Intrauteriner Tod des Feten bei präkonzeptionellem Diabetes, Gestationsdiabetes und Schwangerschaften ohne diabetische Stoffwechsellage. Ergebnisse der Perinatalstatistik Niedersachsen

Zusammenfassung

Fragestellung: Die Prävalenz des intrauterinen Fruchttodes (IUFT) sowie die diesbezüglichen Risikofaktoren für präkonzeptionelle Diabetikerinnen, Gestationsdiabetikerinnen und Schwangerschaften ohne diagnostizierten Diabetes wurden vergleichend untersucht. Methode: Die Daten der Perinatalerhebung Niedersachsen für die Jahre 1987 bis 1999 wurden retrospektiv für Schwangere mit präkonzeptionellem Diabetes mellitus (PDM: n = 3351), Gestationsdiabetes (GDM: n = 3954) und Schwangerschaften ohne Diabetes (KDM: n = 887 779) analysiert. Ergebnisse: Intrauteriner Fruchttod: PDM n = 46 (1,35 %), GDM n = 32 (0,79 %), KDM n = 2756 (0,31 %); Odds Ratio (OR) und 95 %-Konfidenzintervall für PDM vs. KDM 4,468 (3,332 - 5,992; p<0,01), OR für GDM vs. KDM 2,595 (1,829 - 3,682; p<0,01). Zeitpunkt des Todes vor der 32. SSW: PDM 13,0 %, GDM 12,5 %, KDM 27,7 %, (p<0,05 für PDM vs. KDM); Zeitpunkt des Todes zwischen der 32. und 36. SSW: PDM 37,0 %, GDM 43,75 %, KDM 33,0 %; Zeitpunkt des Todes > 36. SSW: PDM 50,0 %, GDM 43,75 %, KDM 39,3 % (p<0,05 für PDM vs. KDM). Anteil der verstorbenen Kinder < 10. Gewichtsperzentile: PDM 15,2 %, GDM 6,3 %, KDM 28,7 %; Anteil verstorbener Kinder > 90. Gewichtsperzentile: PDM 41,3 %; GDM 37,5 %; KDM 8,7 % (p<0,01 jeweils für PDM bzw. GDM vs. KDM). Schlussfolgerung: Das Risiko des intrauterinen Fruchttodes ist in diabetischen Schwangerschaften weiterhin erhöht. Dieses gilt insbesondere für hypertrophe Kinder, während in nichtdiabetischen Schwangerschaften die hypotrophen Kinder gefährdeter sind.

Abstract

Object: The prevalence of intrauterine fetal death as well as the relevant risk factors in pregnancies of women with preconceptional and gestational diabetes mellitus and non-diabetic women were investigated. Methods: The data of the Perinatal Registry of Lower Saxony between 1987 and 1999 for pregnancies of women with preconceptional diabetes mellitus (PDM, n = 3351), gestational diabetes mellitus (GDM, n = 3954) and women without diabetes mellitus (non-diabetic pregnancies, NDM, n = 887,779) were retrospectively analysed. Results: Intrauterine fetal death occurred in 46 women with PDM (1.35 %), 32 women with GDM (0.79 %) and 2756 non-diabetic women (0.31 %). The odds ratio (OR, 95 % CI) for PDM vs. NDM was 4.468 (3.332 - 5.992; p < 0.01) and for GDM vs. NDM it was 2.595 (1.829 - 3.682; p < 0.01). The percentage of death, which occurs before the 32^nd week of gestation, was 13 % in pregnancies with PDM, 12.5 % in pregnancies with GDM and 27.7 % in non-diabetic pregnancies. 50 % of fetal deaths in the PDM group, 43.8 % of those in the GDM group and 39.3 % of those in the NDM group occurred after the 36^th week of gestation. The percentages of dead fetuses who were under the 10^th percentile of growth (small for gestational age, SGA), in pregnancies with PDM, GDM and NDM were 15.2 %, 6.3 %, and 28.7 %, respectively. The percentages of dead fetuses above the 90^th percentile of growth (large for gestational age, LGA) were 41.3 % (PDM), 37.5 % (GDM), and 8.7 % (NDM), (p < 0.01 for PDM vs. NDM and for GDM vs. NDM). Conclusion: The risk of intrauterine fetal death in pregnancies of diabetic women is still increased. It seems that especially the LGA fetuses of diabetic mothers and SGA fetuses of non-diabetic mothers are at greater risk of intrauterine death.

Schlüsselwörter

Totgeburt - Diabetes und Schwangerschaft - Risikoschwangerschaft

Key words

Stillbirth - diabetes and pregnancy - high risk pregnancy

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