Lövestam-Adrian M, Agardh C D, Aberg A, Agardh E
Department of Ophthalmology, University Hospital, Lund, Sweden.
Diabet Med. 1997 Dec;14(12):1059-65. doi: 10.1002/(SICI)1096-9136(199712)14:12<1059::AID-DIA505>3.0.CO;2-8.
The aim of the present study was to examine the influence of pregnancy on deterioration of retinopathy in patients with Type 1 diabetes mellitus. Sixty-five pregnant Type 1 diabetic women attending the University Hospital in Lund were studied retrospectively. The degree of retinopathy, and levels of HbA1c and blood pressure 12 months before, during, and 6 months after pregnancy were compared of those of 56 non-pregnant Type 1 diabetic women matched for age and duration of diabetes. For all patients, sight-threatening deterioration of retinopathy did not differ between the pregnancy group (9/65) and the control group (6/56). Over time, pregnant patients had lower HbA1c levels than controls (p < 0.001). Pregnant patients with sight-threatening deterioration of retinopathy had higher HbA1c levels than those without (p = 0.028 and the decrement in HbA1c between the 6-14th and the 20th week of gestation was more pronounced (p = 0.006). In those patients who developed pre-eclampsia during pregnancy, deterioration of retinopathy ocurred more frequently compared to those without pre-eclampsia (4/8 vs 5/65; p = 0.005). In conclusion, sight-threatening deterioration of retinopathy was not more common during pregnancy in IDDM patients than among age- and duration-matched control patients. In pregnant patients, deterioration of retinopathy was associated with the pregestational degree of metabolic control as well as with a rapidly improved glycaemic control acheived during pregnancy. Among those in whom deterioration occurred during pregnancy, pre-eclampsia was a potent risk factor.
本研究的目的是探讨妊娠对1型糖尿病患者视网膜病变恶化的影响。对在隆德大学医院就诊的65名妊娠1型糖尿病女性进行了回顾性研究。比较了56名年龄和糖尿病病程相匹配的非妊娠1型糖尿病女性在妊娠前12个月、妊娠期间和妊娠后6个月的视网膜病变程度、糖化血红蛋白（HbA1c）水平和血压。对于所有患者，妊娠组（9/65）和对照组（6/56）之间威胁视力的视网膜病变恶化情况并无差异。随着时间推移，妊娠患者的HbA1c水平低于对照组（p<0.001）。发生威胁视力的视网膜病变恶化的妊娠患者的HbA1c水平高于未发生恶化的患者（p=0.028），且妊娠第6 - 14周与第20周之间HbA1c的下降更为明显（p=0.006）。在妊娠期间发生先兆子痫的患者中，与未发生先兆子痫的患者相比，视网膜病变恶化更为频繁（4/8 vs 5/65；p=0.005）。总之，在1型糖尿病患者中，妊娠期间威胁视力的视网膜病变恶化并不比年龄和病程匹配的对照患者更常见。在妊娠患者中，视网膜病变的恶化与妊娠前的代谢控制程度以及妊娠期间血糖控制的快速改善有关。在妊娠期间发生恶化的患者中，先兆子痫是一个重要的危险因素。
