Norwich Medical School, University of East Anglia, Norwich, U.K.
Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K.
Diabetes Care. 2018 Aug;41(8):1563-1571. doi: 10.2337/dci18-0001. Epub 2018 Jun 23.
Studies from Scotland and Canada confirm large increases in the incidence of pregnancies complicated by pregestational type 1 diabetes (T1D). With this increased antenatal workload comes more specialization and staff expertise, which may be important as diabetes technology use increases. While euglycemia remains elusive and obstetrical intervention (earlier delivery, increased operative deliveries) is increasing, there have been some notable successes in the past 5-10 years. These include a decline in the rates of congenital anomaly (Canada) and stillbirths (U.K.) and substantial reductions in both maternal hypoglycemia (both moderate and severe) across many countries. However, pregnant women with T1D still spend ∼30-45% of the time (8-11 h/day) hyperglycemic during the second and third trimesters. The duration of maternal hyperglycemia appears unchanged in routine clinical care over the past decade. This ongoing fetal exposure to maternal hyperglycemia likely explains the persistent rates of large for gestational age (LGA), neonatal hypoglycemia, and neonatal intensive care unit (NICU) admissions in T1D offspring. The Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found that pregnant women using real-time continuous glucose monitoring (CGM) spent 5% less time (1.2 h/day) hyperglycemic during the third trimester, with clinically relevant reductions in LGA, neonatal hypoglycemia, and NICU admissions. This article will review the progress in our understanding of the intensive glycemic treatment of T1D pregnancy, focusing in particular on the recent technological advances in CGM and automated insulin delivery. It suggests that even with advanced diabetes technology, optimal maternal dietary intake is needed to minimize the neonatal complications attributed to postprandial hyperglycemia.
来自苏格兰和加拿大的研究证实，妊娠前 1 型糖尿病（T1D）并发的发病率大幅增加。随着产前工作量的增加，需要更多的专业化和员工专业知识，这可能很重要，因为糖尿病技术的使用正在增加。虽然血糖仍然难以控制，产科干预（更早分娩、更多手术分娩）正在增加，但在过去 5-10 年中，已经取得了一些显著的成功。这些成功包括先天性异常（加拿大）和死产率（英国）的下降，以及许多国家中度和重度母亲低血糖症的大幅减少。然而，患有 T1D 的孕妇在第二和第三个三个月期间仍有约 30-45%（8-11 小时/天）的时间血糖过高。在过去十年的常规临床护理中，母亲高血糖的持续时间似乎没有改变。这种持续的胎儿暴露于母体高血糖可能解释了 T1D 后代中持续存在的巨大胎儿比例（LGA）、新生儿低血糖和新生儿重症监护病房（NICU）入院率。1 型糖尿病妊娠妇女实时连续血糖监测试验（CONCEPTT）发现，使用实时连续血糖监测（CGM）的孕妇在第三个三个月中血糖过高的时间减少了 5%（每天 1.2 小时），LGA、新生儿低血糖和 NICU 入院率有临床相关的降低。本文将回顾我们对 T1D 妊娠强化血糖治疗的理解进展，特别关注 CGM 和自动胰岛素输送的最新技术进步。它表明，即使使用先进的糖尿病技术，也需要最佳的母体饮食摄入，以最大程度地减少归因于餐后高血糖的新生儿并发症。
