Persson Bengt
Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
Semin Fetal Neonatal Med. 2009 Apr;14(2):106-10. doi: 10.1016/j.siny.2009.01.003. Epub 2009 Feb 20.
The definition of neonatal hypoglycemia is controversial. Operational thresholds of blood glucose values at which intervention should be considered have been proposed. IDM and GDM infants frequently exhibit a pronounced drop of plasma glucose immediately after birth. This exaggerated physiological decline of glucose is transient and is seldom accompanied by suppressed lipolysis or clinical symptoms. It is generally attributed to hyperinsulinism elicited by maternal hyperglycemia. Alternative substrates for CNS i.e. lactate and astrocyte glycogen may explain lack of symptoms. Similarly low glucose values later on may cause clinical symptoms. Glucose production rates vary from attenuated to normal likely reflecting differences in maternal glycemic control. The HAPO study of around 25,000 non-diabetic pregnancies revealed strong associations between glucose values (75g OGTT) and increased fetal size and hyperinsulinemia at birth - findings adding strong support to the maternal hyperglycemia - fetal hypinsulinism theory. Mothers with the highest fasting glucose had infants with the highest frequency of clinical neonatal hypoglycaemia (4,6%).
新生儿低血糖的定义存在争议。已经提出了应考虑进行干预的血糖值操作阈值。患有糖尿病母亲的婴儿（IDM）和妊娠期糖尿病母亲的婴儿（GDM）在出生后常常会出现血浆葡萄糖的明显下降。这种葡萄糖的过度生理性下降是短暂的，很少伴有脂肪分解受抑制或临床症状。这通常归因于母体高血糖引起的高胰岛素血症。中枢神经系统的替代底物，即乳酸和星形胶质细胞糖原，可能解释了无症状的原因。同样，随后出现的低血糖值可能会导致临床症状。葡萄糖生成率从减弱到正常不等，这可能反映了母体血糖控制的差异。对约25000例非糖尿病妊娠进行的高血糖与不良妊娠结局（HAPO）研究表明，血糖值（75克口服葡萄糖耐量试验）与出生时胎儿体型增大和高胰岛素血症之间存在密切关联——这些发现为母体高血糖-胎儿低胰岛素血症理论提供了有力支持。空腹血糖最高的母亲所生婴儿发生临床新生儿低血糖的频率最高（4.6%）。
