Ney D, Hollingsworth D R
Diabetes Care. 1981 Nov-Dec;4(6):647-55. doi: 10.2337/diacare.4.6.647.
The important role of diet in the management of pregnancies complicated by diabetes has been recognized since the nineteenth century. In this historical review we have traced the evolution of the diabetic diet from the pre-insulin era, when diabetic pregnancies were not only rare, but accompanied by high maternal mortality and fetal loss to 1981, when the nutritional management of carbohydrate intolerance during gestation is again raising provocative questions. Our recent understanding of diabetes as a heterogeneous syndrome, the 1979 dietary guidelines of the American Diabetes Association (ADA), and the 1980 revised Recommended Dietary Allowances (RDA) for pregnant and lactating women are summarized as representative of the current approach to the nutritional management of diabetic pregnancies. Many questions remain unanswered. These include the hundred-year-old debate concerning the optimal amount of carbohydrate in the diabetic diet, the possible beneficial role of large amounts of dietary fiber, and the nagging concern about total caloric intake in type I insulin-dependent diabetes mellitus (IDDM) versus type II non-insulin-dependent diabetes mellitus (NIDDM) pregnant diabetic women. We suggest that nutritional counseling during gestation in the future may need to be more highly individualized as metabolic distinctions between different types of patients with carbohydrate intolerance are more clearly delineated.
自19世纪以来，人们就已认识到饮食在糖尿病合并妊娠管理中的重要作用。在这篇历史回顾中，我们追溯了糖尿病饮食从胰岛素问世前的时代到1981年的演变历程。在胰岛素问世前的时代，糖尿病合并妊娠不仅罕见，而且孕产妇死亡率高、胎儿丢失率也高。到了1981年，妊娠期碳水化合物不耐受的营养管理再次引发了一些具有挑战性的问题。我们对糖尿病作为一种异质性综合征的最新认识、美国糖尿病协会（ADA）1979年的饮食指南以及1980年修订的孕妇和哺乳期妇女推荐膳食摄入量（RDA）被总结为当前糖尿病合并妊娠营养管理方法的代表。许多问题仍未得到解答。这些问题包括关于糖尿病饮食中碳水化合物最佳摄入量长达百年的争论、大量膳食纤维可能的有益作用，以及对1型胰岛素依赖型糖尿病（IDDM）与2型非胰岛素依赖型糖尿病（NIDDM）合并妊娠的糖尿病女性总热量摄入的持续关注。我们建议，随着不同类型碳水化合物不耐受患者之间的代谢差异得到更清晰的界定，未来妊娠期的营养咨询可能需要更加个体化。
