Kerssen Anneloes, de Valk Harold W, Visser Gerard H A
Department of Perinatology and Gynaecology, University Medical Centre Utrecht, KE.04.123.1, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
Diabetes Care. 2007 May;30(5):1069-74. doi: 10.2337/dc05-1985.
Large-for-gestational-age (LGA) infants (birth weight > or = 90th centile) are a continuing problem in pregnancies of women with type 1 diabetes. We used the continuous glucose monitoring system (CGMS) to assess the relationship between 24-h diurnal glucose profiles in all three trimesters of pregnancy and infant birth weight.
Twenty-nine pregnant women with type 1 diabetes used the CGMS during each trimester of pregnancy. The glucose profiles of the women with a normal-weight infant or an LGA infant were compared.
Of the women with type 1 diabetes, 48% gave birth to an LGA infant. Fifty percent of these infants were already large for dates on ultrasound at < 30 weeks of gestation (early LGA), and all these infants had a birth weight > or = 97.7th centile. The diurnal glucose profiles show that the mothers of early LGA infants had elevated glucose levels for most of the day during the second trimester (P < 0.05). The median 24-h glucose level was significantly higher in women who gave birth to early LGA infants in all three trimesters of pregnancy (6.7, 8.3, and 6.5 mmol/l for the first, second, and third trimesters, respectively). Within the group of women with early LGA infants, the second trimester median glucose level was significantly higher than that in the first and third trimester (P < 0.05).
In women with type 1 diabetes, extreme growth of the fetus starts early in pregnancy and is likely caused by increased maternal glucose levels. Further investigation is needed to see whether early tight glycemic control will reduce the number of extreme LGA infants.
巨大儿（出生体重≥第90百分位数）在1型糖尿病孕妇的妊娠中一直是个问题。我们使用持续葡萄糖监测系统（CGMS）来评估妊娠三个阶段的24小时日间血糖谱与婴儿出生体重之间的关系。
29名1型糖尿病孕妇在妊娠各阶段使用CGMS。比较了分娩正常体重婴儿或巨大儿的孕妇的血糖谱。
1型糖尿病孕妇中，48%分娩出巨大儿。其中50%的婴儿在妊娠<30周时超声检查就已大于孕周（早期巨大儿），所有这些婴儿的出生体重≥第97.7百分位数。日间血糖谱显示，早期巨大儿的母亲在妊娠中期的大部分时间里血糖水平升高（P<0.05）。在妊娠三个阶段均分娩出早期巨大儿的孕妇中，24小时血糖中位数显著更高（妊娠第一、第二和第三阶段分别为6.7、8.3和6.5 mmol/L）。在早期巨大儿的孕妇组中，妊娠中期血糖中位数显著高于第一和第三阶段（P<0.05）。
在1型糖尿病孕妇中，胎儿的过度生长在妊娠早期就开始了，可能是由母体血糖水平升高引起的。需要进一步研究以确定早期严格的血糖控制是否会减少极端巨大儿的数量。
