瑞典1型（胰岛素依赖型）糖尿病孕妇妊娠高血压和子痫前期的流行病学研究

Epidemiology of pregnancy-induced hypertension and preeclampsia in type 1 (insulin-dependent) diabetic pregnancies in Sweden.

作者信息

Hanson U, Persson B

机构信息

Department of Obstetrics and Gynecology, Orebro Medical Center, Sweden.

出版信息

Acta Obstet Gynecol Scand. 1998 Jul;77(6):620-4. doi: 10.1034/j.1600-0412.1998.770608.x.

DOI:10.1034/j.1600-0412.1998.770608.x

PMID:9688239

Abstract

BACKGROUND

The object of this study was to examine if there is an association between pregnancy-induced hypertension (PIH) and/or preeclampsia (PE) and glycemic control assessed by HbA1c in early type 1 diabetic pregnancy, as well as factors such as maternal age, parity, duration of diabetes, presence of diabetes microangiopathy.

METHODS

The nationwide collaborative study included 491 type 1 diabetic pregnancies corresponding to about 80%, of the diabetic pregnancies during the study period 1983-1985. A blood sample for determination of HbA1c was obtained in early gestation (median 9 (5-16) weeks).

RESULTS

The rate of PIH/PE was 20.6% in the type 1 diabetic pregnancies compared to 5.0% in the background population. The type 1 diabetic pregnancies complicated by PIH/PE were associated with significantly longer duration of diabetes, higher initial HbA1c (8.1% vs 7.4%, p < 0.01), higher rate of nephropathy and retinopathy, while there were no significant differences in maternal age or parity compared to those without PIH/PE. Discriminant analysis revealed that occurrence of nephropathy (p<0.001), retinopathy (p<0.01) and high HbA1c (p<0.01) in early pregnancy were independently and significantly associated with occurrence of PIH/PE. Among the 463 patients without prepregnancy proteinuria 38 (8.2%) had PIH and 53 (11.5%) PE. The group with PE had, compared to the no PIH/PE group, significantly higher HbA1c (8.2% vs 7.4%, p<0.01). HbA1c was not significantly different between the PIH and the no PIH/PE group (7.5% vs 7.4%). Both the PIH and the PE group had significantly higher rate of retinopathy compared to the no PIH/PE group. If early HbA1c was equal to or above control mean by +8 s.d., i.e. > or =10.1% the PI rate was 31.0% compared to 10.2% in those with HbA1c below that value.

CONCLUSIONS

We conclude that poor glycemic control in early pregnancy is associated with increased risk of PE in non-proteinuric type 1 diabetic pregnancies.

摘要

背景

本研究旨在探讨1型糖尿病早期妊娠中妊娠高血压（PIH）和/或子痫前期（PE）与通过糖化血红蛋白（HbA1c）评估的血糖控制之间是否存在关联，以及诸如产妇年龄、产次、糖尿病病程、糖尿病微血管病变的存在等因素。

方法

这项全国性合作研究纳入了491例1型糖尿病妊娠病例，约占1983 - 1985年研究期间糖尿病妊娠病例的80%。在妊娠早期（中位孕周9（5 - 16）周）采集血样以测定HbA1c。

结果

1型糖尿病妊娠中PIH/PE的发生率为20.6%，而背景人群中的发生率为5.0%。合并PIH/PE的1型糖尿病妊娠与糖尿病病程显著更长、初始HbA1c更高（8.1%对7.4%，p < 0.01）、肾病和视网膜病变发生率更高相关，而与未合并PIH/PE的产妇相比，产妇年龄或产次无显著差异。判别分析显示，妊娠早期肾病（p<0.001）、视网膜病变（p<0.01）和高HbA1c（p<0.01）的发生与PIH/PE的发生独立且显著相关。在463例孕前无蛋白尿的患者中，38例（8.2%）发生PIH，53例（11.5%）发生PE。与无PIH/PE组相比，PE组的HbA1c显著更高（8.2%对7.4%，p<0.01）。PIH组与无PIH/PE组的HbA1c无显著差异（7.5%对7.4%）。与无PIH/PE组相比，PIH组和PE组的视网膜病变发生率均显著更高。如果早期HbA1c等于或高于对照均值加8个标准差，即≥10.1%，PI发生率为31.0%，而HbA低于该值者的PI发生率为10.2%。