EXERCISE AND GLUCOSE HOMEOSTASIS IN GESTATIONAL DIABETES

妊娠期糖尿病（GDM）导致围产期发病率和死亡率 部分原因是胎儿对母体高血糖的高胰岛素反应。 产生母体高血糖症的代谢缺陷尚未被发现。 最终确定，但可能包括胰岛素 释放和降低胰岛素敏感性。 此外，目前的管理 的GDM需要对所有GDM和胰岛素治疗进行昂贵的监测， 50%的病例，但并没有消除巨大胎儿的风险， 手术分娩和新生儿发病率是这种疾病的特征。 体育锻炼增加胰岛素敏感性和改善葡萄糖 控制非妊娠NIDDM患者，并提供了潜在的成本 降低GDM相关发病率的有效工具。 期间无研究 然而，怀孕期间，检查了体育锻炼对 胰岛素作用。 我们计划扩大我们对急性和慢性 在怀孕期间锻炼，以解决这些问题，并检查 体育锻炼对GDM代谢控制的潜在影响。 首先，胰岛素释放异常在GDM中的作用将通过使用 高血糖钳夹试验在一组患有（n=30）或 无（n=12）既往妊娠糖尿病。 这些女性将被录取 怀孕对胰岛素释放的影响， 敏感性，这些变化在GDM发病机制中的作用将 接受检查。 该队列中发生GDM的受试者将随机分配至 为期6周的运动训练和非运动试验，以及 这项关于早期胰岛素释放和敏感性的试验将 量化。 第二个协议将检查不同的影响， 孤立运动与慢性运动训练对外周 胰岛素敏感性与内源性葡萄糖生成抑制 使用正葡萄糖钳夹。 第二个方案的受试者将包括 瘦（20）和肥胖（20）非糖尿病和妊娠糖尿病（20） 孕妇将被随机分配到6周训练/久坐试验中。 这些协议应定义体能训练的机制， 改善GDM的血糖控制，并量化这种效果，以评估 运动在治疗这种疾病中的治疗潜力。

Gestational diabetes (GDM) results in perinatal morbidity and mortality due, in part, to fetal hyperinsulemic response to maternal hyperglycemia. The metabolic defect(s) producing maternal hyperglycemia has not been conclusively identified, but may include both abnormalities in insulin release and reduced insulin sensitivity. Furthermore, present management of GDM requires costly surveillance of all GDM and insulin therapy in up to 50% of cases, yet does not eliminate the risks of fetal macrosomia, operative delivery and neonatal morbidity characteristic of this disorder. Physical exercise increases insulin sensitivity and improves glucose control in nonpregnant patients with NIDDM and offers a potentially cost effective tool for reducing GDM related morbidity. No studies during pregnancy, however, have examined the effect of physical training on insulin action. We plan to extend our studies of the acute and chronic exercise during pregnancy to resolve these questions and to examine the potential impact of physical exercise on metabolic control in GDM. First, the role of abnormal insulin release in GDM will be examined by use of the hyperglycemic clamp in a cohort of parous subjects with (n=30) or without (n=12) prior gestational diabetes. These women will be enrolled prior to conception, and the effect of pregnancy on insulin release and sensitivity, and the role of these changes in the pathogenesis of GDM will be examined. Subjects in this cohort who develop GDM will be randomized to a 6 week trial of exercise training and non-exercise, and the effect of this trial on early phase insulin release and sensitivity will be quantified. A second protocol will examine the differential effects of an isolated exercise session versus chronic exercise training on peripheral insulin sensitivity and supressability of endogenous glucose production using the euglycemic clamp. Subjects for the second protocol will include lean (20) and obese (20) non-diabetic and gestational diabetic (20) pregnant women who will be randomize to a 6 week training/sedentary trial. These protocols should define the mechanism by which physical training may improve glycemic control in GDM, and quantify this effect to evaluate the therapeutic potential of exercise in managing this disorder.