对受显性糖尿病影响的妇女与受原有 2 型糖尿病影响的妇女的妊娠结果进行回顾性分析

M. Dalfrà, S. Burlina, Maria Giulia Fioretti, Annunziata Lapolla
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摘要

背景:妊娠期糖尿病如果控制不好,会导致母体和胎儿并发症。根据新的妊娠糖尿病诊断标准,妊娠早期也可诊断为糖尿病(显性糖尿病)。目的:本研究旨在确定明显糖尿病妇女与原有 2 型糖尿病妇女的妊娠结局。研究方法在这项回顾性研究中,我们选取了帕多瓦糖尿病护理中心在 2010-2022 年期间至少有一次妊娠的 2 型糖尿病患者和显性糖尿病患者。研究结果我们对 83 例妊娠进行了分析,其中 18 例妊娠确诊为显性糖尿病。共有 95.5% 的显性糖尿病患者和 48% 的 T2DM 患者是移民(P < 0.143)。没有明显糖尿病患者计划怀孕,而 26.3% 的前期 2 型糖尿病患者计划怀孕(p < 0.05)。与原有 2 型糖尿病患者相比,明显糖尿病患者的围孕期和妊娠头三个月血糖控制最差(首次就诊时 HbA1c 为 9.7 ± 3.1% 对 7.3% ± 2.3%,p < 0.044;妊娠头三个月分别为 8.1 ± 1.9% 和 7.0 ± 1.6%,p < 0.037)。在孕产妇结局方面,16.6%的孕妇流产,5.5%的孕妇罹患妊娠高血压;在新生儿结局方面,16.6%的新生儿为LGA,11.1%的新生儿患有先天性畸形,与已患有2型糖尿病的孕妇相比没有显著差异。患有显性糖尿病的孕妇先天性畸形发生率高,这可能是由于围孕期胎儿器官发育期间代谢控制不佳所致。结论:育龄妇女不仅要在怀孕初期进行糖尿病筛查,而且要在孕前阶段或月经后阶段进行糖尿病筛查,因为此时存在糖尿病发病的高危因素,如高体重指数、血糖紊乱以及属于高危种族的妇女。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Retrospective Analysis of the Outcomes of Pregnancies in Women Affected by Overt Diabetes Compared to Women Affected by Pre-Existing Type 2 Diabetes
Background: Pregestational diabetes mellitus, if not well controlled, determines maternal and fetal complications. According to the new diagnostic criteria for gestational diabetes, the diagnosis of diabetes mellitus can also occur in early pregnancy (overt diabetes). Aim: This study aims to determine pregnancy outcomes in women with overt diabetes compared to women with pre-existing type 2 diabetes. Methods: In this retrospective study, we selected women with pre-existing type 2 and overt diabetes who had at least one pregnancy in the 2010–2022 period at the Diabetic Care Unit of Padova. Results: We analyzed 83 pregnancies, and overt diabetes was diagnosed in 18 pregnancies. In total, 95.5% of patients with overt diabetes and 48% of T2DM patients were immigrants (p < 0.143). No patients with overt diabetes planned their pregnancy, while pregnancy was planned in 26.3% of patients with pre-exiting type 2 diabetes (p < 0.05). Periconception and first-trimester glycemic control were the worst in patients with overt diabetes (HbA1c 9.7 ± 3.1% vs. 7.3% ± 2.3%, p < 0.044, at first visit; 8.1 ± 1.9% and 7.0 ± 1.6%, p < 0.037 in the first trimester) with respect to patients with pre-existing type 2 diabetes. As for maternal outcomes, 16.6% of pregnancies ended in miscarriage, and 5.5% of women developed gestational hypertension; as for newborn outcomes, 16.6% of newborns were LGA, and 11.1% were affected by congenital anomalies without any significant difference with respect to women with pre-existing type 2 diabetes. The high rate of congenital malformations in pregnancies of women with overt diabetes is probably a result of the poor, metabolic control observed during the periconception period when the organogenesis of the fetus takes place. Conclusions: It is essential to utilize procedures for diabetes screening in women of childbearing age not only at the beginning of the pregnancy, but also during the preconception phase or the postmenarcheal period when strong risk factors for diabetes onset are present, such as a high BMI, glycemic disorders, and those who fall under high-risk ethnicity categories.
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