Lancet Diabetes Endocrinology:合并1型或2型糖尿病孕妇的不良妊娠结局!

2021-02-02 MedSci原创 MedSci原创

妊娠期糖尿病与早产、极端出生体重儿以及先天异常、死产和新生儿死亡发生率增加相关。本研究旨在确定和比较与1型糖尿病和2型糖尿病女性不良妊娠结局相关的可改变的危险因素。

妊娠期糖尿病与早产、极端出生体重儿以及先天异常、死产和新生儿死亡发生率增加相关。本研究旨在确定和比较与1型糖尿病和2型糖尿病女性不良妊娠结局相关的可改变的危险因素。

这是一项基于人群的国家队列研究,研究人员采用在多个国家172个妇产科诊所进行的国家妊娠糖尿病审核的前5年中收集的1型或2型糖尿病女性的怀孕数据。收集2014年1月1日-2018年12月31日完成的妊娠的妊娠并发症(如早产[<37周]、大出生体重儿[LGA,出生体重>90th])和不良妊娠结局(先天性异常、死胎、新生儿死亡)的数据。评估可调整风险因素(如HbA 1c、BMI、备孕措施、妇产科诊所)和不可调整风险因素(如年龄、种族、流产、1型糖尿病持续时间)与妊娠结局的相关性。

该分析共纳入了15290位妊娠女性的17375次妊娠结局。8690位(50%)妊娠女性患有1型糖尿病,中位分娩年龄为30岁(10-90th: 22-37),1型糖尿病患病持续中位时间为13年(3-25);8685位(50%)患有2型糖尿病,中位分娩年龄为34岁(27-41),糖尿病持续中位时间3年。

合并1型或2型糖尿病的患者的早产率分别为42.5%和23.4%(p<0.0001),LGA发生率分别为52.2%和26.2%(p<0.0001)。妊娠期合并1型糖尿病或2型糖尿病的先天性异常和死胎发生率均无明显差异;但2型糖尿病孕妇的新生儿死亡率明显高于1型糖尿病(11.2/1000活产 vs 7.4/1000活产,p=0.013)

在整个研究人群中,围产期死亡的独立风险因素有孕晚期HbA1c≥6.5%(与<6.5%的风险比为 3.06)、最高流产五分位数(与最低五分位数比的风险比为 2.29)和合并2型糖尿病(与合并1型糖尿病的风险比为 1.65)。HbA1c和LGA出生体重与母亲特征(年龄、糖尿病持续时间、流产、BMI)相关,但无统计学差异。

该研究数据强调了合并1或2型糖尿病女性的不良妊娠结局一致。孕妇的血糖和BMI是关键的可改变的危险因素。

原始出处:

Helen R Murphy, et al. Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes: a 5-year national population-based cohort study. The Lancet Diabetes & Endocrinology. January 28, 2021.

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    2021-04-22 howi
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    2021-06-23 丫丫笑笑

    学习了

    0

  6. 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  9. 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    2021-02-04 ms5000001852640370

    好文章#糖尿病#

    0

  10. 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    2021-02-02 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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