Weiss P A, Hofmann H M, Winter R R, Lichtenegger W, Pürstner P, Haas J
Arch Gynecol. 1986;239(2):81-91. doi: 10.1007/BF02133967.
In spite of dietary treatment, the infants of pregnant patients with abnormal glucose tolerance have hyperinsulinism and diabetogenic fetopathy in 10 to 36% of cases. Those patients, who require insulin to prevent from fetopathy cannot be reliably selected by maternal parameters such as blood glucose and glycosylated hemoglobin values. We recommend the measurement of amniotic fluid insulin between the 28 and 32 weeks of pregnancy to differentiate whether the fetus is compromised or not. Subjects with values above the 97th centile require insulin therapy. Inadequate insulin dosage or delayed fetal hyperinsulinism can be discovered by checking the amniotic fluid insulin level at 33 to 36 weeks. In a total of 88 gestational diabetic patients 19 had raised amniotic fluid insulin levels indicating the onset of diabetic fetopathy at an early stage. Diabetic patients with raised amniotic fluid insulin levels needed large doses of insulin, namely 64.6 +/- 29.5 (Mean +/- SD) U/24 h. This treatment reduced mean blood glucose levels from 98 +/- 9 (Mean +/- SD) mg/dl to 82 +/- 10 mg/dl and was sufficient to prevent from diabetic fetopathy.
尽管进行了饮食治疗，但糖耐量异常的孕妇所生婴儿中，10%至36%的病例存在高胰岛素血症和致糖尿病胎儿病变。那些需要胰岛素来预防胎儿病变的患者，无法通过母体参数如血糖和糖化血红蛋白值来可靠地筛选出来。我们建议在妊娠28至32周期间测量羊水胰岛素水平，以区分胎儿是否受到影响。羊水胰岛素值高于第97百分位数的受试者需要胰岛素治疗。通过在33至36周检查羊水胰岛素水平，可以发现胰岛素剂量不足或胎儿高胰岛素血症延迟的情况。在总共88例妊娠期糖尿病患者中，有19例羊水胰岛素水平升高，表明糖尿病胎儿病变在早期就已发生。羊水胰岛素水平升高的糖尿病患者需要大剂量胰岛素，即64.6±29.5（均值±标准差）U/24小时。这种治疗将平均血糖水平从98±9（均值±标准差）mg/dl降至82±10mg/dl，足以预防糖尿病胎儿病变。
