LACK OF RELATION OF INCREASED MALFORMATION RATES IN INFANTS OF DIABETIC MOTHERS TO GLYCEMIC CONTROL DURING ORGANOGENESIS
LACK OF RELATION OF INCREASED MALFORMATION RATES IN INFANTS OF DIABETIC MOTHERS TO GLYCEMIC CONTROL DURING ORGANOGENESIS
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DOI：
10.1056/nejm198803173181104
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发表时间：
1988-03-17
影响因子：
158.5
通讯作者：
POLK, BF
中科院分区：
文献类型：
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作者：
MILLS, JL;KNOPP, RH;POLK, BF
为了确定胰岛素依赖型糖尿病会在多大程度上增加女性生出畸形婴儿的风险，以及代谢控制如何影响该风险，我们对受孕 21 天内加入研究的 347 名糖尿病女性和 389 名对照女性（早期进入组）以及 279 名较晚进入的糖尿病女性（晚期进入组）进行了跟踪。我们发现，4.9% 的早期糖尿病女性、2.1% 的对照组和 9.0% 的晚期糖尿病女性的婴儿存在严重畸形。早入糖尿病女性的后代畸形率显着高于对照组（比值比，2.45；较低的单侧 95% 置信限，1.12；P = 0.027），晚入糖尿病女性的畸形率高于早入糖尿病女性（比值比，1.91；较低的单侧 95% 置信限，1.07；P = 0.032）。婴儿畸形的女性在器官形成过程中的平均血糖和糖化血红蛋白水平并没有显着升高。低血糖（葡萄糖，≤50 毫克每分升 [2.8 毫摩尔每升]）在同一组中并不明显更常见。高血糖和糖化血红蛋白与畸形无关。数据表明，需要采取更灵敏的措施来确定致畸机制，或者并不是所有的畸形都可以通过良好的血糖控制来预防。尽管与对照组相比，早期进入糖尿病的妇女的婴儿畸形率有所增加，但与晚期进入组相比，前一组的结果更有利，这证明了在受孕期间尝试实现良好代谢控制的合理性。
To determine how much insulin-dependent diabetes increases a woman''s risk of giving birth to a malformed infant and how that risk is influenced by metabolic control, we followed 347 diabetic and 389 control women who enrolled in the study within 21 days of conception (the early-entry group) and 279 diabetic women who entered later (the late-entry group). We detected major malformations in the infants of 4.9 percent of the early-entry diabetic women, 2.1 percent of the controls, and 9.0 percent of the late-entry diabetic women. Malformation rates were significantly higher among offspring of early-entry diabetic women than among those of controls (odds ratio, 2.45; lower one-sided 95 percent confidence limit, 1.12; P = 0.027), and higher among late-entry than among early-entry diabetic swomen (odds ratio, 1.91; lower one-sided 95 percent confidence limit, 1.07; P = 0.032). Mean blood glucose and glycosylated hemoglobin levels during organogenesis were not significantly higher in women whose infants were malformed. Hypoglycemia (glucose, .ltoreq. 50 mg per deciliter [2.8 mmol per liter]) was not significantly more common in the same group. Hyperglycemia and glycosylated hemoglobin were not correlated with malformation. The data suggest that more sensitive measures are needed to identify the teratogenic mechanisms, or that not all malformation can be prevented by good glycemia control. Despite the increased malformation rate among infants of the early-entry diabetic women, as compared with the controls, the more favorable outcome seen in the former group as compared with the late-entry group justifies the attempt to achieve good metabolic control around the time of conception.