Lepercq J
Service de Gynécologie-Obstétrique, Hôpital Saint-Vincent-de-Paul, F-75674 PARIS Cedex 14.
Ann Endocrinol (Paris). 2003 Jun;64(3 Suppl):S7-11.
Clinical data demonstrated a close relationship between the conceptional glycated haemoglobin and the occurrence of spontaneous early abortions and fetal malformations. Blood glucose level during pregnancy was correlated with the risk of fetal macrosomia with significant links between birth weight, fetal hyperinsulinemia and mean maternal blood glucose levels. Tight blood glucose control from conception to term was clearly shown to be able to lower the risk of fetal abnormalities and perinatal mortality to that of the offspring of a non-diabetic mother. But this imply mainly to plan the pregnancy and to maintain a tight normoglycemia from the conception, and to establish a close partnership between diabetologist and obstetrician. The diagnosis and the management of gestational diabetes mellitus (GDM) are still subject to a large debate, and particularly screening and diagnosis criteria. However, diagnosis and management of GDM are clearly mandatory, particularly to identify the undiagnosed type 2 diabetic women. As well as for a diabetic pregnancy, the therapeutic management of GDM must be instituted early and must be intensive in order to reduce the level of fetal macrosomia to the one of the non-diabetic population.
临床数据表明，糖化血红蛋白与自然早期流产及胎儿畸形的发生密切相关。孕期血糖水平与巨大儿风险相关，出生体重、胎儿高胰岛素血症与孕妇平均血糖水平之间存在显著联系。从受孕到足月严格控制血糖，显然能够将胎儿异常和围产期死亡率降低至非糖尿病母亲后代的水平。但这主要意味着要计划妊娠，并从受孕开始维持严格的正常血糖水平，还要在糖尿病专家和产科医生之间建立密切的合作关系。妊娠期糖尿病（GDM）的诊断和管理仍存在很大争议，尤其是筛查和诊断标准。然而，GDM的诊断和管理显然是必要的，特别是要识别未被诊断出的2型糖尿病女性。与糖尿病妊娠一样，GDM的治疗管理必须尽早开始且必须强化，以将巨大儿水平降低至非糖尿病人群的水平。
