Neufeld N D, Kaplan S A, Lippe B M
J Clin Endocrinol Metab. 1981 Mar;52(3):473-6. doi: 10.1210/jcem-52-3-473.
Infants of diabetic mothers have hyperinsulinism at birth, presumably resulting from maternal hyperglycemia or some other derangement of maternal metabolism, and are extremely sensitive to insulin. Such infants have significantly greater numbers of insulin receptors on cord blood monocytes compared to normal infants. To assess the role of maternal diabetic control, nine infants of insulin-dependent diabetic mothers, who were intensively treated during pregnancy, were studied. Maternal blood glucose values were measured during weekly out-patient visits throughout pregnancy, and insulin therapy was given to maintain fasting blood glucose values below 100mg/dl. When necessary, the patients were hospitalized early in pregnancy in order to achieve glucose control, and all patients were hospitalized for up to 2 weeks before delivery for strict glucose control. The mean birth weight (+/- SD) of these infants (3.23 +/- 0.23 kg) was lower than that of nine infants of mothers with gestational diabetes not receiving insulin or intensive efforts at maintenance of normoglycemia (3.99 +/- 0.12; P less than 0.01) and was not significantly different from that of normal infants (3.51 +/- 0.37 kg). Mean cord blood C-peptide levels (+/- SD), determined by RIA, were 1.6 +/- 0.78 ng/ml for infants of these strictly controlled diabetic mothers and 1.4 0.1 ng/ml for normal infants. Scatchard analysis of [125]insulin binding to cord blood monocytes yielded mean receptor numbers for infants of diabetic mothers of 22,500 vs. 105,000 sites/cell for infants of diabetic mothers (P less than 0.001) and 26,600 sites/cell for normal infants. We conclude that the strict control of maternal diabetes during the last trimester of pregnancy prevents fetal hyperinsulinemia and is associated with the development of normal numbers of insulin receptors on the infants' monocytes.
患有糖尿病母亲的婴儿在出生时存在高胰岛素血症，这可能是由于母亲的高血糖或其他母亲代谢紊乱所致，并且这些婴儿对胰岛素极其敏感。与正常婴儿相比，此类婴儿脐带血单核细胞上的胰岛素受体数量明显更多。为了评估母亲糖尿病控制情况的作用，对9名在孕期接受强化治疗的胰岛素依赖型糖尿病母亲的婴儿进行了研究。在整个孕期的每周门诊就诊时测量母亲的血糖值，并给予胰岛素治疗以使空腹血糖值维持在100mg/dl以下。必要时，患者在孕早期住院以实现血糖控制，并且所有患者在分娩前住院长达2周以进行严格的血糖控制。这些婴儿的平均出生体重（±标准差）为（3.23±0.23kg），低于9名未接受胰岛素治疗或未积极维持血糖正常的妊娠糖尿病母亲的婴儿（3.99±0.12；P<0.01），且与正常婴儿（3.51±0.37kg）无显著差异。通过放射免疫分析法测定，这些严格控制糖尿病母亲的婴儿的平均脐带血C肽水平（±标准差）为1.6±0.78ng/ml，正常婴儿为1.4±0.1ng/ml。对[125]胰岛素与脐带血单核细胞结合进行Scatchard分析得出，糖尿病母亲的婴儿的平均受体数量为22,500个/细胞，而糖尿病母亲的婴儿为105,000个/细胞（P<0.001），正常婴儿为26,600个/细胞。我们得出结论，在妊娠晚期严格控制母亲糖尿病可预防胎儿高胰岛素血症，并与婴儿单核细胞上正常数量的胰岛素受体的发育有关。
