Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Denver, Aurora, Colorado, USA.
Diabetes Care. 2011 Oct;34(10):2198-204. doi: 10.2337/dc11-0723. Epub 2011 Jul 20.
We sought to define 24-h glycemia in normal-weight and obese pregnant women using continuous glucose monitoring (CGM) while they consumed a habitual and controlled diet both early and late in pregnancy.
Glycemia was prospectively measured in early (15.7 ± 2.0 weeks' gestation) and late (27.7 ± 1.7 weeks' gestation) pregnancy in normal-weight (n = 22) and obese (n = 16) pregnant women on an ad libitum and controlled diet. Fasting glucose, triglycerides (early pregnancy only), nonesterified fatty acids (FFAs), and insulin also were measured.
The 24-h glucose area under the curve was higher in obese women than in normal-weight women both early and late in pregnancy despite controlled diets. Nearly all fasting and postprandial glycemic parameters were higher in the obese women later in pregnancy, as were fasting insulin, triglycerides, and FFAs. Infants born to obese mothers had greater adiposity. Maternal BMI (r = 0.54, P = 0.01), late average daytime glucose (r = 0.48, P < 0.05), and late fasting insulin (r = 0.49, P < 0.05) correlated with infant percentage body fat. However, early fasting triglycerides (r = 0.67, P < 0.001) and late fasting FFAs (r = 0.54, P < 0.01) were even stronger correlates.
This is the first study to demonstrate that obese women without diabetes have higher daytime and nocturnal glucose profiles than normal-weight women despite a controlled diet both early and late in gestation. Body fat in infants, not birth weight, was related to maternal BMI, glucose, insulin, and FFAs, but triglycerides were the strongest predictor. These metabolic findings may explain higher rates of infant macrosomia in obese women, which might be targeted in trials to prevent excess fetal growth.
通过连续血糖监测（CGM），在正常体重和肥胖孕妇正常进食并控制饮食的情况下，研究孕妇在早孕期（15.7 ± 2.0 周妊娠）和晚孕期（27.7 ± 1.7 周妊娠）的 24 小时血糖变化。
前瞻性地检测 22 名正常体重和 16 名肥胖孕妇在早孕期（15.7 ± 2.0 周妊娠）和晚孕期（27.7 ± 1.7 周妊娠）时自由进食和控制饮食条件下的空腹血糖、甘油三酯（仅早孕期）、非酯化脂肪酸（FFAs）和胰岛素。
尽管饮食得到控制，肥胖孕妇在早孕期和晚孕期的 24 小时血糖曲线下面积均高于正常体重孕妇。晚孕期肥胖孕妇的所有空腹和餐后血糖参数均升高，空腹胰岛素、甘油三酯和 FFAs 也升高。肥胖孕妇所生婴儿的体脂含量更高。母亲的 BMI（r = 0.54，P = 0.01）、晚孕期平均日间血糖（r = 0.48，P < 0.05）和晚孕期空腹胰岛素（r = 0.49，P < 0.05）与婴儿体脂百分比相关。然而，早孕期空腹甘油三酯（r = 0.67，P < 0.001）和晚孕期空腹 FFAs（r = 0.54，P < 0.01）的相关性更强。
这是第一项研究表明，尽管在早孕期和晚孕期都进行了饮食控制，患有糖尿病的肥胖孕妇的日间和夜间血糖水平仍高于正常体重孕妇。婴儿的体脂，而不是出生体重，与母亲的 BMI、血糖、胰岛素和 FFAs 相关，但甘油三酯是最强的预测因素。这些代谢研究结果可能解释了肥胖孕妇婴儿体重大的更高发生率，这可能成为预防胎儿过度生长试验的目标。
