Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study
Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study
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DOI：
10.1136/bmj.315.7103.275
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发表时间：
1997-08-02
影响因子：
--
通讯作者：
Walkinshaw, S
中科院分区：
文献类型：
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作者：
Casson, IF;Clarke, CA;Walkinshaw, S
目的：为了监测妊娠妇女与预先存在的胰岛素依赖型糖尿病的妊娠损失，先天性畸形，胎儿生长在地理上确定的区域西北England.Design：人群队列研究。设定：在柴郡、兰开夏郡和默西塞德郡的10个产科单位，这些单位没有糖尿病妇女妊娠管理的地区指南。（1990- 1994年）。主要结果测量：流产、死产、新生儿和新生儿后期死亡的数量和比率;先天畸形的患病率;结果：462例妊娠中，活产351例（76%），自然流产78例（17%），死产9例（2%），终止妊娠24例（5%）。在终止妊娠的病例中，有9例是因为先天畸形。死产率为25.0/1 000（95%置信区间8.9至41.1），而人口死亡率为5.0/1 000，婴儿死亡率为19.9/1 000（5.3至34.6），而活产婴儿死亡率为6.8/1 000。先天性畸形的患病率为94.0/1 000活产（63.5至124.5），而一般人群为9.7/1 000。当校正胎龄时，样本中的平均出生体重比非糖尿病母亲的婴儿高1.3个标准差。先天性畸形的婴儿体重低于those without.Conclusion：在一个有胰岛素依赖性糖尿病的妇女与预先存在的婴儿人口有10倍以上的先天性畸形的风险和5倍以上的风险死产比一般人群中的婴儿。如果要实现1989年圣文森特宣言的目标，就需要进一步改善糖尿病妇女的妊娠管理。
Objective: To monitor pregnancies in women with pre-existent insulin dependent diabetes for pregnancy loss, congenital malformations, and fetal growth in a geographically defined area of north west England.Design: Population cohort study. Setting: 10 maternity units in Cheshire, Lancashire, and Merseyside which had no regional guidelines for the management of pregnancy in diabetic women.Subjects: 462 pregnancies in 355 women with insulin dependent diabetes from the 10 centres over five years (1990-4 inclusive).Main outcome measures: Numbers and rates of miscarriages, stillbirths, and neonatal and postneonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age.Results: Among 462 pregnancies, 351 (76%) resulted in a liveborn infant, 78 (17%) aborted spontaneously, nine (2%) resulted in stillbirth, and 24 (5%) were terminated. Of the terminations, nine were for congenital malformation. The stillbirth rate was 25.0/1000 total births (95% confidence interval 8.9 to 41.1) compared with a population rate of 5.0/1000, and infant mortality was 19.9/1000 live births (5.3 to 34.6) compared with 6.8/1000. The prevalence of congenital malformations was 94.0/1000 live births (63.5 to 124.5) compared with 9.7/1000 in the general population. When corrected for gestational age, mean birth weight in the sample was 1.3 standard deviations greater than that of infants of non-diabetic mothers. Infants with congenital malformations weighed less than those without.Conclusion: In an unselected population the infants of women with pre-existent insulin dependent diabetes mellitus have a 10-fold greater risk of a congenital malformation and a fivefold greater risk of being stillborn than infants in the general population. Further improvements in the management of pregnancy in diabetic women are needed if target of die St Vincent declaration of 1989 is to be met.