The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy.
The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy.
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DOI：
10.1007/s00125-016-3931-6
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发表时间：
2016-06
期刊：
影响因子：
8.2
通讯作者：
Nolan CJ
中科院分区：
文献类型：
--
作者：
Desoye G;Nolan CJ
对于患有1型和2型糖尿病的母亲来说，不良新生儿结局仍然很高，并且在患有妊娠糖尿病的母亲中还远未消除。这往往是尽管在怀孕的后半段似乎令人满意的贫血控制。在这里，我们认为，这可能是一个后果的早期建立胎儿高胰岛素血症，司机夸大了胎儿葡萄糖偷。实质上，胎儿高胰岛素血症通过其降低胎儿高胰岛素血症的作用，将增加胎盘中的葡萄糖浓度梯度，从而增加葡萄糖流向胎儿。当母体高胰岛素血症和胎儿高胰岛素血症共存时，该梯度和葡萄糖通量的陡度将最大，而胎儿高胰岛素血症将有利于持续的高葡萄糖通量，即使在母体血糖正常的时候。明显的含义是，需要在妊娠早期优化血糖控制，以防止建立胎儿高胰岛素血症，进一步支持孕前计划和早期建立孕产妇血糖控制的需要。高胰岛素血症胎儿过度的葡萄糖偷取也可以降低OGTT期间母体的葡萄糖水平，这就解释了为什么有些母亲的胎儿具有糖尿病胎儿病的所有特征，但其葡萄糖耐量却“正常”。
Adverse neonatal outcomes continue to be high for mothers with type 1 and type 2 diabetes, and are far from eliminated in mothers with gestational diabetes mellitus. This is often despite seemingly satisfactory glycaemic control in the latter half of pregnancy. Here we argue that this could be a consequence of the early establishment of fetal hyperinsulinaemia, a driver that exaggerates the fetal glucose steal. Essentially, fetal hyperinsulinaemia, through its effect on lowering fetal glycaemia, will increase the glucose concentration gradient across the placenta and consequently the glucose flux to the fetus. While the steepness of this gradient and glucose flux will be greatest at times when maternal hyperglycaemia and fetal hyperinsulinaemia coexist, fetal hyperinsulinaemia will favour a persistently high glucose flux even at times when maternal blood glucose is normal. The obvious implication is that glycaemic control needs to be optimised very early in pregnancy to prevent the establishment of fetal hyperinsulinaemia, further supporting the need for pre-pregnancy planning and early establishment of maternal glycaemic control. An exaggerated glucose steal by a hyperinsulinaemic fetus could also attenuate maternal glucose levels during an OGTT, providing an explanation for why some mothers with fetuses with all the characteristics of diabetic fetopathy have ‘normal’ glucose tolerance.