임신성 당뇨 A1형과 A2형의 치료 후 임신 결과 및 신생아 예후 비교
Obstetric and neonatal outcomes after treatment of gestational diabetes mellitus class A1 and class A2
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목적: 한국인 임신성당뇨 A1형과 A2형 산모에서 치료 후 모체 및 신생아의 주산기 예후를 비교하고자 하였다. 연구 방법: 1996년 3월부터 2007년 9월까지 본원 산부인과에서 산전관리 중 임신성 당뇨로 진단받고 치료 후 분만한 산모를 대상으로 후향적 고찰을 하였다. 임신성 당뇨 A1군과 A2군으로 나누어 분만 이전의 당화혈색소 (hemoglobin A1c, HgbA1c) 수치, 임신 이전의 체질량지수 (body mass index, BMI) 산과적 합병증을 포함한 임신 및 주산기 예후를 비교 분석하였다. 결과: 임신성당뇨 A1군은 57명이었고 A2군은 42명이었다. 두 군에서 나이, 분만력, BMI 등에서는 유의한 차이를 보이지 않았으나 진단 시 HgbA1c 수치가 임신성 당뇨 A1군에 비해 A2군에서 더 높았다. 두 군 간에 임신성 고혈압, 조기 진통, 조기 양막 파수, 견갑난산 등 일부 임신 합병증은 차이가 없었으나 A2군에서 A1군에 비해 제왕절개 분만의 빈도가 더 많았다. 또한 분만 시 임신 주수, 신생아 출생 체중, 아프가 점수, 신생아 호흡곤란 증후군, 신생아 일과성 빈호흡, 패혈증, 선천성 기형도 두 군 간에 차이가 없었으나 신생아 중환자실 입원 빈도가 A2군에서 A1군에 비해 더 많았다. 그리고 BMI와 HgbA1c간의 상관 관계를 분석한 결과 BMI가 증가할수록 HgbA1c 수치가 증가하는 상관성을 보였다. 결론: 적절한 치료를 한 임신성당뇨 A2형은 임신성당뇨 A1형과 유사한 임신 예후를 보인다.
Abstract
Objective: The purpose of this study is to compare the pregnancy outcomes of gestational diabetes mellitus (GDM) class A1 to those of GDM A2. Methods: We performed a retrospective analysis of 99 women who were diagnosed as GDM during prenatal care and managed until delivery from March 1996 to September 2007. Subjects were grouped into GDM class A1 and class A2. The obstetric and neonatal outcomes were compared between the two groups. Results: There were 57 cases of GDM class A1 and 42 cases of GDM class A2. Hemoglobin A1c level of GDM A2 group was significantly higher than GDM A1 group. We could not find any significant difference in obstetric (body mass index, hypertensive disorder, preterm delivery, preterm labor, preterm premature rupture of membrane) and neonatal outcomes (gestational age at delivery, macrosomia, shoulder dystocia, respiratory distress syndrome, transient tachypnea of neonate, sepsis, Apgar score, congenital anomaly) between the two groups other than increased frequency of cesarean delivery and admission to neonatal intensive care unit in GDM A2 group. Conclusion: After proper management, overall pregnancy outcomes of women with GDM class A2 are comparable to those with GDM class A1.
참고문헌 (16)
- Metzger BE, "Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus", Diabetes Care, 21(2), pp.161~167 (1998)
- Moore TR, "Diabetes in pregnancy. In Maternal-Fetal medicine. Principles and practice. 5th ed.", pp.1023~1061 (2004), Saunders
- Narayan KM, "Lifetime risk for diabetes mellitus in the United States", JAMA, 290, pp.1884~1890 (2003)
- Sheffield JS, "Maternal diabetes mellitus and infant malformations", Obstet Gynecol, 100, pp.925~930 (2002)
- Silverman BL, "Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center", Diabetes Care, 21(2), pp.142~149 (1998)
- American College of Obstetricians and Gynecologists, "Management of diabetes mellitus in pregnancy", ACOG Technical Bulletin, 92 (1986)
- Crowther CA, "Effect of treatment of gestational diabetes mellitus on pregnancy outcomes", N Engl J Med, 352, pp.2477~2486 (2005)
- Jensen DM, "Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women", Am J Obstet Gynecol, 189, pp.239~244 (2003)
- Langer O, "Overweight and obese in gestational diabetes: the impact on pregnancy outcome", Am J Obstet Gynecol, 192, pp.1768~1776 (2005)
- Johnstone FD, "The effect of established and gestational diabetes on pregnancy outcome", Br J Obstet Gynaecol, 97, pp.1009~1015 (1990)
- National Diabetes Data Group, "Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance", Diabetes, 28, pp.1039~1057 (1979)
- Therasse P, "New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada", J Natl Cancer Inst, 92, pp.205~216 (2000)
- Langer O, "Gestational diabetes: the consequences of not treating", Am J Obstet Gynecol, 192, pp.989~997 (2005)
- Garner P, "A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: a pilot study", Am J Obstet Gynecol, 177, pp.190~195 (1997)
- Landon MB, "A planned randomized clinical trial of treatment for mild gestational diabetes mellitus", J Matern Fetal Neonatal Med, 11, pp.226~231 (2002)
- Naylor CD, "Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators", JAMA, 275, pp.1165~1170 (1996)