Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands
Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands
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DOI：
10.1136/bmj.38043.583160.ee
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发表时间：
2004-04-17
影响因子：
105.7
通讯作者：
Visser, GHA
中科院分区：
文献类型：
--
作者：
Evers, IN;de Valk, HW;Visser, GHA
目的 调查荷兰1型糖尿病女性妊娠的母体、围产期和新生儿结局。
设计 全国性前瞻性队列研究
地点 荷兰全部118家医院
参与者 1999年4月1日至2000年4月1日期间怀孕的323名1型糖尿病女性
主要结局指标 妊娠的母体、围产期和新生儿结局
结果 84%（n = 271）的妊娠是有计划的。大多数女性在妊娠早期血糖控制良好（75%（n = 212）的人群糖化血红蛋白（HbA₁c）≤7.0%），70%（n = 226）的女性叶酸补充充足。314例孕周超过24周的妊娠共分娩324名婴儿。子痫前期发生率（40例；12.7%）、早产率（101例；32.2%）、剖宫产率（139例；44.3%）、孕产妇死亡率（2例；0.6%）、先天性畸形发生率（29例；8.8%）、围产期死亡率（9例；2.8%）以及巨大儿发生率（146例；45.1%）均显著高于普通人群。新生儿发病率（有一种或多种并发症）极高（260例；80.2%）。有计划妊娠的主要先天性畸形发生率显著低于无计划妊娠（4.2%（n = 11）对12.2%（n = 6）；相对危险度0.34，95%置信区间0.13 - 0.88）。
结论 尽管有计划妊娠的频率较高，使得妊娠（早期）总体血糖控制良好且叶酸充足使用率较高，但1型糖尿病女性的母体和围产期并发症仍然增加。新生儿发病率，尤其是低血糖，也极高。接近最佳的母体血糖控制（HbA₁c≤7.0%）显然还不够好。
Objective To investigate maternal, perinatal, and neonatal outcomes of pregnancies in women with type 1 diabetes in the Netherlands.Design Nationwide prospective cohort studySetting All 118 hospitals in the Netherlands.Participants 323 women with type 1 diabetes who became pregnant between 1 April 1999 and 1 April 2000.Main outcome measures Maternal, perinatal, and neonatal Outcomes of pregnancyResults 84% (n = 271) of the pregnancies were planned. Glycaemic control early in pregnancy was good in most women (HbA(1c) less than or equal to 7.0% in 75% (n = 212) of the population), and folic acid supplementation was adequate in 70% (n = 226). 314 pregnancies that went beyond 24 weeks' gestation resulted in 324 infants. rates of pre-eclampsia (40; 12.7%), preterm delivery (101: 32.2%), caesarean section (139; 44.3%), maternal mortality (2, 0.6%), congenital malformations (29; 8.8%), perinatal mortality (9; 2.8%) and macrosomia (146 - 45.1%) were considerably higher than in the general population. Neonatal morbidity (one or more complications) was extremely high (260; 80.2%). The incidence of major congenital malformations was significantly lower in planned pregnancies than in unplanned pregnancies (4.2% (n = 11) v 12.2% (n = 6); relative risk 0.34, 95% confidence interval 0.13 to 0.88).Conclusion Despite a high frequency of planned pregnancies, resulting in overall good glycaemic control (early) in pregnancy and a high rate of adequate use of folic acid, maternal and perinatal complications were Still increased in women With type 1 diabetes. Neonatal morbidity, especially hypoglycaemia, was also extreme]), high. Near optimal maternal glycaemic control (HbA(1c) less than or equal to 7.0%) apparently is not good enough.