摘要
妊娠合并糖尿病时围生儿不良结局的发生风险显著增加,规范孕期血糖管理有助于改善妊娠结局,但仅有限降低相关不良结局的发生率。目前研究主要关注母亲糖代谢紊乱及其对宫内环境的影响,而胎儿代谢异常在其中发挥的主导作用易被忽视。胎儿葡萄糖窃取是胎儿利用母胎间葡萄糖浓度梯度差从母体主动汲取葡萄糖的过程。母亲高血糖状态与胎儿高胰岛素血症协同作用下,胎儿葡萄糖窃取效应最大化,导致糖尿病胎儿病的发生、发展。因此,针对孕前糖尿病及妊娠糖尿病高危孕妇,应在孕前及孕早期加强筛查与合理干预,以早期防治胎儿高胰岛素血症。此外,母亲血糖受胎儿葡萄糖窃取作用的影响,不能客观反映母婴整体的代谢情况,亟待寻找其他有效的生物标志物用于妊娠期间糖尿病的筛查与病情评估。
Diabetes in pregnancy is associated with significantly increased risks of adverse perinatal outcomes.Proper glycemic control during pregnancy improves neonatal outcomes but only to a limited extent.Current research is focused mostly on maternal hyperglycemia and the consequential disturbance of uterine environment.However,the potentially predominant role of the fetus in the pathophysiology of diabetic pregnancy is rarely mentioned.Fetal glucose steal is the course which the fetus drives glucose flux from the mother by the maternal-to-fetal glucose concentration gradient.The steepness of this gradient and effect of fetal glucose steal will be greatest when maternal hyperglycemia and fetal hyperinsulinemia coexist,further leading to the development of diabetic fetopathy.Therefore,it is vital to prevent early establishment of fetal hyperinsulinemia,which requires screening of women at-risk and optimized intervention before and during early pregnancy.Besides,maternal glucose levels can be attenuated due to intensive fetal glucose steal,thus more precise biomarkers are required for the diagnosis of diabetes and assessment of glycemic control during pregnancy.
作者
李晶晶
陆婧
毕艳
朱大龙
LI Jingjing;LU Jing;BI Yan;ZHU Dalong(Department of Endocrinology,Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210000,China)
出处
《医学综述》
2018年第5期833-837,共5页
Medical Recapitulate
基金
国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2017YFC1309605)
国家自然科学青年基金(81400832)
江苏省卫计委指导性科研课题(Z201610)
