Ng W K, Ha M H, Davies D P, Lao T, Pang C P, Swaminathan R
Department of Paediatrics, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
Early Hum Dev. 1989 Sep;20(1):37-44. doi: 10.1016/0378-3782(89)90071-6.
Growth of weight, length, head circumference and skinfold thickness (subscapular and triceps) from birth to 6 months in 53 large-for-dates (LFD) Chinese babies weighing greater than 4.0 kg at term and born to non-diabetic mothers was investigated and correlated with biochemical indices of maternal glucose tolerance at birth: glycosylated haemoglobin (HbA1), serum corrected fructosamine and the area under the oral glucose (50 g) tolerance (OGTT) curve. Growth in all physical dimensions, especially weight, showed a downward shift towards a reference mean. These changes in relative size were caused by slower growth velocities. None of the mothers had abnormally high concentrations of HbA1 or fructosamine nor an abnormal OGTT. However, weight velocities did show small but significant correlations with fructosamine (r = -0.42), and OGTT area units (r = 0.39) but not with HbA1. For some macrosomic babies born to apparently normal mothers, birth is seen to interrupt a process operating in prenatal life that accelerates growth. Covert abnormalities of maternal glucose homeostasis could explain this. Abnormal glucose tolerance during pregnancy might therefore be viewed as a continuum extending from (i) its maximum expression, the frankly diabetic state, through (ii) gestational diabetes to (iii) the mother who has no biochemically evident abnormality of glucose homeostasis but who has sufficient alteration to modify fetal growth. Post-natal growth of LFD babies is additional information which, when taken along with other markers of maternal glucose tolerance, might help to identify the mother at later perinatal risk.
对53名足月出生体重超过4.0kg、母亲无糖尿病的大于胎龄儿（LFD）中国婴儿从出生到6个月的体重、身长、头围和皮褶厚度（肩胛下和三头肌处）的生长情况进行了研究，并将其与出生时母亲葡萄糖耐量的生化指标相关联：糖化血红蛋白（HbA1）、血清校正果糖胺以及口服葡萄糖（50g）耐量试验（OGTT）曲线下面积。所有身体维度的生长，尤其是体重，均向参考均值呈下降偏移。相对大小的这些变化是由生长速度较慢引起的。母亲们的HbA1或果糖胺浓度均未异常升高，OGTT也未异常。然而，体重增长速度确实与果糖胺（r = -0.42）和OGTT面积单位（r = 0.39）存在小但显著的相关性，但与HbA1无关。对于一些母亲明显正常的巨大儿来说，出生似乎打断了产前加速生长的过程。母亲葡萄糖稳态的隐匿异常可以解释这一点。因此，孕期葡萄糖耐量异常可被视为一个连续体，从（i）其最大表现形式，即明显的糖尿病状态，经过（ii）妊娠期糖尿病，到（iii）母亲虽无葡萄糖稳态生化明显异常但有足以改变胎儿生长的改变。LFD婴儿的出生后生长是额外的信息，与母亲葡萄糖耐量的其他标志物一起考虑时，可能有助于识别处于围产期后期风险的母亲。
