Kalhan S C
Department of Pediatrics, Case Western Reserve University, School of Medicine, Cleveland, Ohio 44106-6010, USA.
Diabetes Care. 1998 Aug;21 Suppl 2:B75-8.
Metabolic perturbations associated with gestational diabetes mellitus (GDM) have been shown to result in significant clinical morbidity, both for the mother and the neonate. Although a number of studies have documented the changes in glucose metabolism in GDM, the data on nitrogen and protein metabolism remain scant. Recent data in GDM show that 1) the rate of irreversible nitrogen loss as measured by the rate of urea synthesis in GDM is similar to that in normal pregnancy and is less than that in nonpregnant women; and 2) possibly related to the magnitude of metabolic decompensation as assessed by the nature of therapeutic intervention (diet or diet plus insulin), the rate of protein turnover measured by leucine kinetics is increased in insulin-treated GDM. Whether the decompensation in protein turnover contributes to the persistent fetal macrosomia, even in rigorously managed GDM, remains speculative.
与妊娠期糖尿病（GDM）相关的代谢紊乱已被证明会导致母亲和新生儿出现显著的临床发病率。尽管许多研究记录了GDM患者葡萄糖代谢的变化，但关于氮和蛋白质代谢的数据仍然很少。GDM的最新数据表明：1）通过GDM中尿素合成速率测量的不可逆氮损失率与正常妊娠相似，且低于非妊娠妇女；2）可能与通过治疗干预（饮食或饮食加胰岛素）性质评估的代谢失代偿程度有关，通过亮氨酸动力学测量的蛋白质周转率在接受胰岛素治疗的GDM患者中增加。即使在严格管理的GDM中，蛋白质周转失代偿是否导致持续性巨大儿仍存在推测性。
