El-Sayed Y Y, Lyell D J
Department of Gynecology and Obstetrics, Stanford University, California, USA.
Diabetes Technol Ther. 2001 Winter;3(4):635-40. doi: 10.1089/15209150152811270.
Gestational diabetes complicates 3-5% of pregnancies. Of diabetes seen during pregnancy, 10% is pregestational and the remaining 90% represents gestational diabetes. (1,2) Pregnancy in women with pregestational diabetes is especially high risk. Spontaneous abortion, preterm labor, congenital malformations, preeclampsia, macrosomia, birth injury, and cesarean section are all increased in these pregnancies. Deterioration of maternal health during pregnancy, especially in the setting of diabetes-induced end-organ disease, is a real concern. Vigilant surveillance and management of associated disorders such as retinopathy, nephropathy, and chronic hypertension are required. During the preinsulin era, maternal and perinatal mortality in pregnancies complicated by pregestational diabetes was approximately 50%. (1,2) Although modern obstetrical management and the appropriate use of insulin have dramatically improved maternal-fetal outcomes, pregnant patient with diabetes remains at increased risk for complications. There is no doubt that optimizing maternal glucose control is a key element in avoiding established perinatal risks. The most effective means to accomplish this control are topics of active research. Further, hormonal changes during pregnancy can make glycemic control difficult even for the most compliant and educated patient. This paper discusses several new approaches, either currently in practice or under consideration, to pregnancies complicated by diabetes, including oral hypoglycemic agents, lispro, the insulin pump, and transplantation.
妊娠期糖尿病使3%至5%的妊娠复杂化。在孕期出现的糖尿病中，10%为孕前糖尿病，其余90%为妊娠期糖尿病。（1,2）孕前糖尿病女性的妊娠风险特别高。这些妊娠中自然流产、早产、先天性畸形、先兆子痫、巨大儿、产伤和剖宫产的发生率均增加。孕期母亲健康状况恶化，尤其是在糖尿病所致终末器官疾病的情况下，是一个切实令人担忧的问题。需要对视网膜病变、肾病和慢性高血压等相关疾病进行密切监测和管理。在胰岛素出现之前的时代，孕前糖尿病合并妊娠的孕产妇和围产儿死亡率约为50%。（1,2）尽管现代产科管理和胰岛素的合理使用显著改善了母婴结局，但糖尿病孕妇仍有更高的并发症风险。毫无疑问，优化母亲血糖控制是避免既定围产儿风险的关键因素。实现这种控制的最有效方法是当前积极研究的课题。此外，孕期的激素变化即使对最依从和受过教育的患者来说也可能使血糖控制变得困难。本文讨论了几种目前正在实践或正在考虑的针对糖尿病合并妊娠的新方法，包括口服降糖药、赖脯胰岛素、胰岛素泵和移植。
