Hayslett J P, Reece E A
Baillieres Clin Obstet Gynaecol. 1987 Dec;1(4):939-54. doi: 10.1016/s0950-3552(87)80043-3.
Since the metabolic changes in normal pregnancy are diabetogenic, pregnancy imposes a severe stress on the metabolic milieu of diabetic patients. Moreover, many patients with long-standing diabetes have vascular complications, including retinopathy, renal insufficiency, nephrotic syndrome and hypertension, that represent separate risk factors for optimal fetal development. Recent experience has suggested that maternal hyperglycaemia, and associated fetal hyperinsulinaemia, may represent an important factor in the development of fetal complications. During the past two to three decades the incidence of perinatal deaths has been reduced in all cases of diabetics to a level that approaches the rate in healthy gravidas when severe congenital anomalies are excluded. Fetal and neonatal morbidity have also been reduced, although rates of congenital anomalies, polyhydramnios and respiratory distress syndrome remain high. In patients with significant vascular complications, especially nephropathy and retinopathy, there is no evidence that pregnancy alters the natural course of these complications. Although the morbidity associated with oedema formation and hypertension is elevated, with meticulous management of patients with diabetic nephropathy, especially in the absence of severe renal insufficiency and/or severe hypertension, pregnancy performance and outcome can be similar to other insulin-dependent diabetics.
由于正常妊娠时的代谢变化具有致糖尿病作用，妊娠会给糖尿病患者的代谢环境带来严重压力。此外，许多长期糖尿病患者存在血管并发症，包括视网膜病变、肾功能不全、肾病综合征和高血压，这些都是影响胎儿正常发育的独立危险因素。最近的经验表明，母体高血糖及相关的胎儿高胰岛素血症可能是胎儿并发症发生的一个重要因素。在过去二三十年里，所有糖尿病患者的围产期死亡率均有所降低，若排除严重先天性畸形，其死亡率接近健康孕妇的水平。胎儿和新生儿发病率也有所下降，尽管先天性畸形、羊水过多和呼吸窘迫综合征的发生率仍然较高。对于有严重血管并发症，尤其是肾病和视网膜病变的患者，没有证据表明妊娠会改变这些并发症的自然病程。尽管与水肿形成和高血压相关的发病率有所升高，但通过对糖尿病肾病患者进行精心管理，尤其是在没有严重肾功能不全和/或严重高血压的情况下，妊娠结局可与其他胰岛素依赖型糖尿病患者相似。
