Kernaghan Dawn, Farrell Tom, Hammond Peter, Owen Philip
The Princess Royal Maternity Hospital, 16 Alexandra Parade, Glasgow, G31 2ER, UK.
Eur J Obstet Gynecol Reprod Biol. 2008 Mar;137(1):47-9. doi: 10.1016/j.ejogrb.2007.05.006. Epub 2007 Nov 14.
Fetal hyperinsulinaemia secondary to maternal hyperglycaemia is considered to be the driving force behind excessive fetal growth. We hypothesised that insulin pump therapy (continuous subcutaneous insulin infusion, CSII) would improve maternal glycaemic control and normalise fetal growth parameters. To this end, this study compares maternal glycaemic control and fetal growth of women receiving insulin pump therapy with those receiving conventional insulin therapy.
Prospective non-randomised study of 42 women with pre-existing diabetes attending a joint obstetric diabetic clinic. Each woman was offered the choice of commencing insulin pump therapy or remaining on a conventional insulin regime. Estimated fetal weight and fetal growth velocity were calculated from routinely collected third trimester ultrasound biometry and expressed as standard deviation (Z) scores.
Eighteen women commenced insulin pump therapy. There was no difference in pre-conception glycosylated haemoglobin A1c concentrations (HbA1c) between pump and conventional therapy groups (mean HbA1c 7.62 versus 8.01; p=0.49) or third trimester glycaemic control (mean HbA1c 6.63 versus 6.44; p=0.51). Women using pump therapy had similar mean growth velocity Z scores (1.5 versus 1.36; p=0.83), similar mean estimated fetal weight Z scores prior to delivery (2.80 versus 2.16; p=0.16) and similar mean birthweight Z scores (2.09 versus 2.00; p=0.86) compared to women using conventional insulin therapy.
This small, non-randomised study suggests that the use of insulin pump therapy offers no benefit in terms of normalising fetal growth velocity, fetal size, birthweight or improving maternal glycaemic control compared to conventional insulin therapy.
继发于母体高血糖的胎儿高胰岛素血症被认为是胎儿过度生长的驱动力。我们假设胰岛素泵治疗（持续皮下胰岛素输注，CSII）将改善母体血糖控制并使胎儿生长参数正常化。为此，本研究比较了接受胰岛素泵治疗的女性与接受传统胰岛素治疗的女性的母体血糖控制情况和胎儿生长情况。
对42名患有糖尿病且在联合产科糖尿病诊所就诊的女性进行前瞻性非随机研究。每位女性可选择开始胰岛素泵治疗或继续采用传统胰岛素治疗方案。根据常规收集的孕晚期超声生物测量数据计算估计胎儿体重和胎儿生长速度，并表示为标准差（Z）分数。
18名女性开始胰岛素泵治疗。泵治疗组和传统治疗组在受孕前糖化血红蛋白A1c浓度（HbA1c）方面无差异（平均HbA1c分别为7.62和8.01；p = 0.49），在孕晚期血糖控制方面也无差异（平均HbA1c分别为6.63和6.44；p = 0.51）。与使用传统胰岛素治疗的女性相比，使用泵治疗的女性具有相似的平均生长速度Z分数（1.5对1.36；p = 0.83）、分娩前相似的平均估计胎儿体重Z分数（2.80对2.16；p = 0.16）和相似的平均出生体重Z分数（2.09对2.00；p = 0.86）。
这项小型非随机研究表明，与传统胰岛素治疗相比，使用胰岛素泵治疗在使胎儿生长速度、胎儿大小、出生体重正常化或改善母体血糖控制方面没有益处。
