Magon Navneet, Seshiah Veerasamy
Head, Department of Obstetrics & Gynecology, Air Force Hospital, Jorhat, Assam India.
Dr. V. Seshiah Diabetes Research Institute & Dr. Balaji Diabetes Care Centre, Chennai, Tamil Nadu India.
J Obstet Gynaecol India. 2014 Apr;64(2):82-90. doi: 10.1007/s13224-014-0525-4. Epub 2014 Mar 18.
Diabetic pregnancies have attendant risks. Adverse fetal, neonatal, and maternal outcomes in a diabetic pregnancy can be avoided by optimum glycemic control. Most pregnancies with GDM can be managed with non-insulinic management, which includes medical nutrition therapy. However, many necessitate concomitant insulinic management. The new insulin analogs present undoubted advantages in reducing the risk of hypoglycemia, mainly during the night, and in promoting a more physiologic glycemic profile in pregnant women with diabetes. Rapid-acting insulin analogs seem to be safe and efficient in reducing postprandial glucose levels more proficiently than regular human insulin, with less hypoglycemia. The long-acting insulin analogs do not have a pronounced peak effect as NPH insulin, and cause less hypoglycemia, mainly during the night. The review focuses on glycemic goals in pregnancy, insulinic management of GDM, and posology of insulin and its analogs. Clear understanding of the insulinic management of GDM is essential for women's health care providers to provide comprehensive care to women whose pregnancies are complicated with diabetes and rechristen the ''diabetic capital of the world'' to the ''diabetic care capital of the world.''
糖尿病妊娠存在相关风险。通过优化血糖控制可避免糖尿病妊娠中出现不良的胎儿、新生儿及母体结局。大多数妊娠期糖尿病（GDM）患者可通过非胰岛素治疗进行管理，其中包括医学营养治疗。然而，许多患者需要同时进行胰岛素治疗。新型胰岛素类似物在降低低血糖风险方面具有明显优势，主要是在夜间，并且能使糖尿病孕妇的血糖谱更接近生理状态。速效胰岛素类似物在降低餐后血糖水平方面似乎比常规人胰岛素更安全有效，且低血糖发生率更低。长效胰岛素类似物不像中性鱼精蛋白锌胰岛素（NPH胰岛素）那样有明显的峰值效应，主要在夜间引起的低血糖更少。本综述重点关注妊娠期间的血糖目标、GDM的胰岛素治疗以及胰岛素及其类似物的用药剂量。对于女性医疗保健提供者而言，清楚了解GDM的胰岛素治疗对于为妊娠合并糖尿病的女性提供全面护理至关重要，从而将“世界糖尿病之都”转变为“世界糖尿病护理之都”。
