Small M, Cameron A, Lunan C B, MacCuish A C
Diabetic/Obstetric Clinic, Royal Maternity Hospital, Glasgow, Scotland.
Diabetes Care. 1987 Sep-Oct;10(5):594-9. doi: 10.2337/diacare.10.5.594.
We assessed the factors influencing the birth weight of infants born to 83 women with insulin-dependent diabetes mellitus (IDDM) over a 5-yr period. Maternal glycosylated hemoglobin (HbA1) concentrations at delivery correlated with the percentile birth-weight ratios (r = .43, P less than .001) and indicated that approximately 18% of variance in the birth weight could be ascribed to glycemic control in the third trimester. Fetal macrosomia occurred in 22 (27%) pregnancies. When 20 of these pregnancies were compared closely with 20 nonmacrosomic pregnancies in diabetic women, the mothers of macrosomic infants were found to be more obese, have a history of previous macrosomic birth, and have higher concentrations of serum human placental lactogen and urinary estriols in the third trimester. Macrosomic pregnancy was further distinguished by accelerated fetal growth (judged by serial ultrasonography) from the 32nd wk of gestation and by biochemical (but asymptomatic) hypoglycemia in the neonate. In our study, no serious neonatal morbidity could be attributed to macrosomic pregnancy. Good glycemic control was attained in both groups, and no significant differences between the groups in overall glycemic control throughout pregnancy were noted. Thus, despite good glycemic control, macrosomia remains comparatively common in modern pregnancy complicated by IDDM, and factors other than maternal hyperglycemia must contribute to its etiology.
我们评估了在5年期间83例胰岛素依赖型糖尿病（IDDM）女性所分娩婴儿出生体重的影响因素。分娩时母体糖化血红蛋白（HbA1）浓度与出生体重百分位比值相关（r = 0.43，P < 0.001），这表明出生体重约18%的变异可归因于孕晚期的血糖控制。22例（27%）妊娠发生了巨大儿。将其中20例此类妊娠与20例糖尿病女性的非巨大儿妊娠进行仔细比较时，发现巨大儿婴儿的母亲更肥胖，有既往巨大儿出生史，且孕晚期血清人胎盘催乳素和尿雌三醇浓度更高。巨大儿妊娠的进一步特征是从妊娠第32周起胎儿生长加速（通过系列超声检查判断）以及新生儿出现生化性（但无症状）低血糖。在我们的研究中，没有严重的新生儿发病可归因于巨大儿妊娠。两组均实现了良好的血糖控制，且整个孕期两组在总体血糖控制方面未发现显著差异。因此，尽管血糖控制良好，但巨大儿在现代IDDM合并妊娠中仍然相对常见，且除母体高血糖外的其他因素必定对其病因有影响。
