Thompson D J, Porter K B, Gunnells D J, Wagner P C, Spinnato J A
Department of Obstetrics and Gynecology, University of South Alabama Medical Center, Mobile.
Obstet Gynecol. 1990 Jun;75(6):960-4.
One hundred eight gestational diabetics were randomized to receive either diet alone or diet plus insulin (20 units NPH and 10 units regular) for glycemic control. Blood glucose levels were evaluated weekly in a high-risk clinic where medical and nutritional support and counseling were provided. Among 68 women successfully treated for a minimum of 6 weeks, the mean birth weight, macrosomia rate, and ponderal index were reduced significantly in the insulin-treated group. Insulin reduced birth weights significantly in women with a delivery weight of 200 lb or more (4060 +/- 342 versus 3397 +/- 640 g) and in those with a delivery weight less than 200 lb (3324 +/- 448 versus 3047 +/- 394 g). No patient with good glucose control and a maternal delivery weight under 200 lb had a newborn over 4000 g. Patients failing glycemic control were at greatest risk (30%) for fetal overgrowth whether initially receiving insulin or not. Maternal obesity or failure to achieve glycemic control should alert the clinician to a substantially increased risk of macrosomia.
108名妊娠期糖尿病患者被随机分为两组，一组仅接受饮食控制，另一组接受饮食加胰岛素治疗（20单位中效胰岛素和10单位正规胰岛素）以控制血糖。在提供医疗和营养支持及咨询的高危诊所，每周对血糖水平进行评估。在68名成功治疗至少6周的女性中，胰岛素治疗组的平均出生体重、巨大儿发生率和 ponderal 指数显著降低。胰岛素使分娩体重200磅或以上的女性出生体重显著降低（4060±342克对3397±640克），以及分娩体重低于200磅的女性（3324±448克对3047±394克）。血糖控制良好且母亲分娩体重低于200磅的患者，其新生儿体重均未超过4000克。无论最初是否接受胰岛素治疗，血糖控制不佳的患者发生胎儿过度生长的风险最高（30%）。母亲肥胖或血糖控制不佳应提醒临床医生巨大儿风险大幅增加。
