Roberts R
Ulster Hospital, Dundonald, Belfast, Northern Ireland, U.K.
Diabetes Care. 1998 Aug;21 Suppl 2:B27-32.
Hypertension in pregnancy and gestational diabetes have in common a lack of universally accepted classification and nomenclature that hinders comparison of data between research groups and contributes to the lack of consensus in the literature on these conditions. The inter-relationship of hypertension and gestational diabetes can be considered from three viewpoints according to whether hypertension is present before, during, or after the pregnancy. The first question is whether hypertension predating pregnancy predisposes to gestational diabetes. Epidemiological evidence and physiological argument based on the common etiologic factor of insulin resistance would suggest that gestational diabetes should be more common in the presence of preexisting hypertension. The limited clinical data available support this hypothesis. There are three issues concerning the coexistence of hypertension and gestational diabetes: whether gestational diabetes predisposes to pregnancy-induced hypertension, whether pregnancy-induced hypertension predisposes to gestational diabetes and what effect the combination has on morbidity and mortality. A number of studies have investigated whether pregnancy-induced hypertension is more common in women with gestational diabetes, but no consensus has been reached. There is little direct clinical evidence on the reverse issue, but data are presented to suggest that pregnancy-induced hypertension may only predispose to gestational diabetes when its etiology is gestational hypertension and not preeclampsia. The issue of how the coexistence of pregnancy-induced hypertension and gestational diabetes affects maternal or neonatal morbidity and mortality is largely unanswered. The last question is whether gestational diabetes has any prognostic significance with regard to the future development of hypertension in the mother. It is well known that gestational diabetes predisposes to subsequent NIDDM and that NIDDM is associated with a high incidence of essential hypertension. Once again insulin resistance may be a unifying factor. However, there is no direct clinical evidence that gestational diabetes predisposes to future hypertension.
妊娠高血压和妊娠期糖尿病存在一个共同问题，即缺乏普遍接受的分类和命名方法，这阻碍了研究组之间的数据比较，也导致了文献中对这些病症缺乏共识。根据高血压出现在妊娠前、妊娠期间还是妊娠后，高血压与妊娠期糖尿病的相互关系可以从三个角度来考虑。第一个问题是妊娠前的高血压是否易引发妊娠期糖尿病。基于胰岛素抵抗这一共同病因的流行病学证据和生理学观点表明，在已有高血压的情况下，妊娠期糖尿病应该更为常见。现有的有限临床数据支持这一假设。关于高血压与妊娠期糖尿病并存存在三个问题：妊娠期糖尿病是否易引发妊娠高血压，妊娠高血压是否易引发妊娠期糖尿病，以及二者并存对发病率和死亡率有何影响。许多研究调查了妊娠期糖尿病女性中妊娠高血压是否更常见，但尚未达成共识。关于相反问题，几乎没有直接的临床证据，但有数据表明，只有当妊娠高血压的病因是妊娠期高血压而非子痫前期时，才可能易引发妊娠期糖尿病。妊娠高血压与妊娠期糖尿病并存如何影响孕产妇或新生儿的发病率和死亡率这一问题在很大程度上尚未得到解答。最后一个问题是妊娠期糖尿病对于母亲未来高血压的发展是否具有任何预后意义。众所周知，妊娠期糖尿病易引发后续的非胰岛素依赖型糖尿病，且非胰岛素依赖型糖尿病与原发性高血压的高发病率相关。胰岛素抵抗可能再次成为一个共同因素。然而，没有直接的临床证据表明妊娠期糖尿病易引发未来的高血压。
