Boden G
Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Obstet Gynecol Clin North Am. 1996 Mar;23(1):1-10. doi: 10.1016/s0889-8545(05)70241-2.
Fuel metabolism during pregnancy and in gestational diabetes mellitus (GDM) is reviewed with emphasis on carbohydrate and fat metabolism. In early pregnancy, insulin secretion in response to glucose is increased, peripheral insulin sensitivity is normal or increased, glucose tolerance is normal or slightly enhanced. In addition, there is maternal fat accumulation. During late pregnancy, there is increased fetal growth and increased fetal demand for nutrients. Maternal responses to these demands consist of an accelerated switch from carbohydrate to fat utilization that is facilitated by peripheral insulin resistance and by high blood levels of lipolytic hormones. In patients with GDM, insulin resistance is either comparable or greater than in nondiabetic pregnancy whereas insulin secretion appears to be compromised. Important short term consequences of GDM are perinatal complications, whereas long term complications include an increased rate of development of maternal non-insulin-dependent diabetes mellitus.
本文综述了孕期及妊娠期糖尿病（GDM）期间的燃料代谢，重点关注碳水化合物和脂肪代谢。在妊娠早期，机体对葡萄糖的胰岛素分泌增加，外周胰岛素敏感性正常或增强，糖耐量正常或略有提高。此外，母体脂肪会积累。在妊娠晚期，胎儿生长加快，对营养物质的需求增加。母体对这些需求的反应包括从碳水化合物利用加速转向脂肪利用，这是由外周胰岛素抵抗和高血浓度的脂解激素促成的。在GDM患者中，胰岛素抵抗与非糖尿病妊娠相当或更严重，而胰岛素分泌似乎受损。GDM的重要短期后果是围产期并发症，而长期并发症包括母体非胰岛素依赖型糖尿病的发病率增加。
