孕产妇孕期高血糖症,孕前糖尿病,以及后代出现重大先天性形的风险
Ran S Rotem1,2, Marc G Weisskopf1,3, Brian Bateman4
1Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Human reproduction (Oxford, England)
|October 15, 2024
概括
母亲糖尿病和高糖血红蛋白 (HbA1c) 会增加新生儿先天性心脏缺陷 (CHD) 的风险. 即使HbA1c正常,孕前糖尿病也存在风险,表明超出血糖控制的途径.
科学领域:
- 生殖健康 生殖健康
- 围产儿医学 围产儿医学
- 内分泌学 在内分泌学.
背景情况:
- 孕前糖尿病是已知的重大先天性形 (MCMs) 的风险因素.
- 关于特定高血糖度和器官敏感性的现有证据是不一致的.
- 抗糖尿病药物在预防糖尿病相关的原性风险方面的疗效尚未得到充分证实.
研究的目的:
- 调查孕前糖尿病和孕前高血糖与后代MCM风险之间的关联.
- 探索糖化血红蛋白 (HbA1c) 水平与先天性心脏缺陷 (CHD) 相关的作用.
主要方法:
- 对以色列大量出生队伍 (2001-2020年) 的分析 (46,534名儿童).
- 从怀孕前90天到怀孕中期收集的母亲HbA1c数据.
- 使用临床数据和验证的算法,确定孕产妇糖尿病,心脏代谢状况和新生儿MCM.
- 统计建模采用了带有处罚线的通用增量逻辑回归.
主要成果:
- 超过5.6%的孕产期HbA1c与心血管疾病风险增加有关.
- 在患有2型糖尿病 (T2DM) 的母亲中,HbA1c和CHD之间的关联更加明显.
- 预先存在的T2DM与心脏病 (OR=1.89) 独立相关,即使HbA1c正常且药物坚持.
结论:
- 母亲孕前糖尿病具有独立于血糖控制的冠心病风险.
- 血糖控制治疗可能无法完全减轻与孕产妇糖尿病相关的致病风险.
- 过渡性高血糖,没有被HbA1c捕获,可能会导致原性风险.
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