Durnwald Celeste P, Landon Mark B
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio 43210, USA.
J Matern Fetal Neonatal Med. 2008 May;21(5):309-13. doi: 10.1080/14767050802022797.
To describe perinatal outcomes of women with pregestational diabetes treated with short-acting, regular insulin and the short-acting insulin analogue, lispro.
This was a prospective observational study of women with pregestational diabetes maintained on short-acting insulin regimens over a 3-year period. Clinical characteristics, aspects of diabetic therapy, and perinatal/neonatal outcomes were collected.
Of 107 women, 49 were maintained on regular insulin and 58 utilized the insulin analogue, lispro. Frequency of type 1 diabetes, maternal age, overweight/obese pregravid body mass index (> or =25 kg/m2), preexisting hypertension, and presence of vascular disease were similar between groups. Women treated with lispro had a longer duration of diabetes (11.4 vs. 8.3 years, p = 0.04). Glycemic control was improved in women managed with lispro compared to regular insulin (HgbA1c 5.9 vs. 6.7, p = 0.009). Total insulin requirements were lower in the lispro group in the first (0.58 vs. 0.79 units/kg, p = 0.02), second (0.75 vs. 1.10 units/kg, p = 0.002), and third (0.98 vs. 1.25 units/kg, p = 0.03) trimesters of pregnancy. Mean infant birth weight was greater in the lispro group, whereas the rate of large for gestational age infants and ponderal indices were similar between groups. Malformation rate, gestational age at delivery, neonatal intensive care unit admission, neonatal length of stay, rates of respiratory distress syndrome, and hypoglycemia were similar.
Women treated with lispro demonstrated improved glycemic control and lower total insulin requirements during pregnancy compared to those receiving regular insulin. Perinatal outcomes were similar between women treated with both types of insulin.
描述孕前糖尿病女性使用短效常规胰岛素和短效胰岛素类似物赖脯胰岛素治疗的围产期结局。
这是一项对采用短效胰岛素方案治疗的孕前糖尿病女性进行的为期3年的前瞻性观察研究。收集了临床特征、糖尿病治疗方面以及围产期/新生儿结局。
107名女性中，49名维持使用常规胰岛素，58名使用胰岛素类似物赖脯胰岛素。两组之间1型糖尿病的发病率、产妇年龄、超重/肥胖孕前体重指数（≥25kg/m²）、既往高血压以及血管疾病的存在情况相似。接受赖脯胰岛素治疗的女性糖尿病病程更长（11.4年对8.3年，p = 0.04）。与常规胰岛素相比，使用赖脯胰岛素治疗的女性血糖控制更好（糖化血红蛋白5.9对6.7，p = 0.009）。在妊娠的第一（0.58对0.79单位/千克，p = 0.02）、第二（0.75对1.10单位/千克，p = 0.002）和第三（0.98对1.25单位/千克，p = 0.03）孕期，赖脯胰岛素组的总胰岛素需求量更低。赖脯胰岛素组的平均婴儿出生体重更大，而两组之间大于胎龄儿的发生率和 ponderal指数相似。畸形率、分娩时的孕周、新生儿重症监护病房入住率、新生儿住院时间、呼吸窘迫综合征发生率和低血糖发生率相似。
与接受常规胰岛素治疗的女性相比，使用赖脯胰岛素治疗的女性在孕期血糖控制更好，总胰岛素需求量更低。两种胰岛素治疗的女性围产期结局相似。
