PDF(Pubmed)
Abstract：
Associations of acute glycemic complications with season and ambient temperature have been reported in general population with diabetes. However, little is known about the risks of acute glycemic complications in relation to season and ambient temperature in pregnant women, who are likely to be even more vulnerable. This work aimed to investigate the associations of season and ambient temperature with pregnancies complicated with hyperglycemia emergency or severe hypoglycemia.
Two separate case-control studies were nested within 150,153 pregnancies by women with type 1, type 2, or gestational diabetes between 2009 and 2014 in Taiwan. Hyperglycemia emergency (mainly diabetic ketoacidosis and hyperosmolar hyperglycemic state) and severe hypoglycemia occurred in 77 and 153 diabetic pregnancies (cases), respectively. Ten control pregnancies were randomly selected for each case by matching each case pregnancy on type of diabetes (i.e., T1DM, T2DM, or GDM), maternal age on the date of acute glycemic complication occurrence (i.e., index date), and \"length of gestation at risk\" (i.e., period between conception and index date). Meteorological parameters were retrieved from 542 meteorological monitoring stations across Taiwan during 2008-2014. Conditional logistic regression analysis with generalized estimation equation was separately performed to estimate the covariate adjusted odds ratios (ORs) of each of the two acute glycemic complications in association with season and ambient temperature within 30 days prior to the index date.
Compared to summer, winter season was associated with a significantly elevated risk of severe hypoglycemia with an OR of 1.74 (95% confidence interval (CI) 1.08-2.79). The OR of hyperglycemic emergency was also elevated in winter season at OR of 1.88, but the significance is only marginal (95% CI 0.97-3.64, p = 0.0598). Subgroup analyses further noted that such seasonal variation was also observed in pregnancies with pre-pregnancy type 1 diabetes and gestational diabetes. On the other hand, ambient temperature was not significantly associated with the two acute glycemic complications.
A moderately but significantly elevated risk of severe hypoglycemia was found in pregnant women with diabetes during winter season, and such increased risk was more evident in pregnancies with T1DM.
Two separate case-control studies were nested within 150,153 pregnancies by women with type 1, type 2, or gestational diabetes between 2009 and 2014 in Taiwan. Hyperglycemia emergency (mainly diabetic ketoacidosis and hyperosmolar hyperglycemic state) and severe hypoglycemia occurred in 77 and 153 diabetic pregnancies (cases), respectively. Ten control pregnancies were randomly selected for each case by matching each case pregnancy on type of diabetes (i.e., T1DM, T2DM, or GDM), maternal age on the date of acute glycemic complication occurrence (i.e., index date), and \"length of gestation at risk\" (i.e., period between conception and index date). Meteorological parameters were retrieved from 542 meteorological monitoring stations across Taiwan during 2008-2014. Conditional logistic regression analysis with generalized estimation equation was separately performed to estimate the covariate adjusted odds ratios (ORs) of each of the two acute glycemic complications in association with season and ambient temperature within 30 days prior to the index date.
Compared to summer, winter season was associated with a significantly elevated risk of severe hypoglycemia with an OR of 1.74 (95% confidence interval (CI) 1.08-2.79). The OR of hyperglycemic emergency was also elevated in winter season at OR of 1.88, but the significance is only marginal (95% CI 0.97-3.64, p = 0.0598). Subgroup analyses further noted that such seasonal variation was also observed in pregnancies with pre-pregnancy type 1 diabetes and gestational diabetes. On the other hand, ambient temperature was not significantly associated with the two acute glycemic complications.
A moderately but significantly elevated risk of severe hypoglycemia was found in pregnant women with diabetes during winter season, and such increased risk was more evident in pregnancies with T1DM.
摘要：
背景：在糖尿病普通人群中已经报道了急性血糖并发症与季节和环境温度的关系。然而,鲜为人知的急性血糖并发症的风险与季节和环境温度有关的孕妇，他们可能会更加脆弱。这项工作旨在研究季节和环境温度与妊娠合并高血糖急诊或严重低血糖的关系。
方法：在2009年至2014年期间，台湾有150,153例1型、2型或妊娠期糖尿病妇女怀孕期间，进行了两项独立的病例对照研究。77例和153例糖尿病妊娠发生高血糖症（主要是糖尿病酮症酸中毒和高渗性高血糖状态）和严重低血糖，分别。通过将每个病例的妊娠与糖尿病类型相匹配，为每个病例随机选择了十个对照妊娠（即，T1DM,T2DM,或GDM)，急性血糖并发症发生日期的产妇年龄(即，索引日期)，和“危险妊娠的长度”(即，概念和索引日期之间的时间段)。2008-2014年期间，从台湾542个气象监测站检索了气象参数。分别进行具有广义估计方程的条件逻辑回归分析，以估计指标日期前30天内与季节和环境温度相关的两种急性血糖并发症的协变量调整比值比（OR）。
结果：与夏季相比，冬季与严重低血糖风险显著升高相关,OR为1.74(95%置信区间(CI)1.08~2.79).冬季高血糖急症的OR也升高，OR为1.88，但意义仅微不足道（95％CI0.97-3.64，p=0.0598）。亚组分析进一步指出，在孕前1型糖尿病和妊娠期糖尿病的妊娠中也观察到这种季节性变化。另一方面,环境温度与两种急性血糖并发症无显著相关性。
结论：在冬季有糖尿病的孕妇中发现中度但显著升高的严重低血糖风险，这种增加的风险在T1DM妊娠中更为明显.
方法：在2009年至2014年期间，台湾有150,153例1型、2型或妊娠期糖尿病妇女怀孕期间，进行了两项独立的病例对照研究。77例和153例糖尿病妊娠发生高血糖症（主要是糖尿病酮症酸中毒和高渗性高血糖状态）和严重低血糖，分别。通过将每个病例的妊娠与糖尿病类型相匹配，为每个病例随机选择了十个对照妊娠（即，T1DM,T2DM,或GDM)，急性血糖并发症发生日期的产妇年龄(即，索引日期)，和“危险妊娠的长度”(即，概念和索引日期之间的时间段)。2008-2014年期间，从台湾542个气象监测站检索了气象参数。分别进行具有广义估计方程的条件逻辑回归分析，以估计指标日期前30天内与季节和环境温度相关的两种急性血糖并发症的协变量调整比值比（OR）。
结果：与夏季相比，冬季与严重低血糖风险显著升高相关,OR为1.74(95%置信区间(CI)1.08~2.79).冬季高血糖急症的OR也升高，OR为1.88，但意义仅微不足道（95％CI0.97-3.64，p=0.0598）。亚组分析进一步指出，在孕前1型糖尿病和妊娠期糖尿病的妊娠中也观察到这种季节性变化。另一方面,环境温度与两种急性血糖并发症无显著相关性。
结论：在冬季有糖尿病的孕妇中发现中度但显著升高的严重低血糖风险，这种增加的风险在T1DM妊娠中更为明显.
