Dornhorst A, Nicholls J S, Johnston D G
Baillieres Clin Endocrinol Metab. 1990 Jun;4(2):291-311. doi: 10.1016/s0950-351x(05)80052-7.
The mean additional energy requirement for pregnancy has been calculated at 285 kcal daily and it reflects the energy needs for production of the fetoplacental unit and for the maternal physiological adaptations to pregnancy. In practice there is considerable variation in energy requirement due to alterations in maternal energy expenditure. Optimal energy intakes are dictated also by the pre-pregnancy maternal weight. The outcome of pregnancy is improved in the underweight mother by an intake which produces a weight gain in pregnancy of approximately 14 kg, whereas a rise of only 7 kg may be optimal for the obese mother. Obesity with or without diabetes is associated with macrosomia and other problems and it is sensible to attempt to limit weight gain in pregnancy at a time when maternal motivation is high. Diabetes in pregnancy may arise in patients with pre-existing NIDDM or IDDM, but more commonly it is diagnosed for the first time during pregnancy and it usually disappears after delivery (gestational diabetes). Recent evidence suggests that gestational diabetes has a strong genetic component and is usually NIDDM precipitated early in life by the pregnancy. Both gestational diabetes and NIDDM are characterized by insulin deficiency and by insulin resistance. Long-term follow-up studies have demonstrated that NIDDM or impaired glucose tolerance develop in later life in 50-70% of women with previous gestational diabetes. The adverse effects of pregnancy on the mother with pre-existing diabetes may be minimized by good diabetic control as may be adverse effects on the fetus and neonate of diabetes in the mother. An increased incidence of fetal malformations persists in pregnancies with pre-existing maternal diabetes. Diabetes of any form may be associated with neonatal hypoglycaemia. The aim of therapy is to produce maternal normoglycaemia throughout pregnancy by dietary measures and insulin treatment if required. Women with pre-existing diabetes should tighten their blood glucose control from before conception. Optimization of insulin therapy and diet are required for IDDM and most NIDDM women will require insulin treatment in pregnancy. Gestational diabetics require diet and possibly insulin. Most pregnancies now proceed to term.
孕期额外能量需求的平均值经计算为每日285千卡，它反映了胎儿 - 胎盘单位生成以及母体孕期生理适应过程中的能量需求。实际上，由于母体能量消耗的变化，能量需求存在相当大的差异。最佳能量摄入量还取决于孕前母体体重。体重过轻的母亲孕期摄入能使体重增加约14千克，可改善妊娠结局，而肥胖母亲体重增加7千克可能最为适宜。伴有或不伴有糖尿病的肥胖与巨大儿及其他问题相关，在母体积极性较高时尝试限制孕期体重增加是明智之举。孕期糖尿病可能出现在已患有非胰岛素依赖型糖尿病（NIDDM）或胰岛素依赖型糖尿病（IDDM）的患者中，但更常见的是在孕期首次被诊断出来，通常在分娩后消失（妊娠期糖尿病）。最近的证据表明，妊娠期糖尿病有很强的遗传成分，通常是NIDDM在生命早期因妊娠而诱发。妊娠期糖尿病和NIDDM都以胰岛素缺乏和胰岛素抵抗为特征。长期随访研究表明，既往患有妊娠期糖尿病的女性中，50% - 70%在晚年发生NIDDM或糖耐量受损。孕期对患有糖尿病的母亲的不良影响，以及母亲糖尿病对胎儿和新生儿的不良影响，都可通过良好的糖尿病控制而减至最小。患有糖尿病的母亲所怀胎儿的畸形发生率持续升高。任何形式的糖尿病都可能与新生儿低血糖有关。治疗的目的是通过饮食措施以及必要时的胰岛素治疗，使整个孕期母体血糖正常。患有糖尿病的女性在受孕前就应加强血糖控制。IDDM患者需要优化胰岛素治疗和饮食，大多数NIDDM女性在孕期需要胰岛素治疗。妊娠期糖尿病患者需要饮食控制，可能还需要胰岛素治疗。现在大多数妊娠都能足月分娩。
