Reece E A, Hagay Z, Roberts A B, DeGennaro N, Homko C J, Connolly-Diamond M, Sherwin R, Tamborlane W V, Diamond M P
Department of Obstetrics and Gynecology, Yale University School of Medicine.
Am J Obstet Gynecol. 1995 Jan;172(1 Pt 1):151-5. doi: 10.1016/0002-9378(95)90105-1.
This study was undertaken to assess human fetal behavior and fetal blood flow after insulin-induced symptomatic maternal hypoglycemia of sufficient magnitude to elicit counterregulatory hormones and a symptomatic response.
Plasma glucose was lowered from approximately 95 mg/dl to 45 mg/dl in decrements of 10 mg/dl every 40 minutes with the insulin clamp technique. In 10 insulin-dependent diabetic women in the third trimester, the fetus was studied by monitoring fetal heart rate and recording fetal body and breathing movements and by performing Doppler waveform analysis with real-time ultrasonography. Maternal levels of glucagon, cortisol, epinephrine, and growth hormone were measured at each plasma glucose level.
The mean number of fetal limb and body movements at the start of the study was 25 +/- 16 per 15 minutes, which increased to a mean of 38 +/- 28 at a glucose level of 60 mg/dl and then declined to a mean of 23 +/- 10 at a glucose level of approximately 45 mg/dl. These changes, however, did not achieve statistical significance. In addition, no significant reductions in fetal breathing movements or heart rate were observed, although maternal epinephrine and growth hormone levels were significantly (p < 0.001) increased. No consistent changes in Doppler velocity waveforms were observed.
These data suggest that fetal well-being remains unaltered in spite of moderate maternal hypoglycemia in diabetic women.
本研究旨在评估胰岛素诱导的有症状的母体低血糖达到足以引发反调节激素和有症状反应的程度后胎儿的行为和胎儿血流情况。
采用胰岛素钳夹技术，将血浆葡萄糖水平从约95mg/dl以每40分钟降低10mg/dl的幅度降至45mg/dl。对10名孕晚期胰岛素依赖型糖尿病女性的胎儿进行研究，通过监测胎儿心率、记录胎儿身体和呼吸运动，并使用实时超声进行多普勒波形分析。在每个血浆葡萄糖水平下测量母体胰高血糖素、皮质醇、肾上腺素和生长激素水平。
研究开始时胎儿肢体和身体运动的平均次数为每15分钟25±16次，在葡萄糖水平为60mg/dl时增加到平均38±28次，然后在葡萄糖水平约为45mg/dl时降至平均23±10次。然而，这些变化未达到统计学显著性。此外，尽管母体肾上腺素和生长激素水平显著升高（p<0.001），但未观察到胎儿呼吸运动或心率有显著降低。未观察到多普勒速度波形有一致变化。
这些数据表明，尽管糖尿病女性母体出现中度低血糖，但胎儿状况仍未改变。
