CAN PREPREGNANCY CARE OF DIABETIC WOMEN REDUCE THE RISK OF ABNORMAL BABIES
CAN PREPREGNANCY CARE OF DIABETIC WOMEN REDUCE THE RISK OF ABNORMAL BABIES
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DOI：
10.1136/bmj.301.6760.1070
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发表时间：
1990-11-10
影响因子：
105.7
通讯作者：
SMITH, AF
中科院分区：
文献类型：
--
作者：
STEEL, JM;JOHNSTONE, FD;SMITH, AF
目的：探讨针对糖尿病妇女的孕前门诊能否在妊娠早期实现严格的血糖控制，从而降低糖尿病妇女婴儿重大先天性畸形的高发率。设计：分析妊娠早期糖尿病控制情况，包括与婴儿主要先天性畸形发生相关的严重低血糖发作记录。环境：一所教学医院的糖尿病门诊和糖尿病及产前联合门诊。患者：143名胰岛素依赖妇女在孕前诊所就诊，96名胰岛素依赖妇女在同一时期未接受特殊的孕前护理。主要观察指标：主要先天性畸形发生率。结果：与未接受特殊孕前护理的妇女相比，参加孕前门诊的妇女在妊娠早期血红蛋白AI浓度较低（8.4% v 10.5%），妊娠早期低血糖发生率较高（38/143 v 8/96），婴儿先天性异常较少（2/143 v 10/96；未接受特殊孕前护理妇女的相对风险为7.4(95%置信区间为1.7 ~ 33.2)）。结论：通过孕前临床方法严格控制孕早期孕妇血糖浓度，可显著降低子代发生严重先天性异常的风险。低血糖发作似乎不会导致胎儿畸形，即使它们发生在器官发生期间。
Objective: To see whether a prepregnancy clinic for diabetic women can achieve tight glycaemic control in early pregnancy and so reduce the high incidence of major congenital malformation that occurs in the infants of these women. Design: An analysis of diabetic control in early pregnancy including a record of severe hypoglycaemic episodes in relation to the occurrence of major congenital malformation among the infants. Setting: A diabetic clinic and a combined diabetic and antenatal clinic of a teaching hospital. Patients: 143 Insulin dependent women attending a prepregnancy clinic and 96 insulin dependent women managed over the same period who had not received specific prepregnancy care. Main outcome measure: The incidence of major congenital malformation. Results: Compared with the women who were not given specific prepregnancy care the group who attended the prepregnancy clinic had a lower haemoglobin AI concentration in the first trimester (8.4% v 10.5%), a higher incidence of hypoglycaemia in early pregnancy (38/143 women v 8/96), and fewer infants with congenital abnormalities (2/143 v 10/96; relative risk among women not given specific prepregnancy care 7.4 (95% confidence interval 1.7 to 33.2)). Conclusion: Tight control of the maternal blood glucose concentration in the early weeks of pregnancy can be achieved by the prepregnancy clinic approach and is associated with a highly significant reduction in the risk of serious congenital abnormalities in the offspring. Hypoglycaemic episodes do not seem to lead to fetal malformation even when they occur during the period of organogenesis.