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2 :;< 34' :/0,12 3 ;&/4# & ;P "4# :48 9 4%,7 47 F34 = &4L3 >KR8 3 (% ;& ;4" 3 3& & \4GP :4& 3 1&4 :4& 46) 7 KG J% S=,= 3 S%.? / J& %4 4 1&4 :& 3 \GP :& 1 / "4KK+ 34e 4} 4 4kK 94 9#"KT,= 47 >4% :)K4G 9K/ = : % 8 9K8 = &/ -8A 1 > 1&? B84+ 84G 14 / 1c2 & %+ 18: A 3.-G ;P /3 &.: 18G & FD6 E# / 9D6 E# / K%.48 J3" 3& G 1 & 9D6 > 94p >4 3 # J& (% \GP :& 9 1& / 5 3 4# J4G (% \, :& 9 1& ;3& & :4& 3 \4GP :& E# 3& JKK+ &?,7 9+?#P/ J34" 4 9#"L J3" 8 G F3 % #= 1& 94,+ 14 ;&4 h4+ 4& 9.#G 9.< '%K+ ;4P 14" 94## 4 /G G 6 & 1 &.4 94D6 14 /4# &4 &D= 9 = #G he%# ƒ 18 J&& 13P QL ;8 9 8G J3" >4 / J&4 A& 4= 1" 9## 3 & J3" 9 94 & /G 6 & :& 9 (% i & ;#/.4G he%# YN]O ' YN]H ' )P 98 G 9D6 &3 ;% 8 & 9+ 1& 8 1/ 9 74%L :4D5 #/3K 7 k# / 9+ 8G 0K2 :c4 &4 4 4k# & 1 L & ;"4KK+ :+4G 94,+.#G he%# K%G& \&# &3 4+ :4 3 94D6 4#3 / 84"P 4 9D6.#G 9D6 M^ J34" 48 & t > 1 /g 9## -? 5 94# :} :L 3 1 ;& h+ & 9 9+ & # 5 %. 9## -? ( & ]I) 9D6 ;= >%G& :# & 9+ :A BA 8G NI 3 & H^ 9 4#3 3 4P 9 9L= (WHO) :G #L ;/ ;4K7 94 :4& ;L & :& 1 = = YaaN '44 / 3 &44+ ( % # 442 S #)A 42 > 9,< 9 ;L 18c+ YaaO '4 & %H / ;4L o :DL BA 9 9L= YNO/ :4& 94 ;4(% &4D= IO ' & %O/H 9 >4 & ) # ;, NII 9 # ;, 4 & UV :Ac42 '4 & 18c4p -4 B4A 18c4p & B4A >4 94p 4 & &4 48) :4& -48 J/3 9T". []G & q 9%Ac2 t46 9%Ac42 18c4p uc ;K7 9 F53 vp & w4 4& 94 "4#/ J3& ' ;G J=p &G '4 & 18cp & :& 9 (% &A > & `&3/ 4 & +," -.% & '(%). [] : %c G ;4/ [N].4x(+ J2 5 / 1#/ 0%#, [Ol]] 1&/& 18 1?K8# 3 #P y< [H] `&3/ 14 [YI]#/ ' 18w 3 [a] 9#G G%.& ) 47 3 && 42 & [YY]&/# 3 & >4 9+ :, "# ;4(% / %HI "4<= 3 48& 4 BA ;/ #G (% \GP :& 9 'I, :& &,4 :4& 94+ : JG &3P >KR8. [Y] J8, >3 / D 18, / & NIl^a & %& ;& ;&/# 3 [YN]&%A 8) { = :& 46) 94p 1 9 [YH]KG :& / 1=g 6) & y4% ' & S E# :& 1 & 3 4 & YO ;& 3 ;8) & & ^ ;#/A &.[YOlYM] :44 J44G &3P44 44 & NI 448,53& ;%. & :&, :& 9<,%e FD6 g4 ;4) c4a BMI =g4 181& &D= 3 > 3.44+= >44 9<44 44\A :44DA 447 1&4 :& /3 } 7 ;K7 9 `KP8 47 >4% &4 & 4 4# 9%A" 5 ~ & 9L=.[Y]l^] && &L3 8k# (%) %,7

3 = ( ). & % = > / 9, > &.:A" 5 \GP :& 9 (% 9#"L 9 J% S=,= 4 3 K%4G& & 4KD ƒ4= 1& ;3& & :& 3 4kK 94.4#& (I/O / 4%+ ) 1& KD 9 S&# 4 3 4?\ 4 9 \ & #P } = 4,= &4 Multinomial Logistic Regression 3.-&& 5 9#" KT 9 (% (% NY/H) # := # UV+ /, :& 9 (% (% ^]/^) # H] 3 \GP :& J3" 3& 8 J&&,= & %c :5& kk 9 3 #& & 9D6 := - ;& 9#"L ;&.-&& 5 9.< c4a >4 148% 94+ 8& ;c# S '3L BMI %42 %& ;) ca %. ;) 3 I/IIY / 4%+ 64 & 1&4 / 4D 3 45 '4%K+ J34" 9 > & I/IH 6 & # :DA 1&4 :4& 3 \4GP :4& 94 (%4 ;& 3 94p 14 9.&& ;c# 1& KD 1P (%) ;4) c4a >4 >#4 '4%K+ J34" ;& & BMI %442 '%44& ;44) c44a '%.44 4,= 3 J&& 45 & 8G NOI 3 & MI (1&4 :& 3 \GP :&) 1 E# S\ = 9.-&&?# &4L 148:&34 &4L3 F7( 13P QL 14\8 7 G 6 & 8;% "K+2 G 9, i 18 / ;& 3 K2 ) J4 & =47( 4G %A %)4 9Kc42 18, J & =7( & SA"& F ec 4?# & 13, J& =7( 13,5 142 ; 4 e% y= 9Kc2 3.:A" 4& 94 3 :4 J4 4 = 9 ;/ 3 ;#/ 3 9 = 4 := 18% 3 /# & F7( ;& K%. 94 /4# 7 3 ;& :5 18 J#32 3 8B/P & ;P 42 B?K4 9 1/# &A 9kA 13 13P & F7( = ;# 5 9 :L >KR8.:.# 148 / ;%4 48 & 48 J&& 13P Q4L & :4} J4# 3 /4# &4 F7( 9K/ &) J& /P ;%4 ;48 ( & 18% D= 3 #P.G J& % 3 94# J&& &33 3 F47( 13P QL /!2 4?# YN B43 SPSS A # #P,= 3 9?= 18;/P / J% S=,= :L '3 9, &.G ;4" '4 3 4G J& %!#3 #P 3 1+ Q J& %4 &4 94#"KT 4,= :L 9#" KT S%.? 5 I J BBC C D%E; $ >? %$ #$%!" #$% NI/] ± O/M N ± ^/] ^/N ± O/IN (( ) & ˆV/ˆ ± ^ Y/MY ± Y/M] ^N/Y ± I/Y YY ± Y Ma ± ] M/O ± O/a a/o ± O/HN ˆ/$ ± O/a Y/] ± Y/O^ ^I/] ± NI Y^/N^ ± Y/YM ]I/HO ± a/aa ^/YY ± H/aH ]/YO ± H/H.( P< I/IO)& &KD P &< ˆV/U ± ^/]O I/]Y ± I/aa MY/] ± YY/] YY^/HM ±Y/^ MH/NI ± a/]o N/H ± N/]^ ^ ± N/] (CM) +, (/)+-. & (mmhg) (mmhg) +0 % 02 3 (kg/m 2 ) %$ / 45 BMI (kg/m 2 ) %$ / 6$ BMI.: Mean ± SD #c# ±&<.( P> I/IO) &# &KD P &<

4 :;< 34' :/0,12 K ;&/4# / %c - J3" ;&/# & (<I/IIY), :4& 94 1&4 :4& 3 \GP :& 9 (% ;& ;&/4# 4 3& k# / J34" 94 > &.P.(P>I/IO) c# J& 1& KD (%) 4 &4 4# ;& } 9D6 > & 9<4 ;%.4 & :4& 94+ G dec 3 :A" 5 /3+4 9<4 ;)c4a 9<, :& & 13+," `KP8.x(+ J2 > 9< :4& 94 (%4 ;&4 / 4%+ 1&4 / 4D 3 5 BMI %42 '%& ;) ca >KR8.& 1& ;& / '%K+ J3" ;& > & 1& / D >4 4.4P :& 9 %+ # \GP :& 9 (%.(P>I/IO)c# J& 1& KD (%) ;& := ;& ;&/# SA"& F ec /!2 ;&4 (P<I/I);&/4# ;/ G dec 9D6 J34" 3& ;&/4# / 4%+ 1& KD \G 9 - J3" >4 3 (I/INH) = > 2P J# ># 3 & & 5 I J BBC C,AN 505 M;7 $ L >? (8%) %$ #$% n=48 HN/] O ]/N NN/N Y^/M H/ YI/H H/N O/Y YH/^ I/] Y^/M (8%)!" #$% n=22 M/M N^/H M/N M/N a/y M/N H/O YN/^ NY/] NY/] NY/] YN/^ (8%) (7 n=350 Y /N O/Y Y^ M/H /a ^/N N/Y I/a ^/N YM/H Y/H -1$ % #$% +-. #$% $ 023 $ +@/ % $ +/ $ +/ $ A%/ B/ $ +B10C $ &D $ +1FE, % #0GH A07" I/O HM/^ N/H ( % D0 YO/a N]/Y /^ I% % D0 ^/M NO /N I0J % D0 a/ Y]/ YH/N &" +02.( P> I/IO) &# &KD P &<.( P< I/IO)& &KD P &<

5 ( ). 5 I J BBC C 4 8 2' 50PQ > $O >?!" #$% +-. #$% OR(CI) I/a] (I/aOlY/IY) I/ (I/IHlY/Y) I/^ (I/IHlY/^) I/]N(I/I]l]/M) $ / ˆ(V/Žl q/ ) OR(CI) Y/IN (Y/IlY/I^H) H/Ia (Y/lYN/Y) N/YH (O/HlaM/M) YN/^ (/alnia/^) YY/Ha (Y/]lMI/Y) YY/a^ (Y/HlYII/M) Y/aH(I/^l^/I) Ž/Ž$ (/ŽlUUq/Ž) U/ŽV(V/ UlV /) +-. & -1$ % #$% %$ #$% $ A07" I0 % D0 &D $ +/ $.( P< I/IO)& &KD P &<.( P> I/IO) &# &KD P &< c2 >% (OR=YY/a^),5 18;/ & > 9<4 3 (P<I/IIY) 64 & 3 3& ' (N '3L).KG \GP :& JKK (P<I/IHH).+= 9< (P<I/II]) / J& %+ - J3" ;#/ > & (P<I/INY) >8P <A #) KL$.: J& :& 9 (% ;#/ / 1&/4# w k# / >KR8 9D6 := ;& ;&/# J4% S4= 4,= & 94+ && ;c4# 9D6 0%#.4 K= `%.4& (P<V/VV) /3+ (P<V/VV) 4 3,4 :4& (%4 4 4 & 7 %c ; (P<V/VV) ,"x8 (P<V/VV) 94D6 > & #& 1& KD ƒ= \GP :& 94 (%4 3 (P<V/VVU). K= 1 9 /# (P<V/VV) 3,4 :& 9D6 := 7 / P (%44) 44\ 44 (P<V/VV$) 144?K8# #4" '4 S & 9#"L F 9 \GP :& 3 )& G )= k# / #&& ;c# 1&KD >% b== > 3 :A" 5 & 9#" KT J4& 1& 4KD (%4) J34" 9 > & ;/ `KP48 b== 9, :& JKK+ >D= 7.(P>I/IO)c# & 13+4," 1&4 :4& 9<4 -<%. ƒ= >D= 3 J% S=,= / D.#G >D=, > 3 ;%. & :& 1& 18% 9,+ 1 9D6 & 7 -<%. i 47 ;4K7 94 4# '4 & 7 > / `&3/ ;/ 9< 3 & 5 L 9 9D6 := 3 4### 54 1& & \GP :& JKK+ >D= \%.? ' &3 K%G& I/I/ B 1&KD < & >4 9<4 3 /3+4 9<4 47 3& 4L 94 &3 7 + / 9+ &&;c# ' > :# & 9+ #G >4 D= 4 # '4 / 48% 948 4,5 148;4/ (OR=N/YH), :& 9< ' & JG.#G ) \GP :& 18JKK & 13+," (OR=YN/^) `KP8 & '3 9L& ;%. (% 9+ G dec 9D6 > & > 3 (OR=H/Ia);%. & :& (OR=YY/Ha) 4 4T,4 :4& 94 (%!#G :& 9 18 JKK+ >D= >% b== 9 (OR=Y/IN), [Y]] Oung F4D6 04 % # & & 4 B4A 9< 3 (OR=Y]/]N)/3+ 9< 3, :& Dick [Ya](OR = /) 4P ;4#/ & Wah Cheung.

6 :;< 34' :/0,12 S 3 [Y]] Oung [Ya] Wah Cheung. [Y] Weijers [O] 4 54K= >4 :,7.G 5K% [NI] ;5G 94 & F4D6 & &L S% 18F3 = & ;= J4G 1K83" 3 + F 9 % > ;& +.:.#& 8J&&,= & F3 % 1P 3 3 & 9c4 F4D6 4 04%# K+ & 9D6 > 0%# 13+4,", :& 9< }= JK8& ;c# ; 4 3 :4 14 /34 & 4A 17 & :& 3 h,64# 182 :# & 3 1 / 1c2 :L 47 4 J3( &G &Kc2 & ;& & ;P ," J4KK+ &4? 47 / 4 9+ & & :&,A 9< 9+ & ;& / 9%& ;P K# 148;/ & 1& :& 9< >KR8 3 ;%. 45 4k# 4 %c4 E > # 9%G& &),5 1c2 ;c#&/# 3 &) & / = K8& 4KT : %\# > + + &.K# 1& 4KD 96 J% S= ' & 9+ 7 / 1. #P ### 5 # ' & #& J&& ;c# :4& '4% ;<A 9#c# 9#" KT ;" ' / &4? 47 '4%K :.4# 7 ;P & >4 4/ 4 4 4k# 9 13 \GP :& JKK+ \4GP :4& 94 (% ;& / 9%& ;P 13 9D6 >4\ 3 4#& & ;3& 9+ G?# 1. } 1& 7 3 8;8 }= & 9 :.G JG # -+ :& JKK+ &? - 7 / D- F Jc#& c83j2 :#3D : <= > ' & M^M h JG := /G \G2,7.: JG?# YN]H 4 [] /3c+ [Y] Weijers [I] (OR =/M) 4## 5 ' & # [H] (OR =a/h) i JG [N].&& #e8 0%# &4 &, :& 9< 9D6 &,4 :4& JKK+ >D= 7 >% ;K7 9,5 N B4A b4 47 >4 94p 1 9 P :& 9.&G 1& ;3& & :& 9 (%!#G & 1 9<4 &4L3 4 (%4!#4G [O] Dabelea 94 D 6 & & >4KR8 && ;c4# BA I, :& & 3 44 (OR =,4 :4& 9< YH/O) [Ya] (OR = Wah Cheung Y/]^) [I] F44D6 Dick 9D6 (%4.4G 9%)KG JKK+ c2 7 >% ;K P ƒ44= 44# 1&44 44 & `KP !#4G 9p 1 9 && ;c# 1& :& 1&KD & 4# c4 04%#.&4 g YN 1 9 (%.:4 J4P :4& 9 [] (OR = YO/O) /3c+ 9D6 & 4# 1& & 13+," >KR & 9+ #& 9p 1 9 # 5 # ' #4G 4 (%4 13+," & 98.KG (% 6) & 97 > ;3 ;& YY/O JP :& 9 [] ]/O!#G > /3c+ 9D6 &.& 9<4 3 /3+4 9<4 7 3& K= 9D6 & dec4 \4GP :& 18JKK+ >D= ;K7 9 > >4% ;4K7 94 /3+4 9<4 9p 1 9 #G B4A 4 Ya \4GP :4& 14!#G 7 4 & :4& 3 /3+4 9<4 >4 ƒ=.8&.:4 J4 P :4& 94 4# [NINIYa] F4D6 148;4/ & >4 9<4 9+ G dec >KR8.8& BA Y (%!#G,5 4 <%.4 1P ƒ= & > J% S=,= & && ;c4# 1&4 &, 3 \GP :& 9 (% [H]i JG [I] Dick [^] Stone FD6 9+ []] J4K2 ;&4 [N] [M]?=&D 3 J&/K5 '4 94 &33 /!42 4 && #4e8 [a] 4+ 3 Dabelea F4D G ) ' / #"

7 ( ). #<#L >. = ;3A 17.Y 1 '%Kp 3 12.;u8 3 >. 9 YNMa {%G c# ;=.; & QG.N 2. Roglic G.,Unwin N., Bennett P.,et al. The burden of mortality attributable to diabetes. Diabetes Care 2005;28(9): Garner, PR, D'Alton, ME, Dudley, DK, et al. Preeclampsia in diabetic pregnancies. Am J Obstet Gynecol 1990; 163 (2) : Greene M.F., Hare J.W., Krache M., et al. Prematurity among insulin-requiring diabetic gravid women. Am J Obstet Gynecol 1989 ;161(1): American Diabetes Association. Preconception care of women with diabetes. Diabetes Care 2003; 26 (Suppl) 1:S Greene M.F., Hare J.W., Cloherty J.P., Benacerraf B.R., Soeldner J.S., Firsttrimester hemoglobin A and risk for major malformation and spontaneous abortion in diabetic pregnancy. Teratology 2002; 65(3) : Miller E., Hare J.W., Cloherty J.P., et al. Elevated maternal hemoglobin A1C in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med ; 304(22): Becerra J.E., Khoury M.J., Cordero J.F., et al. Diabetes mellitus during pregnancy and the risks for specific birth defects: a population-based case-control study. Pediatrics :1990; 85:1. 9. Langer O., Berkus M.D., Huff R.W., Samueloff A., Shoulder dystocia: Should the fetus weighing greater than or equal to 4000 grams be delivered by cesarean section? Am J Obstet Gynecol 1991;165(4 Pt 1): Weintrob N., Karp M., Hod M., Short- and long-range complications in offspring of diabetic mothers. J Diabetes Complications 1996;10 (5): D2,9A KG,9< +.YY :& 1i ;/P 9?%# ƒ=.>. +) +," " MO / J& %,,7 9,?.1& ;3& #& %G F) 3 \G2,7 Jc#&.YMlN F :HN JG,YN]N ;%.=,;?#/ 12. Xuming B.,Ping G.,Xiaoyan X.,et al.,risk factor for development of diabetes mellitus M2N in women with history of gestational diabetes mellitus. Chin Med J (Engl) 2000; 113(8): Macneill S.,Dodds L., Hamilton D., et al. Rate and risk factor for recurrence of gestational diabetes. Diabetes Care 2001; 24(4): Reece E.A., Homko C.J., Infant of the diabetic mother. Semin Perinatol 1994; 18(5) : Atkinson M.A., Maclaren N.K., The pathogenesis of insulin-dependent diabetes mellitus. N Engl J Med 1994; 331(21): Redondo M.J., Rewers M., Yu L., et al. Genetic determination of islet cell autoimmunity in monozygotic twin, dizygotic twin, and non-twin siblings of patients with type 1 diabetes: Prospective twin study. BMJ 1999 Mar 13; 318(7185): Kaprio J., Tuomilehto J., Koskenvuo M., et al. Concordance for type 1 (insulindependent) and type 2 (non-insulindependent) diabetes mellitus in a population-based cohort of twins in Finland. Diabetologia 1992 ; 35(11): Ouyang F., Shen F., Jiang F., Pan M., Risk factors in women with gestational diabetes mellitus. Zhonhua Yu fang yi xue zazhi 2002,36 (6): Cheung N., Wasmer G.,Jalila A., Risk factor for gestational diabetes among asian women. Diabetes Care 2001; 24 (5): Dyck R., Klomp H., Tan L., et al. A comparison of rate,risk factors and outcomes of gestational diabetes between aboriginal and non-aboriginal women in the Saskatoon health district. Diabetes Care 2002 ; 25 (3): Rob N.M.,Dick J., Yvo M., Determinants of mild gestational hyperglycemia and gestational diabetes mellitus in a large dutch multiethnic cohort. Diabetes Care 2002 ;25(1): Keshavarz M., Wah Cheung N.,Babaee GH., et al. Gestational diabetes in Iran :incidence,risk factors and pregnancy outcomes. Diabetes Res Clin Pract 2005; 69(3): Epub 2005 Mar D B# ) &/A.N EG.- 1= DAG 9,?. `7 K & & ;#/ &, :&

8 :;< 34' :/0,12 # YN]N 2. ; -.% 3 ;3& &i.o lnnn F : N JG -cg ' 7.>cA 1,9,DG i JG.H :& 9 (% ;#/ &, :& y= ;% :& + 9 JKK+ 9DL, \G2,7 Jc#&,7 9,?.;%&+ 3 :. JG -% 8 ' YN]Y 2 ;%&+.MlNY F : -?K2 25. Dabela D., Snell Bergeon J., Hartsfield C., et al. Increasing prevalence of gestational diabetes mellitus over time and by birth cohort. Diabetes Care 2005; 28(3): Stone C.H.,Mclachlan K.H., Alliday J,et al. Gestational diabetes in Victoria in :incidence,risk factors and outcomes. Med J Aust ;179(2):118.4,7 4?=&D4 48# J&/ 4K5.M 94 (% 9, ; & KKL 3 KL \G2,7 Jc#&,7 9,?. :&. Na = N^ F JG YY J3& YN]N. 1& + JK2 ;&.] 3 ;) ca ;P ƒ= 3 :& EG ' & KK G ' YI 1g &A & 5T.;%&+ \G2,7 Jc#& 9,?.YNM^ JG T ' YNM] ;%./.M ln F :-8&T 1D2,9A KG,9< +.a :& 1i ;/P 9?%# ƒ=.>. +) +," " MO / J& %,,7 9,?.1& ;3& #& %G F) 3 \G2,7 Jc#&.YMlNF :HN JG,YN]N;%.=,;?#/ 83j2 9A De# ;5G.NI :& / 6) 7 KG.;\8 3 9,?. # & ;# & ;P :8 3,,YNM],; ( 1L \G2 k#,7.hhlna F :N JG,-8 8 J3&

PREGESTATIONAL DIABETES (TYPE 1 AND 2)

PREGESTATIONAL DIABETES (TYPE 1 AND 2) Women with diabetes prior to pregnancy need to evaluate and optimize their baseline to assure the healthiest pregnancy possible.[1] The overall prevalence of pregnant