葡萄糖可能影响怀孕

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葡萄糖可能影响怀孕


Glucose may affect more pregnancies

By Robert Mitchum
Tribune staff reporter
Published June 23, 2007

Expectant mothers are warned frequently of the dangers of gestational diabetes. Now, doctors say a wider range of pregnant women may need to be concerned about high blood-sugar levels.

Researchers at the annual meeting of the American Diabetes Association in Chicago on Friday presented data showing that even a moderately elevated glucose level during pregnancy was associated with more cesarean sections and heavier babies, among other complications.

Although most expectant mothers in the United States are tested for glucose levels, only women with blood sugar above a certain point and with no history of diabetes are officially diagnosed with the gestational diabetes. The condition affects about 4 percent of pregnant women.

If gestational diabetes is not treated through diet or insulin, large amounts of glucose can be transmitted to the fetus via the placenta.

In addition to higher birth weight and increased risk of birth complications, high fetal glucose also can trigger increased production of insulin in the fetus, which scientists link with obesity and diabetes as the baby grows up.

The new study sought to establish the effect of less severe levels of blood sugar during pregnancy.

\"One of the issues is where on the spectrum of normal to abnormal does glucose in pregnancy begin to have a clinically significant effect on the outcome of the pregnancy,\" said Boyd Metzger, principal investigator of the study and professor of medicine at Northwestern University. \"That's the big unanswered question.\"

To help answer it, researchers measured glucose levels and pregnancy outcome in nearly 25,000 women from nine countries, including the United States.

They found that women with the highest measured blood glucose were six times more likely to have an overweight baby and 10 times more likely to have a newborn with elevated blood insulin than women with the lowest levels of glucose.

However, women in a range just below established criteria for gestational diabetes were still two to four times more likely to deliver a baby with high birth weight or elevated insulin levels.

\"This study will finally give us the chance to reach a consensus in all countries on how to diagnose diabetes in pregnancy,\" said one of the authors, Dr. Moshe Hod, a professor of obstetrics and gynecology at Tel Aviv University.

Metzger said more discussion will be necessary before any changes are made to guidelines for diagnosis of gestational diabetes and treatment of high glucose levels.

\"You can't point to [a] number and say this is obviously the point\" of diagnosis, he said.

葡萄糖可能对怀孕有更大影响

在周五（6月22日）于芝加哥举行的美国糖尿病学会年会上，研究者提交的资料数据表明：在怀孕期间即使血糖轻度升高也会使剖腹产和超重儿的发生率升高。

孕妇们经常受到提醒要注意发生妊娠期糖尿病的危险，但医疗人士说需要对更多孕妇的高血糖加以关注。

在美国，尽管大多数孕妇都进行血糖检测，但只有那些血糖高于一定数值并且无糖尿病史的女性才会被正式诊断为妊娠期糖尿病。这种情况使约4%的孕妇受到影响。如果不采用控制饮食或注射胰岛素对妊娠期糖尿病进行治疗的话，大量的葡萄糖可以通过胎盘被传送给胎儿。除了增加出生体重和分娩并发症的发生率之外，胎儿体内的高血糖也会刺激胎儿产生更多的胰岛素，而科学家认为这与婴儿长大后出现的肥胖和糖尿病相关。

这一新研究的目的是寻求建立一个孕期的安全血糖值，如果孕妇的血糖在这一范围内，就不会对其造成伤害。“问题之一是孕妇血糖达到正常与异常值之间的哪一点就会对怀孕造成有临床意义的影响。” Boyd Metzger说，他是这一研究的主要研究者，也是西北大学的一名医学教授。“这是最大的尚未解决的问题。”为了解答这一问题，研究者们测量了来自九个国家（包括美国）的将近25000名孕妇的血糖值，并记录她们的最终怀孕结果。

结果他们发现与血糖水平低的孕妇相比，那些测量血糖水平很高的孕妇生产超体重儿的几率升高六倍，而且有十倍的几率会生产出体内胰岛素水平升高的新生儿。然而，那些血糖水平在妊娠期糖尿病诊断标准以下的孕妇也有2到4倍的几率会生产超体重儿或体内高胰岛素水平的新生儿。

“这一研究将有助于世界各国在如何诊断妊娠期糖尿病这方面达成一致。”研究者之一、特拉维夫大学的妇产科教授Moshe Hod说。Metzger说在对妊娠期糖尿病的诊断指南和高血糖的治疗方法进行修改以前，尚需作进一步的讨论。