IMPAIRED GLUCOSE-TOLERANCE IN ADOLESCENT OFFSPRING OF DIABETIC MOTHERS - RELATIONSHIP TO FETAL HYPERINSULINISM
IMPAIRED GLUCOSE-TOLERANCE IN ADOLESCENT OFFSPRING OF DIABETIC MOTHERS - RELATIONSHIP TO FETAL HYPERINSULINISM
复制标题
DOI：
10.2337/diacare.18.5.611
复制
发表时间：
1995-05-01
期刊：
影响因子：
16.2
通讯作者：
LOEB, CA
中科院分区：
文献类型：
--
作者：
SILVERMAN, BL;METZGER, BE;LOEB, CA
目的：验证子宫内代谢经历可能改变长期出生后发育的假说。研究设计和方法：我们在一项1977 - 1981年的前瞻性研究中纳入了患有妊娠期糖尿病（包括胰岛素依赖型糖尿病[IDDM]和非胰岛素依赖型糖尿病[NIDDM]）和妊娠期糖尿病的妇女的后代。在妊娠32-38周时，通过测定羊水胰岛素（AFI）来评估胎儿β细胞功能。出生后，从禁食后1.5岁和口服1.75 g/kg葡萄糖后2小时开始每年测量血糖和胰岛素。对照组在10-16岁时进行单次口服葡萄糖挑战。在糖尿病母亲的后代中，糖耐量受损（2小时葡萄糖浓度bbb7.8 mmol/l）的患病率为：10岁时为1.2%（9名男孩和8名女孩），其中包括1名患有NIDDM的女孩。IGT与母亲的糖尿病（妊娠期与妊娠期）或出生时巨大儿的病因无关。在AFI正常（小于等于100 pmol/l）的青少年中，IGT仅占3.7%(1 / 27)，而在AFI升高的青少年中，IGT占33.3% (12 / 36)（P < 0.001）。虽然IGT患儿多为肥胖，但经多元logistic分析，AFI和肥胖与IGT独立相关。结论：证实了我们最初的假设，后代的IGT是母亲糖尿病的长期并发症。子宫内过量的胰岛素分泌，如AFI浓度评估，是儿童IGT的一个强有力的预测因子。
OBJECTIVE- To test the hypothesis that long-term postnatal development may be modified by metabolic experiences in utero.RESEARCH DESIGN AND METHODS- We enrolled offspring of women with pregestational diabetes (this included insulin-dependent diabetes mellitus [IDDM] and non-insulin-dependent diabetes mellitus [NIDDM]) and gestational diabetes in a prospective study from 1977 through 1981. Fetal beta-cell function was assessed by measurement of amniotic fluid insulin (AFI) at 32-38 weeks gestation. Postnatally, plasma glucose and insulin were measured yearly from 1.5 years of age after fasting and 2 h after 1.75 g/kg oral glucose. Control subjects had a single oral glucose challenge at 10-16 years.RESULTS- In offspring of diabetic mothers, the prevalence of impaired glucose tolerance (IGT) (2-h glucose concentration >7.8 mmol/l) was: 1.2% at 10 years of age (9 boys and 8 girls) include one girl with NIDDM. IGT was not associated with the etiology of the mother's diabetes (gestational versus pregestational) or macrosomia at birth. IGT was found in only 3.7% (1 of 27) of adolescents whose AFI was normal (less than or equal to 100 pmol/l) and 33.3% (12 of 36) of those with elevated AFI (P < 0.001). Although most of the children with IGT are obese, AFI and obesity are independently associated with IGT by multiple logistic analysis.CONCLUSIONS- In confirmation of our original hypothesis, IGT in the offspring is a long-term complication of maternal diabetes. Excessive insulin secretion in utero, as assessed by AFI concentration, is a strong predictor of IGT in childhood.