Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: Systematic review of observational studies

被引：142

作者：

Inkster M.E. ^{[1
]}

Fahey T.P. ^{[2
]}

Donnan P.T. ^{[1
]}

Leese G.P. ^{[3
]}

Mires G.J. ^{[4
]}

Murphy D.J. ^{[5
]}

机构：

[1] Division of Community Health Sciences, University of Dundee, Dundee DD2 4BF, MacKenzie Building

[2] Department of General Practice, Royal College of Surgeons in Ireland, Mercer's Medical Centre, Dublin 2, Stephen Street Lower

[3] Diabetes Centre, Ninewells Hospital and Medical School

[4] Maternal and Child Health Sciences, Ninewells Hospital and Medical School

[5] Department of Obstetrics and Gynaecology, Trinity College, University of Dublin, Dublin

来源：

BMC Pregnancy and Childbirth | / 6卷 / 1期

关键词：

Pregnancy Outcome; Glycaemic Control; Congenital Malformation; Perinatal Mortality; Adverse Pregnancy Outcome;

D O I：

10.1186/1471-2393-6-30

中图分类号：

学科分类号：

摘要：

Background: Glycaemic control in women with diabetes is critical to satisfactory pregnancy outcome. A systematic review of two randomised trials concluded that there was no clear evidence of benefit from very tight versus tight glycaemic control for pregnant women with diabetes. Methods: A systematic review of observational studies addressing miscarriage, congenital malformations and perinatal mortality among pregnant women with type 1 and type 2 diabetes was carried out Literature searches were performed in MEDLINE, EMBASE, CINAHL and Cochrane Library. Observational studies with data on glycated haemoglobin (HbAIc) levels categorised into poor and optimal control (as defined by the study investigators) were selected. Relative risks and odds ratios were calculated for HbAIc and pregnancy outcomes. Adjusted relative risk estimates per 1-percent decrease in HbAIc were calculated for studies which contained information on mean and standard deviations of HbAIc. Results: The review identified thirteen studies which compared poor versus optimal glycaemic control in relation to maternal, fetal and neonatal outcomes. Twelve of these studies reported the outcome of congenital malformations and showed an increased risk with poor glycaemic control, pooled odds ratio 3.44 (95%Cl, 2.30 to 5.15). For four of the twelve studies, it was also possible to calculate a relative risk reduction of congenital malformation for each 1-percent decrease in HbAIc, these varied from 0.39 to 0.59. The risk of miscarriage was reported in four studies and was associated with poor glycaemic control, pooled odds ratio 3.23 (95%Cl, 1.64 to 6.36). Increased perinatal mortality was also associated with poor glycaemic control, pooled odds ratio 3.03 (95%Cl, 1.87 to 4.92) from four studies. Conclusion: This analysis quantifies the increase in adverse pregnancy outcomes in women with diabetes who have poor glycaemic control. Relating percentage risk reduction in HbAIc to relative risk of adverse pregnancy events may be useful in motivating women to achieve optimal control prior to conception. © 2006 Inkster et al; licensee BioMed Central Ltd.

引用

共 33 条

[1]

Hawthorne G., Modder J., Maternity Services for Women With Diabetes in the UK, Diabetic Medicine, 19, SUPPL. 4, pp. 50-55, (2002)

[2]

Casson I.F., Clarke C.A., Howard C.V., McKendrick O., Pennycook S., Pharoah P.O., Platt M.J., Stanisstreet M., van Velszen D., Walkinshaw S., Outcomes of Pregnancy in Insulin Dependent Diabetic Women: Results of a Five Year Population Cohort Study, BMJ, 315, pp. 275-278, (1997)

[3]

Hawthorne G., Robson S., Ryall E.A., Sen D., Roberts S.H., Ward Platt M.P., Prospective Population Based Survey of Outcome of Pregnancy in Diabetic Women: Results of the Northern Diabetic Pregnancy Audit, 1994, BMJ, 315, pp. 279-281, (1997)

[4]

Hawthorne G., Irgens L.M., Lie R.T., Outcome of Pregnancy in Diabetic Women in Northeast England and in Norway, 1994-7, BMJ, 321, pp. 730-731, (2000)

[5]

Janz N.K., Herman W.H., Becker M.P., Charron-Prochownik D., Shayna V.L., Lesnick T.G., Jacober S.J., Fachnie J.D., Kruger D.F., Sanfield J.A., Diabetes and Pregnancy. Factors Associated With Seeking Pre-Conception Care, Diabetes Care, 18, 2, pp. 157-165, (1995)

[6]

Martin F.I.R., Heath P., Mountain K.R., Pregnancy in Women With Diabetes Mellitus. Fifteen Years' Experience: 1970-1985, Medical Journal of Australia, 146, 4, (1987)

[7]

Temple R., Aldridge V., Greenwood R., Heyburn P., Sampson M., Stanley K., Association Between Outcome of Pregnancy and Glycaemic Control in Early Pregnancy in Type 1 Diabetes: Population Based Study, BMJ, 325, pp. 1275-1276, (2002)

[8]

Platt M.J., St Vincent's Declaration 10 Years on: Outcomes of Diabetic Pregnancies, Diabetic Medicine, 19, 3, pp. 216-220, (2002)

[9]

Goldstein D.E., Little R.R., Lorenz R.A., Malone J.I., Nathan D., Peterson C.M., Sacks D.B., Tests of Glycemia in Diabetes, Diabetes Care, 27, 7, pp. 1761-1773, (2004)

[10]

Rosenn B., Miodovnik M., Dignan P.S., Siddiqi T.A., Khoury J., Mimouni F., Minor Congenital Malformations in Infants of Insulin-Dependent Diabetic Women: Association With Poor Glycemic Control, Obstetrics & Gynecology, 76, 5 PART 1, pp. 745-749, (1990)

← 1 2 3 4 →