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Diabetologia:1型糖尿病对孕产妇长期住院和死亡风险的影响

2018-07-03 MedSci MedSci原创

近日,国际杂志 《Diabetologia》上在线发表一项关于1型糖尿病对孕产妇长期住院和死亡风险的影响,该研究是一项全国性结合临床和基于登记的队列研究(EPICOM研究)。研究的目的是根据妊娠前蛋白尿水平,高血压,先兆子痫和孕周HbA 1c的总体情况,调查1型糖尿病母亲的长期死亡率和发病率。 这项研究是EPICOM(环境与遗传和表观遗传对母亲1型糖尿病后代的生长,代谢和认知功能的影响)研究

近日,国际杂志 《Diabetologia》上在线发表一项关于1糖尿病对孕产妇长期住院和死亡风险的影响,该研究是一项全国性结合临床和基于登记的队列研究(EPICOM研究)。研究的目的是根据妊娠前蛋白尿水平,高血压,先兆子痫和孕周HbA 1c的总体情况,调查1糖尿病母亲的长期死亡率和发病率。

这项研究是EPICOM(环境与遗传和表观遗传对母亲1糖尿病后代的生长,代谢和认知功能的影响)研究的一部分,该研究是一项前瞻性随访研究,主要研究对象为妊娠合并1型糖尿病的母亲。研究人员对19922000年间分娩的糖尿病母亲(n = 986)的死亡率和入院率进行了全国范围的临床和基于注册的队列研究。对照组(n=91,441)是根据年龄和分娩年份进行匹配来自相似背景的女性。随访年龄为32-66岁。

与对照组母亲相比,糖尿病母亲的死亡率增加了三倍(HR 3.41 [95CI 2.42,4.81]; P <0.0001),并且妊娠前存在的肾功能不全出现增加(正常白蛋白尿,HR 2.17 [95CI 1.28 3.68];微量白蛋白尿,HR 3.36 [95CI 0.82,13.8];大量白蛋白尿,HR 12.9 [95CI 5.45,30.7])。此外,在妊娠前或妊娠过程中高血压以及先兆子痫也增加了死亡率(高血压,HR 4.34 [95CI 2.13,8.84];先兆子痫,HR 5.55 [95CI 2.71,11.4 ])。在妊娠早期死亡率的增加伴随着较高水平的HbA1C增加(HBA 1C75mmol/mol[9]HR 2.15 [95CI 1.313.53];HbA1C > 75mmol/mol [> 9]HR 6.10 [95CI 2.67,14.0])。然而,妊娠早期糖尿病和HbA 1c <64 mmol/mol<8%)和正常妊娠前尿白蛋白排泄率(n=517)的母亲的死亡率与对照组母亲相当。糖尿病母亲中,死亡率与相关的HbA 1C水平为每HbA1C增加11mmol/mol1个百分点),HR1.5295CI 1.191.94; p = 0.001)。在糖尿病母亲中,住院总发生率超过对照组母亲的数量一倍(发病率[IRR] 2.69 [95CI 2.59,2.80]; p<0.0001)。糖尿病母亲中,对于住院的IRR增加与HbA 1C关系为:每HbA 1c增加11mmol/mol1个百分点),HR1.0795CI 1.041.10; p <0.0001)。

总体而言,1型糖尿病母亲死亡率和发病率增加2-3倍。HbA 1c水平,妊娠期间白蛋白尿的水平以及高血压和先兆子痫的存在是该队列中死亡率/发病率的重要危险因素。然而,可以肯定的是,妊娠早期无肾脏并发症和HbA 1c <64 mmol / mol<8%)的1型糖尿病母亲在抚养子女期间,与对照组具有相似的生存潜力。

原始出处:

Sine Knorr, Svend Juul, Birgitte Bytoftet al. Impact of type 1 diabetes on maternal long-term risk of hospitalisation and mortality: a nationwide combined clinical and register-based cohort study (The EPICOM study)

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