HYPOGLYCEMIA--MATERNAL AND PERINATAL MORTALITY

涉及糖尿病和怀孕的主要临床试验集中在 高血糖对孕产妇发病率和新生儿结局的影响。 这项前瞻性研究将评估受损的后果 肾上腺素能激素(肾上腺素)对 妊娠期胰岛素依赖型糖尿病患者的低血糖 血糖控制水平(见临床试验)和长期检查 肾上腺素能适应强化胰岛素治疗(IIT)。以下是 假说将被检验：1)肾上腺素能反调节功能受损 对Hypo的反应增加了Hypo的频率和严重性 妊娠；2)胰岛素依赖者妊娠期频发低血症 糖尿病会增加产妇和新生儿的发病率；3)IIT导致更多 肾上腺素能受损患者的频发和重度低血症 与不那么严格的控制相比，反监管机制； 怀孕前的前瞻性临床和生化评估将 在IIT期间确定有严重低氧风险的患者：和5)在ITT期间 妊娠导致肾上腺素能激素对低氧的适应 降低肾上腺素对Hypo的反应并增加 妊娠期胰岛素依赖型糖尿病患者的重度低血糖四组患者将被 研究包括临床试验中的I-IV组。登记的患者 PPG孕前计划将接受自主神经的床边测试 神经病。胰岛素输注研究也将通过测量 胰高血糖素、儿茶酚胺、皮质醇和生长激素对低氧的反应。 然后将使用胰岛素钳技术对患者进行研究，然后 妊娠28周和34周。孕前荷尔蒙 将这些值与怀孕期间的值进行比较，以评估肾上腺素能 适应IIT。在整个研究中，患者将使用记忆葡萄糖 反射率计，并记下与Hypo相关的事件日记以评估 作为IIT的结果发生的病态产妇事件，并提供 肾上腺素能适应IIT的临床测量。预计 肾上腺素能逆调节反应有缺陷的患者，已确诊 预计，Hypo的发作将更加频繁和严重 比那些肾上腺素能反应完整的人更好，所以在未来 可以设计适当的治疗方案，以避免频繁的低氧 这些病人。钳夹研究将显示肾上腺素能反应减弱 那些先前反应完好的患者，如妊娠和持续时间 个人所得税的进展。

Major clinical trials dealing with diabetes and pregnancy have focused on the effects of hyperglycemia on maternal morbidity and neonatal outcome. This prospective study will evaluate the consequences of impaired adrenergic hormonal (epinephrine) counterregulatory responses to hypoglycemia (HYPO) in the pregnant insulin dependent diabetic at two levels of glycemic control (See Clinical Trial) and to examine longer term adrenergic adaptation to intensive insulin therapy (IIT). The following hypotheses will be tested: 1) Impairment of adrenergic counterregulatory response to HYPO increases the frequency and severity of HYPO during pregnancy; 2) Frequent HYPO during pregnancy in the insulin dependent diabetic increases maternal and neonatal morbidity; 3) IIT results in more frequent and severe HYPO in patients with impaired adrenergic counterregulatory mechanisms compared to less strict control; 4.) Prospective clinical and biochemical evaluation pre-pregnancy will identify patients at risk for severe HYPO during IIT: and 5) ITT during pregnancy results in adaptation of adrenergic hormonal response to HYPO by diminishing the epinephrine response to HYPO and increases the risk of severe HYPO in pregnant IDDM patients. Four groups of patients will be studied comprising groups I-IV in the Clinical Trial. Patients enrolled in the PPG Pre-Pregnancy Program will undergo bedside tests for autonomic neuropathy. Insulin infusion studies will also be done with measurement of glucagon, catecholamine, cortisol and growth hormone responses to HYPO. Patients will then be studied using the insulin clamp technique prior to conception, and at 28 and 34 weeks gestation. Pre-pregnancy hormonal values will be compared to those during pregnancy to assess adrenergic adaptation to IIT. For the entire study, patients will use memory glucose reflectance meters, and keep diaries of events related to HYPO to assess morbid maternal events occurring as a result of IIT and to provide a clinical measure of adrenergic adaptation to IIT. It is anticipated that patients with defective adrenergic counter regulatory response, identified prospectively, will have more frequent and more severe episodes of HYPO than those with intact adrenergic response so that in the future an appropriate therapeutic regime can be designed to avoid frequent HYPO in these patients. Clamp studies will show diminished adrenergic response in those patients with previously intact responses as gestation and duration of the IIT progresses.