Biasini A, Casadei G, Cerasoli G
Divisione Pediatrica e Patologia Neonatale, Ospedale Maurizio Bufalini, Cesena, Forlì.
Minerva Endocrinol. 1994 Jun;19(2):91-4.
The prevalence of infants of diabetic mothers is estimated at 2-3% of all pregnancies in the Italy, with 60-90% of gestational diabetes. The perinatal mortality rate has decreased ten-fold over the past four decades; at present it is 2% mainly for congenital anomalies. The effects on the fetus and newborns depend on the degree of maternal diabetes. Macrosomia has served as a marker for evaluating morbidity and may be defined as occurring in an infant whose weight with reference gestation, exceeds the 97.5 percentile. This is mainly due to fetal hyperinsulinism secondary to hyperglycemia from inadequate maternal metabolic control. Insulin-requiring diabetes during organogenesis doubles or triples a woman's risk of producing a malformed infant (major risk for sacral dysgenesis). Hypoglycemia is a common complication of fetal hyperinsulinemia but is also caused by lower systemic glucose production rate. Hypocalcemia is recognized in these infants but the major problem and principal cause of death is respiratory distress syndrome which is identical to that found in premature infants and it comes from hyperinsulinemia retarding lung maturation through cortisol inhibition. Cardiomyopathy complicating the infants of diabetic mothers, shows a characteristic pattern with thickened intraventricular septum producing obstruction to flow.
在意大利，糖尿病母亲所生婴儿的患病率估计占所有妊娠的2%-3%，其中60%-90%为妊娠期糖尿病。在过去的四十年中，围产期死亡率下降了十倍；目前主要因先天性异常为2%。对胎儿和新生儿的影响取决于母亲糖尿病的程度。巨大儿一直被用作评估发病率的指标，可定义为相对于相应孕周体重超过第97.5百分位数的婴儿。这主要是由于母亲代谢控制不佳导致高血糖继发胎儿高胰岛素血症。器官形成期需要胰岛素治疗的糖尿病会使女性生出畸形婴儿的风险增加一倍或两倍（骶骨发育不全的主要风险）。低血糖是胎儿高胰岛素血症的常见并发症，但也由较低的全身葡萄糖生成率引起。这些婴儿中会出现低钙血症，但主要问题和主要死亡原因是呼吸窘迫综合征，这与早产儿的情况相同，其源于高胰岛素血症通过抑制皮质醇延缓肺成熟。糖尿病母亲所生婴儿并发的心肌病表现出一种特征性模式，即室间隔增厚导致血流受阻。
