糖尿病母亲青少年后代的糖耐量受损。与胎儿高胰岛素血症的关系。

Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism.

作者信息

Silverman B L, Metzger B E, Cho N H, Loeb C A

机构信息

Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA.

出版信息

Diabetes Care. 1995 May;18(5):611-7. doi: 10.2337/diacare.18.5.611.

DOI:10.2337/diacare.18.5.611

PMID:8585997

Abstract

OBJECTIVE

To test the hypothesis that long-term postnatal development may be modified by metabolic experiences in utero.

RESEARCH DESIGN AND METHODS

We enrolled offspring of women with pregestational diabetes (this included insulin-dependent diabetes mellitus [IDDM] and non-insulin-dependent diabetes mellitus [NIDDM]) and gestational diabetes in a prospective study from 1977 through 1983. Fetal beta-cell function was assessed by measurement of amniotic fluid insulin (AFI) at 32-38 weeks gestation. Postnatally, plasma glucose and insulin were measured yearly from 1.5 years of age after fasting and 2 h after 1.75 g/kg oral glucose. Control subjects had a single oral glucose challenge at 10-16 years.

RESULTS

In offspring of diabetic mothers, the prevalence of impaired glucose tolerance (IGT) (2-h glucose concentration > 7.8 mmol/l) was: 1.2% at < 5 years, 5.4% at 5-9 years, and 19.3% at 10-16 years. The 88 offspring of diabetic mothers (12.3 +/- 1.7 years), when compared with 80 control subjects of the same age and pubertal stage, had higher 2-h glucose (6.8 +/- 1.4 vs. 5.7 +/- 0.9 mmol/l, P < 0.001) and insulin (660 +/- 720 vs. 455 +/- 285 pmol/l, P < 0.03) concentrations. The 17 subjects with IGT at > 10 years of age (9 boys and 8 girls) include one girl with NIDDM. IGT was not associated with the etiology of the mother's diabetes (gestational versus pregestational) or macrosomia at birth. IGT was found in only 3.7% (1 of 27) of adolescents whose AFI was normal ( < or = 100 pmol/l) and 33.3% (12 of 36) of those with elevated AFI (P < 0.001). Although most of the children with IGT are obese, AFI and obesity are independently associated with IGT by multiple logistic analysis.

CONCLUSIONS

In confirmation of our original hypothesis, IGT in the offspring is a long-term complication of maternal diabetes. Excessive insulin secretion in utero, as assessed by AFI concentration, is a strong predictor of IGT in childhood.

摘要

目的

验证子宫内代谢经历可能会改变产后长期发育这一假说。

研究设计与方法

我们对1977年至1983年一项前瞻性研究中患有孕前糖尿病（包括胰岛素依赖型糖尿病[IDDM]和非胰岛素依赖型糖尿病[NIDDM]）及妊娠期糖尿病的女性的后代进行了研究。在妊娠32 - 38周时通过测量羊水胰岛素（AFI）评估胎儿β细胞功能。产后，从1.5岁起每年在空腹及口服1.75 g/kg葡萄糖2小时后测量血浆葡萄糖和胰岛素。对照组在10 - 16岁时进行单次口服葡萄糖耐量试验。

结果

在糖尿病母亲的后代中，糖耐量受损（IGT）（2小时血糖浓度>7.8 mmol/l）的患病率为：5岁以下为1.2%，5 - 9岁为5.4%，10 - 16岁为19.3%。88名糖尿病母亲的后代（12.3±1.7岁），与80名年龄和青春期阶段相同的对照组相比，2小时血糖（6.8±1.4 vs. 5.7±0.9 mmol/l，P<0.001）和胰岛素（660±720 vs. 455±285 pmol/l，P<0.03）浓度更高。17名10岁以上患有IGT的受试者（9名男孩和8名女孩）包括一名患有NIDDM的女孩。IGT与母亲糖尿病的病因（妊娠期与孕前）或出生时的巨大儿无关。在AFI正常（≤100 pmol/l）的青少年中IGT仅见于3.7%（27名中的1名），而AFI升高的青少年中IGT见于33.3%（36名中的12名）（P<0.001）。尽管大多数患有IGT的儿童肥胖，但通过多因素逻辑分析，AFI和肥胖与IGT独立相关。