Pardi G, Buscaglia M, Kustermann A, Bozzetti P, Ferrari M M, Marconi A M
Institute of Obstetrics and Gynecology, University of Milano, Ospedale San Paolo, Italy.
Eur Respir J Suppl. 1989 Mar;3:50s-52s.
In pregnancies complicated by diabetes, foetal lung maturation depends on a good control of maternal blood glucose values. In poorly controlled maternal diabetes, foetal hyperinsulinaemia may cause a delay in pulmonary maturation. There was no single case of respiratory distress syndrome (RDS) in 112 pregnant class B-F diabetic patients that we treated with high doses of insulin. Furthermore, in a controlled randomized trial of diet versus insulin treatment in class A diabetes we found no differences in perinatal mortality in patients with adequate metabolic control. In pregnancies complicated by Rh isoimmunization, determination of phosphatidylglycerol in amniotic fluid is a more reliable marker of foetal lung maturity than is the lecithin/sphingomyelin ratio. The marked decrease in perinatal mortality due to Rh incompatibility observed in recent years depends on several factors including administration of corticosteroids to the mother to prevent RDS, irrespective of whether amniotic fluid parameters indicate foetal lung maturity.
在糖尿病合并妊娠中，胎儿肺成熟取决于对母体血糖值的良好控制。在母体糖尿病控制不佳的情况下，胎儿高胰岛素血症可能导致肺成熟延迟。我们用大剂量胰岛素治疗的112例B-F级糖尿病孕妇中，无一例发生呼吸窘迫综合征（RDS）。此外，在一项A类糖尿病饮食与胰岛素治疗对照随机试验中，我们发现代谢控制良好的患者围产期死亡率无差异。在Rh血型免疫不合合并妊娠中，羊水磷脂酰甘油的测定比卵磷脂/鞘磷脂比值是胎儿肺成熟更可靠的标志物。近年来观察到的由于Rh血型不相容导致的围产期死亡率显著下降取决于几个因素，包括给母亲使用皮质类固醇以预防RDS，无论羊水参数是否表明胎儿肺成熟。
