Catalano P M, Tyzbir E D, Roman N M, Amini S B, Sims E A
Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington.
Am J Obstet Gynecol. 1991 Dec;165(6 Pt 1):1667-72. doi: 10.1016/0002-9378(91)90012-g.
To assess the longitudinal changes in insulin release and insulin sensitivity in nonobese normal women during gestation, six women were evaluated with oral glucose tolerance testing, body composition analysis, intravenous glucose tolerance tests, and the hyperinsulinemic-euglycemic clamp before conception, at 12 to 14 weeks, and at 34 to 36 weeks' gestation. There was a significant increase in the insulin/glucose ratio (p = 0.028) during the oral glucose tolerance test during gestation. There was also a significant 3.0- to 3.5-fold increase throughout gestation in first-phase (p = 0.001) and second-phase (p = 0.0001) insulin release during the intravenous glucose tolerance test. Peripheral insulin sensitivity was estimated as the glucose infusion rate (in milligrams per kilogram fat-free mass per minute) during the hyperinsulinemic-euglycemic clamp. There was a significant (p = 0.0003) 56% decrease in insulin sensitivity through 36 weeks' gestation. These results are the first to prospectively evaluate the longitudinal changes in maternal carbohydrate metabolism from the time before conception through late gestation with newer methods such as the hyperinsulinemic-euglycemic clamp.
为评估非肥胖正常女性在孕期胰岛素释放和胰岛素敏感性的纵向变化，对6名女性在受孕前、孕12至14周以及孕34至36周时进行了口服葡萄糖耐量试验、身体成分分析、静脉葡萄糖耐量试验和高胰岛素正常血糖钳夹试验。孕期口服葡萄糖耐量试验期间，胰岛素/葡萄糖比值显著升高（p = 0.028）。静脉葡萄糖耐量试验期间，整个孕期第一阶段（p = 0.001）和第二阶段（p = 0.0001）胰岛素释放也显著增加3.0至3.5倍。外周胰岛素敏感性通过高胰岛素正常血糖钳夹试验期间的葡萄糖输注速率（毫克/千克去脂体重/分钟）进行评估。至孕36周时，胰岛素敏感性显著降低（p = 0.0003）56%。这些结果首次采用高胰岛素正常血糖钳夹试验等新方法，前瞻性评估了从受孕前到妊娠晚期母体碳水化合物代谢的纵向变化。
