Center for Pregnant Women with Diabetes, Rigshospitalet, 2100 Copenhagen O, Denmark.
Department of Endocrinology and Metabolism, 2100 Rigshospitalet, Denmark.
J Clin Endocrinol Metab. 2022 May 17;107(6):e2237-e2244. doi: 10.1210/clinem/dgac159.
Falling insulin requirements often lead to considerations of whether a pregnancy can continue safely or if delivery is indicated.
To evaluate prevalence and predictors of falling insulin requirements in pregnant women with preexisting diabetes delivering preterm and to explore the relationship to fetal asphyxia and neonatal morbidity.
A prospective cohort study of 101 consecutive singleton pregnant women with preexisting diabetes delivering preterm < 37 weeks (68 type 1 and 33 type 2 diabetes) where the prevalence of falling insulin requirements (≥20%) before delivery was recorded.
In total, 27% (27/101) experienced falling insulin requirements of median 30% (interquartile range 24-40) before delivery. In all women with type 1 diabetes, the prevalence was 37% (25/68), whereas it was 43% (24/56) in those with indicated preterm delivery and 6% (2/33) among women with type 2 diabetes. In women with type 1 diabetes and indicated preterm delivery, falling insulin requirements were first identified at 34 + 5 (33 + 6-35 + 4) weeks + days and delivery occurred 3 (1-9) days later. Gestational age at delivery, prevalence of suspected fetal asphyxia, and neonatal morbidity were similar in women with and without falling insulin requirements. Neither glycemic control, nausea, or preeclampsia was associated with falling insulin requirement.
Falling insulin requirements often preceded preterm delivery in women with type 1 diabetes, foremost when preterm delivery was indicated, but was not related to fetal asphyxia or neonatal morbidity. Whether falling insulin requirements in late pregnancy are a warning sign of placental insufficiency or mainly reflects variations in normal physiology needs further investigation.
胰岛素需求下降通常会引发关于是否能够继续安全妊娠或是否需要分娩的考虑。
评估患有糖尿病的孕妇在早产时胰岛素需求下降的发生率和预测因素，并探讨其与胎儿窒息和新生儿发病率的关系。
对 101 例连续的患有糖尿病的单胎早产孕妇（<37 周，68 例 1 型糖尿病，33 例 2 型糖尿病）进行前瞻性队列研究，记录分娩前胰岛素需求下降（≥20%）的发生率。
共有 27%（27/101）的孕妇在分娩前经历了胰岛素需求下降，中位数为 30%（24-40%）。所有 1 型糖尿病孕妇中，该发生率为 37%（25/68），而在有指征的早产孕妇中为 43%（24/56），在 2 型糖尿病孕妇中为 6%（2/33）。在有指征的早产且患有 1 型糖尿病的孕妇中，胰岛素需求下降首先在 34+5（33+6-35+4）周+天被发现，分娩发生在 3（1-9）天后。胰岛素需求下降孕妇和未下降孕妇的分娩时的胎龄、疑似胎儿窒息的发生率和新生儿发病率相似。血糖控制、恶心或子痫前期与胰岛素需求下降均无相关性。
1 型糖尿病孕妇的胰岛素需求下降常先于早产，当有早产指征时尤为明显，但与胎儿窒息或新生儿发病率无关。妊娠晚期胰岛素需求下降是否是胎盘功能不全的警告信号，或者主要反映了正常生理的变化，需要进一步研究。
