Associations of Type 1 diabetes mellitus, maternal vascular disease and complications of pregnancy

被引:65
作者
Howarth, C. [1 ]
Gazis, A. [1 ]
James, D. [1 ]
机构
[1] Univ Nottingham Hosp, Queens Med Ctr, Nottingham, England
关键词
birthweight; perinatal outcome; pre-eclampsia; pregnancy; Type; 1; diabetes;
D O I
10.1111/j.1464-5491.2007.02254.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Maternal diabetes increases the risk of pre-eclampsia and abnormalities of fetal growth. We studied the additional impact of maternal vascular disease on these risks. Methods The first viable (> 23 weeks) pregnancies of 138 women with Type 1 diabetes mellitus (Type 1 DM), delivered between 1994 and 2003 at the Queen's Medical Centre, Nottingham, UK were studied. Women were divided into groups with and without vascular disease (retinopathy and/or nephropathy and/or pre-existing hypertension). Primary outcomes were pre-eclampsia and fetal customized birthweight percentile (cbp) (adjusted for maternal weight, height, parity, ethnicity, gestational age and gender). Secondary outcomes were perinatal outcome (miscarriage, intrauterine or neonatal death), preterm birth, birth asphyxia, neonatal hypoglycaemia and delivery mode. Results Women with vascular disease were more likely to develop pre-eclampsia (OR 3.5; CI 1.28-9.53) and deliver infants with lower cbp (median 89.0, range 0-100 vs. 98.0, range 0-100; P <= 0.005). Infants were less likely to be macrosomic (OR 0.46; CI 0.224-0.928) but more likely to have intrauterine growth restriction (IUGR; OR 6.0; CI 1.54-23.33). Women with vascular disease had higher Caesarean section rates (90 vs. 56%, P <= 0.001). Conclusions/interpretation Women with Type 1 DM and vascular disease are at greater risk of pre-eclampsia and pathological fetal growth. This should influence counselling and merit increased pregnancy surveillance.
引用
收藏
页码:1229 / 1234
页数:6
相关论文
共 18 条
[1]   DIABETIC FETAL MACROSOMIA - SIGNIFICANCE OF DISPROPORTIONATE GROWTH [J].
BALLARD, JL ;
ROSENN, B ;
KHOURY, JC ;
MIODOVNIK, M .
JOURNAL OF PEDIATRICS, 1993, 122 (01) :115-119
[2]  
BERK MA, 1989, PEDIATRICS, V83, P1029
[3]   Classification of hypertension in pregnancy [J].
Brown, MA ;
de Swiet, M .
BEST PRACTICE & RESEARCH CLINICAL OBSTETRICS & GYNAECOLOGY, 1999, 13 (01) :27-39
[4]   Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study [J].
Casson, IF ;
Clarke, CA ;
Howard, CV ;
McKendrick, O ;
Pennycook, S ;
Pharoah, POD ;
Platt, MJ ;
Stanisstreet, M ;
vanVelszen, D ;
Walkinshaw, S .
BRITISH MEDICAL JOURNAL, 1997, 315 (7103) :275-278
[5]   Pregnancy outcome in type 1 diabetic women with microalbuminuria [J].
Ekbom, P ;
Damm, P ;
Feldt-Rasmussen, B ;
Feldt-Rasmussen, U ;
Molvig, J ;
Mathiesen, ER .
DIABETES CARE, 2001, 24 (10) :1739-1744
[6]   Management of diabetes mellitus complicating pregnancy [J].
Gabbe, SG ;
Graves, CR .
OBSTETRICS AND GYNECOLOGY, 2003, 102 (04) :857-868
[7]   AN ADJUSTABLE FETAL WEIGHT STANDARD [J].
GARDOSI, J ;
MONGELLI, M ;
WILCOX, M ;
CHANG, A .
ULTRASOUND IN OBSTETRICS & GYNECOLOGY, 1995, 6 (03) :168-174
[8]   CUSTOMIZED ANTENATAL GROWTH CHARTS [J].
GARDOSI, J ;
CHANG, A ;
KALYAN, B ;
SAHOTA, D ;
SYMONDS, EM .
LANCET, 1992, 339 (8788) :283-287
[9]  
GARDOSI J, 2003, SOFTWARE PROGRAM CAL
[10]   TYPE-I DIABETES-MELLITUS AND PREGNANCY [J].
GARNER, P .
LANCET, 1995, 346 (8968) :157-161