糖尿病管理对妊娠合并轻度糖尿病孕妇胎儿脂肪代谢的影响

The effect of diabetes mellitus treatment to the fetus fat metabolism of pregnant woman complicated with mild diabetes mellitus

目的:比较妊娠合并轻度糖尿病孕妇、妊娠合并轻度糖尿病接受治疗的孕妇和妊娠未合并糖尿病孕妇脐血糖、胰岛素、瘦素和脂联素水平的差异。方法:经OGTT试验诊断为妊娠合并轻度糖尿病的孕妇随机分为GDM组(43名)和GDM治疗组(43名),OGTT试验正常的43名孕妇为对照组,三组孕妇均接受普通的孕妇管理,此外,GDM治疗组还接受饮食调整、血糖监测和必要时的胰岛素治疗等糖尿病管理。检测各组脐血糖、瘦素、胰岛素和脂联素。结果:GDM组血糖高于对照组,GDM治疗组血糖正常。三组间脐血胰岛素和胰岛素/血糖比值无明显差别。GDM治疗组瘦素显著低于GDM组,但与对照组比较无显著差异。GDM组和GDM治疗组脂联素均显著低于对照组,GDM组和GDM治疗组脂联素比较无差异,但GDM组脂联素/瘦素比值显著低于GDM治疗组和对照组。结论:妊娠合并轻度糖尿病能改变新生儿体内血糖、瘦素和脂联素水平,有效的糖尿病管理能逆转这种改变。

Objective：To compare the plasma glucose concentrations and serum insulin,leptinand adiponectin in cord blood of babies of women（a） without gestatlonal diabetes mellitus（GDM）,（b） with mild GDM under routine care, or （c） mild GDM with treatment. Methods： Women with mild GDM on oral glucose tolerance testing （OGTF） randomized to either treatment group（n=43） or routine care group（n=43）,and women with a normal OGTT as control group（n=43）. All the women with mild GDM （treatment or routine care group） and OGTT normal women received routine pregnancy care. In addition, women with treated mild GDM received dietary advice,blood glucose monitoring and insulin if necessary.The primary outcome measures were cord blood concentrations of glucose,insulin,adiponectin and leptin.Results：Cord plasma glucose was higher in women receiving routine care compared with control,but was normalized by treatment for mild GDM. Cord serum insulin and ratio of insulin to glucose were similar between the three groups. Leptin concentration in cord serum was lower in GDM treated women compared with routine care and not different to control. Adiponectin was lower in both mild GDM groups compared with control and routine care,while the adiponectin to leptin ratio was lower for women receiving routine care compared with treatment and control. Conclusion：Treatment of women with mild GDM using diet, blood glucose monitoring and insulin if necessary, influences the altered fetal adipoinsular axis characteristic of mild GDM in pregnancy.