妊娠晚期胰岛素需求量下降：与产科和新生儿结局的关系。
Falling insulin requirement in late pregnancy: association with obstetric and neonatal outcomes.
机构信息
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
Department of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA.
出版信息
J Perinatol. 2021 May;41(5):1043-1049. doi: 10.1038/s41372-021-00979-x. Epub 2021 Mar 4.
OBJECTIVE
To investigate whether diminishing insulin requirement in the third trimester is associated with placental dysfunction.
STUDY DESIGN
Two-year retrospective cohort study at one tertiary care center of women with pregestational or gestational diabetes, their insulin requirements, and complications associated with placental dysfunction.
RESULTS
Of 157 women, 21 (13%) experienced declining insulin requirement, with average decline of 28% at 34 weeks. They were more likely to have pregestational diabetes (71.4% vs. 42.6%; p < 0.01) and delivered earlier (median 36w4d vs. 37w4d; p < 0.01). There was no difference in placental dysfunction related complications (33% vs. 24%; p = 0.37). There was an increased rate of polyhydramnios (42.9% vs. 8.8%; p < 0.01). NICU admission (62% vs. 33%; p < 0.01) and neonatal respiratory distress (52% vs. 24%; p < 0.01) was higher in cases of declining insulin requirement independent of gestational age.
CONCLUSIONS
A decline in insulin requirement should raise concern for increased risk of NICU admission and neonatal respiratory distress.
目的
探讨妊娠晚期胰岛素需求减少是否与胎盘功能障碍有关。
研究设计
在一家三级保健中心对患有孕前或妊娠糖尿病的妇女进行了为期两年的回顾性队列研究，评估其胰岛素需求以及与胎盘功能障碍相关的并发症。
结果
在 157 名妇女中，有 21 名（13%）经历了胰岛素需求的下降，平均在 34 周时下降了 28%。她们更有可能患有孕前糖尿病（71.4%比 42.6%；p<0.01）和更早分娩（中位数 36w4d 比 37w4d；p<0.01）。与胎盘功能障碍相关的并发症无差异（33%比 24%；p=0.37）。羊水过多的发生率更高（42.9%比 8.8%；p<0.01）。在独立于胎龄的情况下，胰岛素需求下降的情况下，NICU 入院率（62%比 33%；p<0.01）和新生儿呼吸窘迫发生率（52%比 24%；p<0.01）更高。
结论
胰岛素需求下降应引起对 NICU 入院和新生儿呼吸窘迫风险增加的关注。
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