行的一项产前和围产期保健质量保证项目。在观察期内，该地区每年出生人口的93% - 100%（约100000例）纳入了研究。其数据由产科医生记录在一份标准的多项选择题问卷中。分析了围产期死亡率、巨大儿、早产和畸形等结局参数与几个定义的解释变量之间的关系。孕前糖尿病孕妇分娩2402例（占所有分娩的0.4%）。孕前糖尿病女性不良妊娠结局的比例分别为：围产期死亡率2.8%，巨大儿27.6%，早产21.1%，畸形2.1%。与非糖尿病母亲相比，相应的相对风险分别为：围产期死亡率4.3（95%可信区间3.4 - 5.5），巨大儿3.1（95%可信区间2.9 - 3.3），早产2.7（95%可信区间2.5 - 2.9），畸形1.7（95%可信区间1.3 - 2.3）。在对母亲吸烟、种族、父母职业成就、产科医院类型和母亲年龄进行调整后，糖尿病母亲所生儿童围产期死亡的主要风险因素是产前保健使用不达标。
孕前糖尿病母亲分娩的患病率及其妊娠结局与其他西方国家相似。尚未达到非糖尿病母亲的标准。如果所有糖尿病女性在整个孕期都能被说服使用标准的产前保健设施，可能会取得进一步的改善。
