Buchanan T A, Kjos S L, Montoro M N, Wu P Y, Madrilejo N G, Gonzalez M, Nunez V, Pantoja P M, Xiang A
Department of Medicine, Los Angeles County and University of Southern California Medical Center.
Diabetes Care. 1994 Apr;17(4):275-83. doi: 10.2337/diacare.17.4.275.
To determine whether fetal ultrasound early in the third trimester can identify Latina with mild gestational diabetes mellitus (GDM) whose fetuses are at risk for macrosomia and, if so, whether maternal insulin therapy can reduce that risk.
Study subjects included 303 consecutive women with GDM and a fasting serum glucose level < 5.8 mM on diet therapy who had a fetal ultrasound between 29 and 33 weeks gestation. Of the women, 98 (32%) had a fetal AC > or = 75th percentile for gestational age, and 59 women completed a randomized trial of diet therapy (n = 29) or diet plus twice daily insulin (n = 30). Maternal nutrient levels were assessed by meal tolerance testing (MTT) before and during therapy and by capillary glucose monitoring four to seven times a day. Birth weights corrected for gestational age and neonatal glycemia and skin folds were the primary outcome variables compared between treatment groups.
Diet and diet-plus-insulin groups were well matched for maternal age, prepregnancy relative weight, weight gain during pregnancy, and glycemia at entry. Insulin therapy reduced maternal capillary (P < 0.005) and MTT (P < 0.001) glucose levels and prevented a diet-associated rise in MTT triglyceride levels (P < 0.002). Gestational age at delivery was similar in insulin- and diet-treated groups (39.6 +/- 0.2 vs. 39.5 +/- 0.2 weeks). Birth weights (3,647 +/- 67 vs. 3,878 +/- 84 g; P < 0.02), the prevalence of large-for-gestational age infants (13 vs. 45%, P < 0.02), and neonatal skin-fold measurements at three sites (P < 0.005) were reduced in the insulin-treated group. Rates of transient neonatal hypoglycemia were low in both treatment groups (14 and 18%, respectively) and did not differ significantly between groups.
Fetal ultrasound early in the third trimester identified women with mild GDM whose infants were at high risk for fetal macrosomia in the absence of standard glycemic criteria for insulin therapy. Insulin treatment reduced the macrosomia, indicating that fetal ultrasound can be used to guide metabolic therapy in pregnancies complicated by mild GDM.
确定孕晚期早期的胎儿超声检查能否识别患有轻度妊娠期糖尿病（GDM）且胎儿有巨大儿风险的拉丁裔女性；若能识别，母体胰岛素治疗能否降低该风险。
研究对象包括303名连续患有GDM且饮食治疗时空腹血清葡萄糖水平<5.8 mM的女性，她们在妊娠29至33周期间接受了胎儿超声检查。其中，98名（32%）女性的胎儿腹围（AC）大于或等于胎龄的第75百分位数，59名女性完成了饮食治疗（n = 29）或饮食加每日两次胰岛素治疗（n = 30）的随机试验。在治疗前和治疗期间通过糖耐量试验（MTT）评估母体营养水平，并通过每天4至7次的毛细血管血糖监测进行评估。比较治疗组之间校正胎龄后的出生体重、新生儿血糖和皮肤褶皱作为主要结局变量。
饮食组和饮食加胰岛素组在母体年龄、孕前相对体重、孕期体重增加和入组时的血糖水平方面匹配良好。胰岛素治疗降低了母体毛细血管（P < 0.005）和MTT（P < 0.001）血糖水平，并防止了饮食相关的MTT甘油三酯水平升高（P < 0.002）。胰岛素治疗组和饮食治疗组的分娩孕周相似（39.6 +/- 0.2 vs. 39.5 +/- 0.2周）。胰岛素治疗组的出生体重（3,647 +/- 67 vs. 3,878 +/- 84 g；P < 0.02）、大于胎龄儿的患病率（13% vs. 45%，P < 0.02）以及三个部位的新生儿皮肤褶皱测量值（P < 0.005）均降低。两个治疗组的短暂性新生儿低血糖发生率均较低（分别为14%和18%），且两组之间无显著差异。
孕晚期早期的胎儿超声检查可识别患有轻度GDM且在缺乏胰岛素治疗标准血糖标准的情况下其婴儿有巨大儿高风险的女性。胰岛素治疗降低了巨大儿的发生率，表明胎儿超声可用于指导患有轻度GDM的妊娠的代谢治疗。
