Sutherland H W, Stowers J M, Cormack J D, Bewsher P D
Br Med J. 1973 Jul 7;3(5870):9-13. doi: 10.1136/bmj.3.5870.9.
The intravenous glucose tolerance test (I.V.G.T.T.) was used to diagnose chemical diabetes during pregnancy in 180 women, 50 of whom subsequently received chlorpropamide therapy in a daily dosage of 100 mg; the remainder had no drug therapy.Preliminary work showed the I.V.G.T.T. to be reproducible in the second and third trimesters but not in the puerperium in normal pregnancy. Though intravenous glucose tolerance deteriorates between the second and third trimesters in women with no features of diabetes, a significant improvement occurs after a course of chlorpropamide in a daily dosage of 100 mg during pregnancy in chemical diabetes, but this treatment did not enhance the rate of return to normal glucose tolerance post partum.Plasma glucose and insulin studies showed no evidence of hypoglycaemia or hyperinsulinism in the mother at delivery or in the newborn when chlorpropamide had been used compared with a group receiving no such treatment. In the infants of the chlorpropamide-treated mothers there was a suggestion of an increased rate of glucose disposal in response to a glucose challenge, but no increase in birth weight.There were two fetal deaths in the 50 pregnancies of mothers treated with chlorpropamide, one being due to a mistaken premature delivery and the other to a diaphragmatic hernia. Thus chlorpropamide in a dose of 100 mg a day has been shown to reverse chemical diabetes diagnosed and treated in pregnancy without apparent risk to the fetus.
采用静脉葡萄糖耐量试验（I.V.G.T.T.）对180名孕期妇女进行化学性糖尿病诊断，其中50名随后接受每日剂量100毫克的氯磺丙脲治疗，其余未接受药物治疗。前期研究表明，I.V.G.T.T.在正常妊娠的孕中期和孕晚期可重复进行，但在产褥期不可重复。尽管无糖尿病特征的女性在孕中期和孕晚期之间静脉葡萄糖耐量会变差，但在化学性糖尿病孕妇孕期接受每日剂量100毫克的氯磺丙脲治疗一个疗程后，葡萄糖耐量会有显著改善，但这种治疗并未提高产后葡萄糖耐量恢复正常的速率。血浆葡萄糖和胰岛素研究表明，与未接受此类治疗的一组相比，使用氯磺丙脲的母亲在分娩时及新生儿中均未出现低血糖或高胰岛素血症的迹象。在接受氯磺丙脲治疗的母亲所生婴儿中，有迹象表明对葡萄糖刺激的葡萄糖处置速率增加，但出生体重未增加。在接受氯磺丙脲治疗的母亲的50次妊娠中有2例胎儿死亡，1例因误诊早产，另1例因膈疝。因此，已证明每日剂量100毫克的氯磺丙脲可逆转孕期诊断和治疗的化学性糖尿病，且对胎儿无明显风险。
