Reece E A, Sivan E, Francis G, Homko C J
Department of Obstetrics, Gynecology and Reproductive Sciences at Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Am J Perinatol. 1998;15(9):549-55. doi: 10.1055/s-2007-994059.
The objective of this paper is to evaluate the impact of contemporary management on the maternal and neonatal outcomes of pregnancies complicated by diabetes in women with microvascular disease versus women without microvascular disease. The study population consisted of two hundred and eighty-eight (288) pregnant women with pregestational diabetes and one hundred and fifty (150) healthy pregnant controls. Diabetic women were grouped according to the presence (n = 103) or absence of diabetic microvascular disease (n = 185). Data were collected regarding diabetes management, level of glycemic control, and the development of antenatal complications. Maternal and neonatal outcomes were compared among the three groups. Women in the diabetes groups were stratified according to mean blood glucose levels and glycosylated hemoglobin during each trimester. There was no significant difference found between the two diabetes groups in terms of preterm labor, polyhydramnios, pyelonephritis, and growth restriction. The only maternal complications that occurred with increased incidence among women with microvascular disease were acute hypertensive complications (51.6 vs. 32.9%; p<0.05). However, when the diabetes groups were compared to healthy controls, a significant difference was seen in all maternal and neonatal complications. Preterm delivery, polyhydramnios, and large-for-gestational-age (LGA) infants were associated with poor third-trimester metabolic control as compared with others in satisfactory metabolic controls: 30.8 vs. 11.4% for preterm delivery; 17.3 vs. 5.1% for polyhydramnios; 51.9 vs. 33.9% for LGA; p<0.05. Congenital malformations were associated with poor first-trimester glucose control (5.8 vs. 1.3% anomalies in well-controlled women). Furthermore, major congenital malformations were also significantly increased in the offspring of women with diabetic microvascular disease 6.8%, as compared to 1.69% in diabetic women without microvascular disease; p<0.01. The incidence of hypertensive complications did not differ between the two diabetic groups. Pregestational diabetic women with and without microvascular disease can be counseled to anticipate comparably favorable pregnancy outcomes, although maternal and neonatal complications may exceed that experienced by pregnant women without diabetes mellitus.
本文的目的是评估当代管理方式对患有微血管疾病的糖尿病孕妇与未患微血管疾病的糖尿病孕妇母婴结局的影响。研究人群包括288例孕前糖尿病孕妇和150例健康孕妇作为对照。糖尿病女性根据是否存在糖尿病微血管疾病分为两组（分别为103例和185例）。收集了有关糖尿病管理、血糖控制水平和产前并发症发生情况的数据。比较了三组的母婴结局。糖尿病组的女性根据各孕期的平均血糖水平和糖化血红蛋白进行分层。在早产、羊水过多、肾盂肾炎和生长受限方面，两个糖尿病组之间未发现显著差异。微血管疾病女性中发生率增加的唯一母体并发症是急性高血压并发症（51.6%对32.9%；p<0.05）。然而，将糖尿病组与健康对照组进行比较时，所有母婴并发症均存在显著差异。与代谢控制良好的其他孕妇相比，早产、羊水过多和大于胎龄（LGA）婴儿与孕晚期代谢控制不佳有关：早产为30.8%对11.4%；羊水过多为17.3%对5.1%；LGA为51.9%对33.9%；p<0.05。先天性畸形与孕早期血糖控制不佳有关（血糖控制良好的女性中畸形率为5.8%对1.3%）。此外，患有糖尿病微血管疾病的女性后代中主要先天性畸形也显著增加，为6.8%，而无微血管疾病的糖尿病女性为1.69%；p<0.01。两个糖尿病组之间高血压并发症的发生率没有差异。可以建议患有和未患有微血管疾病的孕前糖尿病女性预期获得相当良好的妊娠结局，尽管母婴并发症可能超过非糖尿病孕妇。
