Patterns of congenital anomalies and relationship to initial maternal fasting glucose levels in pregnancies complicated by type 2 and gestational diabetes
Patterns of congenital anomalies and relationship to initial maternal fasting glucose levels in pregnancies complicated by type 2 and gestational diabetes
复制标题
DOI：
10.1016/s0002-9378(00)70217-1
复制
发表时间：
2000-02-01
影响因子：
9.8
通讯作者：
Kjos, SL
中科院分区：
文献类型：
--
作者：
Schaefer-Graf, UM;Buchanan, TA;Kjos, SL
目的：我们试图确定影响妊娠糖尿病或 2 型糖尿病女性婴儿的先天性异常类型，并检查这些畸形类型与 2 型糖尿病女性进入产前护理时或妊娠糖尿病女性诊断时的初始血糖测量值之间的关系。 研究设计：总共 4180 例妊娠合并妊娠糖尿病的孕妇妊娠 20 周后分娩的 (n = 3764) 或 2 型糖尿病 (n = 416) 在出院前接受了检查，看是否存在诊断出的先天畸形。异常被分类为缺失、轻微、严重、遗传综合征或非整倍体。主要异常根据受影响器官系统的数量和类型进一步分类。除了母亲的临床和历史参数外，还检查了诊断性葡萄糖耐量试验（妊娠糖尿病）或进入产前护理（2 型糖尿病）时的初始空腹血糖以及胰岛素治疗前的初始糖化血红蛋白与异常的关系。 结果：重度妊娠（n = 143）和轻度妊娠（n = 112）的初始空腹血糖和糖化血红蛋白水平显着较高异常和遗传综合征 (n = 9) 与无异常妊娠 (n = 3895) 相比。在那些有重大异常的妊娠中，最常受影响的器官系统是心脏（37.6%）、肌肉骨骼（14.7%）和中枢神经系统（9.8%）以及涉及多个器官系统的异常（16%）。在患有严重先天性异常的妊娠中，空腹血糖水平的升高并没有观察到任何特定器官系统受累的优势增加。与影响一个器官系统的妊娠（141 +/- 55 mg/dL，P
OBJECTIVES: We sought to determine the types of congenital anomalies affecting infants of women with gestational diabetes mellitus or type 2 diabetes and to examine the relationship between those malformation types and measures of initial glycemia of women at entry into prenatal care with type 2 diabetes or at time of diagnosis in women with gestational diabetes mellitus.STUDY DESIGN: A total of 4180 pregnancies complicated by gestational diabetes mellitus (n = 3764) or type 2 diabetes (n = 416) that were delivered after 20 weeks of gestation were reviewed for the presence of congenital malformations diagnosed before hospital discharge. Anomalies were categorized as being absent, minor, major, genetic syndromes, or aneuploidies. Major anomalies were further categorized by the number and type of affected organ systems. In addition to maternal clinical and historical parameters, the initial fasting serum glucose either from the diagnostic glucose tolerance test (gestational diabetes mellitus) or at entry to prenatal care (type 2 diabetes) and the initial glycosylated hemoglobin before insulin therapy were examined for a relationship to anomalies.RESULTS: The initial fasting serum glucose and glycosylated hemoglobin levels were significantly higher in pregnancies with major (n = 143) and minor (n = 112) anomalies and genetic syndromes (n = 9) compared with pregnancies with no anomalies (n = 3895). Of those pregnancies with major anomalies, the most commonly affected organ systems were the cardiac (37.6%), musculoskeletal (14.7%), and central nervous systems (9.8%) and anomalies involving multiple organ systems (16%). There was no increased predominance of any specific organ system involvement seen with increasing fasting serum glucose levels in pregnancies with major congenital anomalies. Pregnancies with major anomalies affecting multiple organ systems had significantly higher initial fasting serum glucose levels (166 +/- 64 mg/dL) compared with pregnancies in which one organ system was affected (141 +/- 55 mg/dL, P