Fasching P, Kainz C, Damjancic P, Endler M, Schneider B, Kurzemann S, Vierhapper H, Waldhäusl W
Universitätsklinik für Innere Medizin III, Abteilung für Endokrinologie und Stoffwechsel, AKH Wien.
Geburtshilfe Frauenheilkd. 1992 Oct;52(10):596-601. doi: 10.1055/s-2007-1023191.
Pregnancy is a state of natural insulin resistance, which is due to placental production of human placental lactogen (HPL), an insulin antagonising hormone, leading to a remarkable increase of insulin requirement in pregnant diabetics in the 2nd and 3rd trimester. Aim of the prospective study was the quantification of daily insulin requirement during the last 28 days before delivery in pregnant women suffering from insulin-dependent diabetes mellitus (n = 20) with and without evidence of "placental insufficiency syndrome" employing peripheral rheography as indirect parameter for placental haemoperfusion. All diabetic women included controlled carbohydrate metabolism by means of a functional insulin therapy (FIT; HbA1c in normal range < 5.8%), a multiple injection regime with frequent blood glucose self-control at least from the 2nd trimester of pregnancy. According to the results of peripheral rheography in the 34th gestational week, an impedanceplethysmographic method for quantifying peripheral haemoperfusion, patients were subdivided in a group with (B: n = 8) and without (A: n = 12) indirect evidence of placental dysfunction. Groups did not differ in maternal age, duration of diabetes, maternal weight and week of delivery (A: 39.08 +/- 1.44; B: 39.12 +/- 1.46). Mean weight of neonates was lower in group B (3319 +/- 619 g) compared to group A (3613 +/- 437 g). During a comparable state of near-normoglycaemia in both groups, 7 out of 8 women in group B, but only 1 out of 12 women in group A displayed a significant decrease in daily insulin requirement from day -28 to day -3 before delivery (linear regression; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
怀孕是一种自然的胰岛素抵抗状态，这是由于胎盘产生人胎盘催乳素（HPL），一种胰岛素拮抗激素，导致妊娠中晚期妊娠糖尿病患者的胰岛素需求量显著增加。这项前瞻性研究的目的是，采用外周血流图作为胎盘血流灌注的间接参数，对患有胰岛素依赖型糖尿病的孕妇（n = 20）在分娩前最后28天的每日胰岛素需求量进行量化，这些孕妇有或没有“胎盘功能不全综合征”的证据。所有纳入的糖尿病女性均通过功能性胰岛素治疗（FIT；糖化血红蛋白A1c在正常范围<5.8%）控制碳水化合物代谢，至少从妊娠中期开始采用多次注射方案并频繁自我监测血糖。根据妊娠第34周外周血流图的结果（一种用于量化外周血流灌注的阻抗体积描记法），患者被分为有（B组：n = 8）和无（A组：n = 12）胎盘功能障碍间接证据的两组。两组在产妇年龄、糖尿病病程、产妇体重和分娩孕周方面无差异（A组：39.08 +/- 1.44；B组：39.12 +/- 1.46）。B组新生儿的平均体重（3319 +/- 619 g）低于A组（3613 +/- 437 g）。在两组血糖接近正常的可比状态下，B组8名女性中有7名，但A组12名女性中只有1名在分娩前第 -28天至第 -3天的每日胰岛素需求量显著下降（线性回归；p < 0.001）。（摘要截断于250字）
