Zhelyazkova-Savova M
Akush Ginekol (Sofiia). 2012;51(1):36-40.
Diabetes mellitus is frequent during pregnancy and is associated with substantial risks both for the mother and the newborn. An adequate therapy ensures the normal course of pregnancy and delivery and postnatal development of the baby. Insulin, for its well known safety record, has long been considered the drug of first choice for achieving optimal glycemic control in pregnant women. Pregnancy is an indication for intensive insulin therapy. The pre-mixed insulins are not recommended due to their inability to provide the needed therapeutic flexibility during the different periods of pregnancy. The short acting insulin analogue aspart is currently registered for meal-time use in basal therapy with NPH insulin. The long-acting analogues glargine and detemir are still investigated clinically and for the moment are only used off label in pregnancy. Maternal hypoglycemia, the need of injection and the high cost are the main drawbacks of insulin therapy. Evidence has accumulated in recent years that some oral antidiabetics are as efficacious and safe as insulin in gestational diabetes. Metformin and glibenclamide are now increasingly viewed as a rational alternative to insulin therapy--a treatment both preferred by the women and a less expensive one, during pregnancy and breastfeeding.
糖尿病在孕期很常见，并且对母亲和新生儿都有很大风险。适当的治疗可确保孕期、分娩过程正常以及婴儿的产后发育。胰岛素因其众所周知的安全记录，长期以来一直被视为实现孕妇最佳血糖控制的首选药物。妊娠是强化胰岛素治疗的指征。由于预混胰岛素在孕期不同阶段无法提供所需的治疗灵活性，因此不推荐使用。短效胰岛素类似物门冬胰岛素目前已获批与中性鱼精蛋白锌胰岛素联合用于基础治疗中的餐时使用。长效类似物甘精胰岛素和地特胰岛素仍在进行临床研究，目前仅在孕期用于标签外使用。母体低血糖、需要注射以及成本高昂是胰岛素治疗的主要缺点。近年来有证据表明，一些口服抗糖尿病药物在妊娠期糖尿病中与胰岛素一样有效且安全。二甲双胍和格列本脲现在越来越被视为胰岛素治疗的合理替代方案——这是一种在孕期和哺乳期女性都更青睐且成本更低的治疗方法。
