Reece E A, Coustan D R, Sherwin R S, Tuck S, Bates S, O'Connor T, Tamborlane W V
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510.
Am J Obstet Gynecol. 1991 Jul;165(1):126-30. doi: 10.1016/0002-9378(91)90240-r.
Intensive treatment of insulin-dependent diabetes mellitus during pregnancy often normalizes plasma glucose levels. However, it is unclear whether this adversely affects other metabolic fuels that are essential to normal fetal growth and development. Metabolic studies were conducted after the subjects ingested a standardized mixed meal during each trimester in 7 normal and 15 insulin-dependent diabetic pregnant women. The latter were treated with continuous subcutaneous insulin infusion or multiple injections, which were adjusted to achieve strict glucose control throughout pregnancy. Insulin, alanine, branched-chain amino acids, triglycerides, free fatty acids, and ketones were measured every 15 to 30 minutes before a standardized breakfast and for 150 minutes after the breakfast. Patients with insulin-dependent diabetes mellitus were studied while they received their unusual insulin dosages. Fasting glucose levels (87 +/- 7 mg/dl) and glucose levels 150 minutes after the meal (112 +/- 11 mg/dl) were near normal. However, normoglycemia was achieved at the expense of increased plasma insulin levels (area under insulin response curves, p less than 0.01, vs nondiabetic curves). Nevertheless, fasting and post-prandial plasma branched-chain amino acids, alanine, and free fatty acids were similar in both groups. Fasting cholesterol, triglyceride, and ketone levels were also normalized. We conclude that normalization of circulating amino acids and lipids in conjunction with correction of hyperglycemia may contribute to favorable outcomes in infants of intensively treated diabetic mothers.
孕期对胰岛素依赖型糖尿病进行强化治疗往往能使血糖水平恢复正常。然而，目前尚不清楚这是否会对正常胎儿生长发育所必需的其他代谢燃料产生不利影响。对7名正常孕妇和15名胰岛素依赖型糖尿病孕妇在妊娠各期摄入标准化混合餐后进行了代谢研究。后者接受持续皮下胰岛素输注或多次注射治疗，并进行调整以在整个孕期实现严格的血糖控制。在标准化早餐前每隔15至30分钟以及早餐后150分钟测量胰岛素、丙氨酸、支链氨基酸、甘油三酯、游离脂肪酸和酮体。对胰岛素依赖型糖尿病患者在接受其特殊胰岛素剂量治疗时进行研究。空腹血糖水平（87±7mg/dl）和餐后150分钟血糖水平（112±11mg/dl）接近正常。然而，血糖正常是以血浆胰岛素水平升高为代价实现的（胰岛素反应曲线下面积，与非糖尿病曲线相比，p<0.01）。尽管如此，两组的空腹和餐后血浆支链氨基酸、丙氨酸和游离脂肪酸相似。空腹胆固醇、甘油三酯和酮体水平也恢复正常。我们得出结论，循环氨基酸和脂质的正常化以及高血糖的纠正可能有助于强化治疗的糖尿病母亲所生婴儿获得良好结局。
