{"created":"2023-06-19T11:24:21.416843+00:00","id":5053,"links":{},"metadata":{"_buckets":{"deposit":"60f49852-4c38-47d4-9d24-3a38f18f37e8"},"_deposit":{"created_by":1,"id":"5053","owners":[1],"pid":{"revision_id":0,"type":"depid","value":"5053"},"status":"published"},"_oai":{"id":"oai:asahikawa-med.repo.nii.ac.jp:00005053","sets":["7","7:23"]},"author_link":["15853","15856","15859","15855","15857","15862","15858","15860","15854","15863","15861"],"item_5_biblio_info_21":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2014-08-01","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"119","bibliographicPageStart":"115","bibliographicVolumeNumber":"14","bibliographic_titles":[{"bibliographic_title":"糖尿病と妊娠"}]}]},"item_5_description_33":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"耐糖能異常合併妊娠では妊娠中の厳格な血糖コントロールにおいて、血糖値の目標下限値は70mg/dlとされているが、低血糖が母児へ与える影響については不明な点が多い。動物実験では妊娠初期の低血糖が胎児奇形や発育遅滞に影響するといった報告もある。今回われわれは、非妊娠時より低血糖発作を繰り返した症例で、2度の妊娠管理を経験した。症例は19歳ごろより空腹時の脱力感を自覚し、21歳で随時血糖値24mg/dlの低血糖発作を発見され、2007年1月当科紹介初診。低血糖の入院精査にて、インスリノーマや内分泌疾患などは否定し、75gブドウ糖負荷試験(OGTT)にて血糖値は0分値65mg/dl、60分値122mg/dl、120分値65mg/dlであり、インスリン値からも反応性低血糖症と診断した。αグルコシダーゼ阻害薬を開始したが、挙児希望のため内服を中止し、2007年10月(22歳)に第1子の妊娠判明。妊娠19週2日に食後血糖値66mg/dl、HbA1c 4.6%、40〜50mg/dlの低血糖発作を繰り返しており、補食や分割食で対応していた。妊娠25週5日の75g OGTTでは0分値78mg/dl、60分値154mg/dl、120分値112mg/dl。5分割食として低血糖発作を予防し、妊娠40週1日で2420g、低出生体重児でSFD(small for date)の女児を出産。25歳時には第2子の妊娠判明、HbA1c 5.4%であり、妊娠初期から5分割食を指示し、重篤な低血糖発作はなく経過。妊娠37週4日で2754g、AFD(appropriate for date)の女児を出産。母体体重は第1子妊娠中には約11kg、第2子妊娠中には約8kgの増加であった。2児ともに奇形や明らかな新生児合併症はなく、その後の発育も順調である。本症例では、胎児発育に影響を与えるその他の要因を認めず、2回の異なる妊娠経過から、妊娠中の繰り返す低血糖は児の発育遅延に関係する可能性が考えられた。","subitem_description_type":"Abstract"}]},"item_5_description_36":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"雑誌掲載版","subitem_description_type":"Other"}]},"item_5_description_37":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"text","subitem_description_type":"Other"}]},"item_5_description_41":{"attribute_name":"フォーマット","attribute_value_mlt":[{"subitem_description":"application/pdf","subitem_description_type":"Other"}]},"item_5_relation_27":{"attribute_name":"医中誌ID","attribute_value_mlt":[{"subitem_relation_type":"isIdenticalTo","subitem_relation_type_id":{"subitem_relation_type_id_text":"2015002495","subitem_relation_type_select":"ICHUSHI"}}]},"item_5_source_id_22":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"1347-9172","subitem_source_identifier_type":"ISSN"}]},"item_5_text_44":{"attribute_name":"ID(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"2015002495"}]},"item_5_text_54":{"attribute_name":"閲覧数(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"822"}]},"item_5_text_55":{"attribute_name":"ダウンロード数(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"712"}]},"item_5_text_7":{"attribute_name":"著者 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