Mimouni F, Tsang R C, Hertzberg V S, Neumann V, Ellis K
Department of Pediatrics, University of Cincinnati College of Medicine, Ohio.
Obstet Gynecol. 1989 Jul;74(1):49-54.
In pregnancy, an increase in serum calcitriol and parathyroid hormone concentrations has been reported in several studies, though the increase in parathyroid hormone remains controversial. In magnesium deficiency states, parathyroid hormone and calcitriol secretion may be decreased. Because magnesium deficiency may occur in insulin-dependent diabetic patients, mainly because of urinary magnesium losses, we hypothesized that serum parathyroid hormone and calcitriol do not increase in the diabetic pregnancy. We studied, in a prospective longitudinal manner, 35 nondiabetic and 199 insulin-dependent diabetic pregnancies. In diabetic women, the goals of glycemic control were fasting blood glucose below 100 mg/dL and postprandial blood glucose less than 140 mg/dL. Serum magnesium, calcium, parathyroid hormone (whole molecule; ie, 1-84 fragment), and calcitriol were measured three times: 1) 8-12 weeks, 2) 22-28 weeks, and 3) 32-38 weeks' gestation. In normal women, serum parathyroid hormone did not change significantly over pregnancy, and a wide scatter of values was observed. Serum calcitriol increased significantly with advancing gestation. In diabetic women, serum parathyroid hormone had a narrow scatter, but values were within the low-normal range. During the third trimester there was no increase, and even a decrease, in serum calcitriol concentrations. Diabetics had, throughout pregnancy, significantly reduced serum magnesium concentrations when compared with controls. Their serum calcium and ionized calcium concentrations were similar to those of controls, except in the third trimester, when diabetic women had significantly lower serum calcium and ionized calcium concentrations than controls. We speculate that mineral metabolism abnormalities in diabetic pregnancies might be due to relative magnesium and/or insulin deficiency.
在妊娠期间，多项研究报告了血清骨化三醇和甲状旁腺激素浓度升高，不过甲状旁腺激素的升高仍存在争议。在镁缺乏状态下，甲状旁腺激素和骨化三醇的分泌可能会减少。由于胰岛素依赖型糖尿病患者可能会出现镁缺乏，主要是由于尿镁丢失，我们推测糖尿病妊娠时血清甲状旁腺激素和骨化三醇不会升高。我们以前瞻性纵向方式研究了35例非糖尿病妊娠和199例胰岛素依赖型糖尿病妊娠。对于糖尿病女性，血糖控制目标为空腹血糖低于100mg/dL，餐后血糖低于140mg/dL。在妊娠的三个阶段（1）妊娠8 - 12周、（2）22 - 28周、（3）32 - 38周时，测量血清镁、钙、甲状旁腺激素（全分子；即1 - 84片段）和骨化三醇。在正常女性中，血清甲状旁腺激素在妊娠期间无显著变化，且观察到数值分布较广。血清骨化三醇随妊娠进展显著升高。在糖尿病女性中，血清甲状旁腺激素分布范围较窄，但数值在低正常范围内。在妊娠晚期，血清骨化三醇浓度没有升高，甚至有所下降。与对照组相比，糖尿病患者在整个妊娠期间血清镁浓度显著降低。除妊娠晚期糖尿病女性血清钙和离子钙浓度显著低于对照组外，她们的血清钙和离子钙浓度与对照组相似。我们推测糖尿病妊娠中的矿物质代谢异常可能是由于相对镁缺乏和/或胰岛素缺乏所致。
