Fallucca F, Maldonato A, Iavicoli M, Di Rollo G, Di Biase N, Napoli A, De Vecchis P, Sciullo E, Gerlinì G, Pachi A
Cattedra di Diabetologia, La Sapienza University, Rome, Italy.
Diabetes Res Clin Pract. 1989 Nov 6;7(4):277-84. doi: 10.1016/0168-8227(89)90016-8.
Circulating insulin antibodies at birth and the degree of maternal metabolic control were measured in 68 infants of insulin-treated diabetic mothers. Their correlation with neonatal B cell function and with the clinical features of the infants was evaluated in order to better understand their influence on fetal outcome. Maternal metabolic control was assessed on the basis of blood glucose levels, glycosuria and the occurrence of hypoglycemia and/or ketonuria. All infants were clinically evaluated for gestational age, macrosomia, hypoglycemia, hyperbilirubinemia, hypocalcemia, and respiratory distress syndrome. Cord blood plasma glucose, C peptide, and IgG insulin antibodies were also measured. It was shown that poor maternal metabolic control was associated with a higher prevalence of fetal morbidity as well as with signs of B cell hyperfunction. Also the presence of circulating insulin antibodies correlated well with higher C peptide levels and with several neonatal complications. B cell hyperfunction, indicated by high C peptide levels in the infants of diabetic mothers, may possibly play a causal role in the pathogenesis of fetal morbidity. In conclusion, a good fetal outcome in insulin-treated diabetic pregnancies was associated with and may have depended upon: (1) good maternal metabolic control, and (2) absence or low levels of circulating insulin antibodies.
对68例接受胰岛素治疗的糖尿病母亲所生婴儿，测定其出生时的循环胰岛素抗体及母亲的代谢控制程度。评估它们与新生儿B细胞功能以及婴儿临床特征的相关性，以便更好地了解它们对胎儿结局的影响。根据血糖水平、糖尿以及低血糖和/或酮尿的发生情况评估母亲的代谢控制。对所有婴儿进行临床评估，包括胎龄、巨大儿、低血糖、高胆红素血症、低钙血症和呼吸窘迫综合征。还测定了脐血血浆葡萄糖、C肽和IgG胰岛素抗体。结果表明，母亲代谢控制不佳与胎儿发病率较高以及B细胞功能亢进的体征有关。循环胰岛素抗体的存在也与较高的C肽水平和几种新生儿并发症密切相关。糖尿病母亲所生婴儿中C肽水平升高表明的B细胞功能亢进，可能在胎儿发病机制中起因果作用。总之，胰岛素治疗的糖尿病妊娠中良好的胎儿结局与以下因素有关，也可能取决于：（1）母亲良好的代谢控制，以及（2）循环胰岛素抗体的缺乏或低水平。
