Widness J A, Teramo K A, Clemons G K, Voutilainen P, Stenman U H, McKinlay S M, Schwartz R
Department of Pediatrics, Brown University, Providence, Rhode Island.
Diabetologia. 1990 Jun;33(6):378-83. doi: 10.1007/BF00404643.
In the present study the antepartum relationship between maternal diabetic glucose control and fetal hypoxaemia was examined in 44 Type 1 (insulin-dependent) diabetic and 23 non-diabetic control pregnancies. Maternal HbA1C was used to assess maternal integrated blood glucose control while fetal metabolic control was evaluated by antepartum glucose, insulin, and C-peptide determinations in amniotic fluid at elective caesarean delivery. Fetal hypoxaemia was assessed indirectly by fetal umbilical vein plasma erythropoietin level at delivery. A prospectively developed statistical pathway model was used to examine the relationship of these variables. In applying forced stepwise multiple regression with this model, we observed in the diabetic subjects that mean maternal HbA1C during the last month of pregnancy correlated significantly with fetal umbilical venous erythropoietin at delivery (r = 0.57, p less than 0.001). Additional significant contributions to umbilical venous erythropoietin were found for amniotic fluid glucose and amniotic fluid insulin when these two independent variables were added in stepwise fashion (p less than 0.01). We conclude that in diabetic pregnancy, antepartum control of maternal hyperglycaemia is a significant factor associated with fetal hypoxaemia. We speculate that this effect is mediated through perturbations which accelerate fetal metabolism and which is expressed by amniotic fluid levels of glucose and insulin.
在本研究中，对44例1型（胰岛素依赖型）糖尿病孕妇和23例非糖尿病对照孕妇的产前母体糖尿病血糖控制与胎儿低氧血症之间的关系进行了研究。母体糖化血红蛋白（HbA1C）用于评估母体的综合血糖控制情况，而胎儿代谢控制则通过择期剖宫产时羊水内的产前葡萄糖、胰岛素和C肽测定来评估。胎儿低氧血症通过分娩时胎儿脐静脉血浆促红细胞生成素水平进行间接评估。使用一个前瞻性开发的统计路径模型来研究这些变量之间的关系。在对该模型应用强制逐步多元回归时，我们在糖尿病受试者中观察到，妊娠最后一个月的母体平均HbA1C与分娩时胎儿脐静脉促红细胞生成素显著相关（r = 0.57，p < 0.001）。当逐步加入羊水葡萄糖和羊水胰岛素这两个自变量时，发现它们对脐静脉促红细胞生成素也有额外的显著贡献（p < 0.01）。我们得出结论，在糖尿病妊娠中，产前控制母体高血糖是与胎儿低氧血症相关的一个重要因素。我们推测这种效应是通过加速胎儿代谢的扰动介导的，并且由羊水葡萄糖和胰岛素水平表现出来。
