Boehn F H, Graber A L, Hicks M M
South Med J. 1978 Jan;71(1):37-42. doi: 10.1097/00007611-197801000-00012.
Diabetes during pregnancy is associated with insulin resistance, an increase in insulin requirement, and a greater tendency to ketosis and ketoacidosis. Increased perinatal mortality is related to maternal hyperglycemia and can be decreased dramatically with strict control of plasma glucose during pregnancy and a smooth-working obstetrician-internist-neonatologist team. Bad prognostic signs include pyelonephritis, ketoacidosis, toxemia, and poor prenatal care. Timing of delivery is no longer arbitrary at 36 or 37 weeks, but is based upon signs of fetal lung maturation and estimates of fetal risk. Abnormalities in the infant, including congenital abnormalities, biochemical abnormalities, respiratory distress syndrome, and large body weight must be managed in a well-equipped newborn intensive care unit under the care of experienced neonatologists. Strict attention to these principles has resulted in viable infants in the last 36 pregnant diabetic patients delivered at Vanderbilt University Hospital. Therefore, close medical supervision, use of modern obstetric technics, and the availability of a well-equipped and staffed neonatal intensive care unit can result in a good outcome in this group of patients. Finally, the decision for pregnancy must be carefully considered by the diabetic patient, her husband, and her physician long before pregnancy occurs.
妊娠期糖尿病与胰岛素抵抗、胰岛素需求量增加以及酮症和酮症酸中毒倾向增加有关。围产期死亡率增加与母亲高血糖有关，通过孕期严格控制血糖水平以及产科医生、内科医生和新生儿科医生组成的高效协作团队，可显著降低围产期死亡率。不良预后体征包括肾盂肾炎、酮症酸中毒、毒血症和产前护理不佳。分娩时机不再随意定在36或37周，而是基于胎儿肺成熟的迹象和对胎儿风险的评估。婴儿的异常情况，包括先天性异常、生化异常、呼吸窘迫综合征和巨大体重，必须在设备完善的新生儿重症监护病房，由经验丰富的新生儿科医生进行处理。对这些原则的严格关注使得范德比尔特大学医院分娩的最后36例妊娠糖尿病患者所产婴儿得以存活。因此，密切的医疗监督、现代产科技术的应用以及配备完善且人员充足的新生儿重症监护病房，可使这组患者获得良好结局。最后，糖尿病患者及其丈夫和医生必须在怀孕前很久就仔细考虑是否决定怀孕。
