Effect of dietary therapy on pancreatic beta cell function in noninsulin-dependent diabetes mellitus

Twenty-four noninsulin-dependent diabetics, who were newly diagnosed or had discontinued therapy for at least 10 months, were studied for the effect of dietary therapy on pancreatic beta cell function. The mean fasting plasma glucose (176 +/- 14 vs 212 +/- 16 mg/dl, p less than 0.01) and glycosylated hemoglobin (HbA1c, 8.6 +/- 0.5 vs 9.4 +/- 0.6%, p less than 0.001) decreased significantly after 1 month of dietary control, although there was no significant change in mean body weight (57.4 +/- 2.0 vs 57.7 +/- 2.0 kg, p greater than 0.5). The mean incremental serum C-peptide (delta CP) response to oral glucose stimulation (OGTT) increased (4.6 +/- 0.6 vs 3.5 +/- 0.7 ng/ml, p less than 0.01), but that to intravenous glucagon (GT) did not (2.5 +/- 0.2 vs 2.7 +/- 0.2 ng/ml, p greater than 0.1). In 12 patients whose glycemic control improved after dietary treatment, there was a good correlation between the decrement in fasting plasma glucose and the increment in delta CP response to OGTT (r = 0.66, p less than 0.05). In conclusion: after 1 month of dietary therapy in noninsulin-dependent diabetics, (1) the serum C-peptide response to OGTT, but not to GT, improved; (2) the beta cell secretion increased only in those patients with improved glycemic control; (3) there was a good correlation between glycemic control and beta cell function.     

C-peptide and insulin levels at 24-30 weeks' gestation: an increased risk of adverse pregnancy outcomes?

OBJECTIVE: The hypothesis was that fasting C-peptide and insulin values, during an oral glucose tolerance test (OGTT), might allow an estimation of the increased risk for gestational hypertension (GH) and fetal macrosomia. STUDY DESIGN: Two-hundred and six consecutive patients were submitted to an OGTT. Thirty-five developed gestational hypertension and 29 delivered large-for-gestational-age (LGA) newborns. Plasma glucose levels (mg/dl) and insulin levels (microU/ml) were measured fasting and after 60, 120 and 180 min C-peptide fasting levels (ng/ml) were also measured. RESULTS: Twenty-five patients were excluded, 181 were enrolled. According to the OGTT, 143 patients were classified as normal, 26 were found affected by gestational diabetes (GD) mellitus, and 12 had impaired gestational glucose tolerance (IGGT). Hypertensive women exhibited higher 60 and 120 min insulin values than the normotensive group (128.3+/-69.9 microU/ml versus 86.2+/-58.3 microU/ml, P<0.05; 104.9+/-66.4 microU/ml versus 78.7+/-56.5 microU/ml, P<0.05).C-peptide cut-off at 2.9 ng/ml resulted predictive for patients delivering large-for-gestational-age newborns (OR=3.42, 95% CI=1.59-7.39). CONCLUSIONS: C-peptide and insulin may be used as indicators of risk for the development of complications in late pregnancy.     

Clinical usefulness of estimation of serum fructosamine concentration as screening test for gestational diabetes

Serum fructosamine levels and fructosamine/protein ratios were measured in 100 pregnant women who underwent glucose tolerance tests because of clinical risk. Compared with normal pregnant women, the 13 study participants with gestational diabetes had higher fructosamine/protein levels (39 +/- 3.9 mumol/gm versus 37 +/- 3.2 mumol/gm, p less than 0.05), fasting serum glucose levels (107 +/- 13.7 mg/dl versus 82 +/- 8.6 mg/dl, p less than 0.001), and area under curve of glucose tolerance test (36 +/- 5 gm x min x dl-1 versus 22 +/- 3.6 gm x min x dl-1, p less than 0.001). The serum fructosamine levels were not significantly different between the two groups of participants (2.3 +/- 0.26 mmol/L versus 2.2 +/- 0.17 mmol/L); 10 of the 13 women with diabetes had a fructosamine/protein ratio within 2 SD of the mean of the groups of normal pregnant women. Spontaneous caloric intakes (r = 0.72, p less than 0.005) and the hospital mean daily capillary glucose levels during diabetic diet (r = 0.72, p less than 0.005) correlated better with the fructosamine/protein ratio than with fasting serum glucose levels (r = 0.58, p less than 0.05) and area under curve (r = 0.57, p less than 0.05). Consequently, serum fructosamine and fructosamine/protein ratio levels should be considered insensitive as a screening test in pregnant patients with clinical risk of gestational diabetes.     

Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes

We studied the impact of a training program on glucose tolerance in gestational diabetes mellitus. Women with gestational diabetes mellitus (N = 19) were randomized into either group I, a 6-week diet alone group (24 to 30 kcal/kg/24 hours; 20% protein, 40% carbohydrate, 40% fat), or group II, which followed the same diet plus exercise (20 minutes three times a week for 6 weeks). An arm ergometer was used to maintain heart rate in the training range. Glycemic response was monitored by glycosylated hemoglobin, a 50 gm oral glucose challenge with a fasting and 1-hour plasma glucose, and blood glucose self-monitoring, fasting and 1 hour after meals. Week 1 glycemic parameters were the same for both groups. Week 6 data (mean +/- SD) were as follows: group I glycosylated hemoglobin, 4.7% + 0.2% versus group II, 4.2% +/- 0.2%; p less than 0.001. The group I glucose challenge fasting value was 87.6 +/- 6.2 versus 70.1 +/- 6.6 mg/dl, p less than 0.001 for group II. The group I 1-hour plasma glucose challenge result was 187.5 +/- 12.9 mg/dl versus 105.9 +/- 18.9 mg/dl for group II, p less than 0.001. The glycemic levels diverged between the groups at week 4. We conclude that arm ergometer training is feasible in women with gestational diabetes mellitus and results in lower glycosylated hemoglobin, fasting, and 1-hour plasma glucose concentrations than diet alone. Arm ergometer training may provide a useful treatment option for women with gestational diabetes mellitus and may obviate insulin treatment.     

First prenatal visit glucose screening

In order to determine the benefit of glucose screening at different stages of pregnancy, a prospective study of 999 patients was performed. All the patients underwent a nonfasting glucose screen at their first prenatal visit. This screen consisted of an oral 50 gm glucose load followed by a 1 hour serum glucose determination. If the glucose result was 130 mg/dl or higher, a 3-hour oral glucose tolerance test was performed at that time. There were 228, 354, 122, and 295 patients with gestational ages less than 14 weeks, 14 to 23 weeks, 24 to 28 weeks, and more than 28 weeks, respectively. The group less than 24 years of age had a significantly lower mean screening glucose value (106.1 +/- 35.9 mg/dl) than the group whose age was 24 years or older (117.4 +/- 35.9 mg/dl). There were significantly fewer patients with elevated screening glucose values when the patients were less than 24 years of age. Nevertheless, in the final analysis, 13% of the gestational diabetics diagnosed were in the age group younger than 24 years. Although the majority of the diagnosed gestational diabetic had elevated screening glucose values after 23 weeks of gestation, 33% had positive screening tests before 24 weeks. Earlier glucose screening, regardless of maternal age or gestational age, can lead to an earlier diagnosis of gestational diabetes. Cost of universal screening, regardless of maternal age, is only slightly more expensive than a screening protocol with a minimum age limit.     

Neonatal morbidity in pregnancy complicated by diabetes mellitus: predictive value of maternal glycemic profiles

The relationship between glycemic control and perinatal outcome was assessed in a relatively uniform population of 75 White Class B through D pregnant diabetic women. All patients used glucose reflectance meter self-monitoring and performed a minimum of four determinations daily. Mean capillary blood glucose was calculated from a minimum of 16 weeks of determinations. Regression analysis confirmed a correlation between these values and third-trimester hemoglobin A1 (p less than 0.001). The study population was divided into two groups on the basis of mean capillary blood glucose values: group I, mean capillary blood glucose less than 110 mg/dl (43 patients) (mean = 96.8 +/- 7.1); group II, mean capillary blood glucose greater than 110 mg/dl (32 patients) (mean = 126 +/- 9.0). Of the 32 patients in group II, eight had mean capillary blood glucose greater than or equal to 130 mg/dl. The degree of maternal glycemic control appeared to affect perinatal outcome. At least one form of infant morbidity was present in 33% of group I infants compared with 53% of group II. Significant differences were observed for the incidence of hypoglycemia (p less than 0.05), macrosomia (p less than 0.05), and respiratory distress syndrome (p less than 0.01). One of six group I infants delivered at 35 to 36 weeks developed respiratory distress syndrome, compared with four of seven group II patients. The appearance of phosphatidylglycerol in amniotic fluid appeared delayed in group II patients at term. These data suggest that maintaining mean capillary blood glucose values less than 110 mg/dl may serve to reduce several major forms of morbidity in the infant of the diabetic mother. This information is helpful in establishing objectives for glycemic control in pregnant women using self-monitoring techniques.     

The prevalence of gestational diabetes mellitus in Polish population

OBJECTIVE: The aim of the study was to determine the frequency of GDM in different parts of Poland and to assess whether 1 h--glucose plasma levels after 50 g glucose tolerance test (50 g OGTT) reflect the risk of GDM. MATERIAL AND METHODS: A total of 5778 pregnant women were screened with 50 g OGTT between 24 and 28 weeks of gestation. All subjects whose post-challenge glucose levels exceeded 140 mg/dl had 75 g OGTT performed according to WHO criteria. RESULTS: The rate of abnormal screening test results ranged from 8.0% to 20.7% for different regions of Poland, respectively. The pathological 50 g OGTT results were from 140 mg/dl to 320 mg/dl. Screening test results within 140 mg/dl to 149 mg/dl were confirmed by positive 75 g OGTT only in 2.9% subjects. All patients whose 1 h--glucose levels at 50 g OGTT were greater than 190 mg/dl had pathological 75 g OGTT results as well. CONCLUSION: The prevalence of GDM in different parts of Poland ranged from 2.0% to 3.8% (the average 3.4%).     

Pregnancy in patients with chronic glomerulonephritis

This study was carried out to clarify the effect of pregnancy on chronic glomerulonephritis (CGN). Fifteen patients with CGN diagnosed by renal biopsy were studied throughout 17 pregnancies. The following criteria were adopted: 1) Creatinine clearance (Ccr) over 70 ml/min and serum creatinine (s-Cr) 1.2 mg/dl or less. 2) Blood pressure lower than 140/90 mmHg when not receiving any medicine. 3) No evidence of active progress of nephropathy. In two patients excluded from the criteria, renal function was adversely affected, but there was no evidence that pregnancy affected the natural course of the underlying renal disease. In the patients to which the criteria were applied, the outcome of pregnancy and renal function were good. In conclusion, we recognized that there was no relationship between the body weight of the newborn and maternal serum albumin but that there was a significant correlation between serum uric acid and body weight (r = -0.67). These results show that serum uric acid is a useful indicator of placental dysfunction and fetal growth. In the patients with preeclampsia, the serum uric acid concentration was higher than in the CGN group (8.95 +/- 2.58 mg/dl vs 5.88 +/- 1.49 mg/dl: Scheffe method p less than 0.001). There was no significant difference between the CGN and normal control (5.88 +/- 1.49 mg/dl vs 4.51 +/- 0.68: Scheffe method p less than 0.1). Uric acid serves to distinguish CGN and preeclampsia.     

Can adiponectin predict gestational diabetes?

The aim of the present study was to evaluate whether adiponectin is a predictive factor for gestational diabetes mellitus (GDM) and is appropriate as a screening test for GDM. Three-hundred and fifty-nine women with singleton pregnancy and indications for GDM screening according to criteria of the American College of Obstetricians and Gynecologists were enrolled in the study between July 5, 2004 and March 11, 2005. After confirming gestational age (GA) and number of fetuses by ultrasound, all women underwent a 1-h glucose challenge test with 50 g glucose load (50-g GCT) between 21 and 27 weeks of GA. Blood samples for determination of adiponectin levels were also obtained on the same day. Subsequently, between 24 and 28 weeks of GA, the women underwent an oral glucose tolerance test with 100 g glucose load (100-g OGTT). The diagnosis of GDM was established when two or more of the following criteria were fulfilled: (1) fasting glucose >95 mg/dl; (2) 1-h glucose >180 mg/dl; (3) 2-h glucose >155 mg/dl; (4) 3-h glucose >140 mg/dl. Sixty women were diagnosed with GDM, a prevalence of 16.7%. There was no difference in age between the GDM and non-GDM groups. Pre-pregnancy and sampling-day body mass index (BMI), increase in weight and all blood glucose levels were greater in women with GDM than in those without (p < 0.05). Adiponectin concentrations were significantly negatively correlated with GA and plasma glucose levels of the GCT and each OGTT. Using logistic regression analyses, adiponectin, but not age, pre-pregnancy BMI and increase in weight, was demonstrated as an independent predictive factor for GDM. The area under the receiver-operator characteristic curve of adiponectin was significantly lower than that of the GCT [0.63 (95% confidence interval (CI) 0.53-0.67) vs. 0.73 (95% CI 0.71-0.80), p < 0.001]. At a cut-off value of 140 mg/dl of the 50-g GCT, the sensitivity and specificity of the test were 90% and 61%, respectively. The 50-g GCT could identify GDM in 54 (90%) out of 60 women. On the other hand, at an arbitrary cut-off value of 10 microg/ml for adiponectin, sensitivity of 91% and specificity of 31% were achieved. If this cut-off value was used for ruling in or out pregnant women for the GDM screening, 27% of all women could be eliminated from needing to perform an OGTT, with five women (8.3%) misclassified. In conclusion, this study demonstrated that adiponectin was an independent predictor for GDM. As for GDM screening, adiponectin was not as strong a predictor as GCT. However, with advantage of being less cumbersome, adiponectin could be used to rule out pregnant women at low risk of GDM.     

Amniotic fluid glucose and intraamniotic infection

Thirty-nine patients with either premature labor and/or preterm premature ruptured membranes underwent transabdominal amniocentesis to enable the following amniotic fluid analyses to be performed: culture and sensitivity, Gram's stain, and glucose determination. All nine patients with intraamniotic infection had amniotic fluid glucose values less than 10 mg/dl. Three patients with amniotic fluid glucose levels less than 10 mg/dl but without chorioamnionitis were delivered of infants within 72 hours of admission. The mean amniotic fluid glucose level of patients with intraamniotic infection (5 +/- 2.4 mg/dl) was significantly lower than in those without intraamniotic infection (39.8 +/- 18.42 mg/dl). All patients with amniotic fluid glucose values less than 10 mg/dl had either bacteria and/or white blood cells on Gram's stain. Two patients without chorioamnionitis had white cells on Gram's stain and amniotic fluid glucose values greater than 10 mg/dl. It appears that amniotic fluid glucose is more sensitive and more specific than Gram's stain in the diagnosis of intraamniotic infection. All 12 patients with low amniotic fluid glucose values were delivered of infants within 72 hours as the result of either the presence of infection or the progression of labor.     

The association between maternal obesity, glucose intolerance and hypertensive disorders of pregnancy in nondiabetic pregnant women.

OBJECTIVE: The aim of this study is to evaluate whether pregnancy-induced hypertension (PIH) among nondiabetic patients is associated with glucose intolerance. MATERIALS AND METHODS: A retrospective case-control study was designed including a study group who had pregnancy-induced hypertension or preeclampsia. Patients with normal pregnancy were used as a control group matched to cases by parity. Diabetic patients, nonsingleton pregnancies, and women without prenatal care were excluded. Data concerning fasting glucose levels, glucose challenge test (GCT), and oral glucose tolerance test (OGTT) were collected from patients' files. RESULTS: There were 131 patients in each study group. The study group had significantly higher mean maternal age, mean GCT levels, and mean pregestational body mass index (BMI) (28.0 +/- 5.8 vs. 26.5 +/- 5.3, p = 0.02; 5.8 +/- 1.4 vs. 5.1 +/- 1.1 p = 0.0018; 26 +/- 5.1 vs. 23 +/- 4.0 p < 0.001, respectively) than the control group. Mean gestational age and birthweight were also significantly lower in the study group (38.5 +/- 2.1 vs. 39.4 +/- 1.7 p < 0.001; 2929 g +/- 614.7 vs. 3225 +/- 461.1 p < 0.001, respectively). Stratified analysis according to parity demonstrated that pregestational BMI, weight gain during pregnancy, and cesarean section (CS) were significantly higher in women with pregnancy-induced hypertension than in controls in all parity groups. Maternal age and mean GCT levels of women with pregnancy-induced hypertension were higher in all parity groups but statistically significant only among multiparous patients. Multiple logistic regression demonstrated that BMI, weight gain, and maternal age were independently associated with pregnancy-induced hypertension, while GCT level was not. Conclusions. Elevated pregestational BMI is an independent risk factor for development of pregnancy-induced hypertension (PIH). Its association with elevated GCT levels implies that even without overt diabetes, glucose intolerance may play a role in the pathogenesis of preeclampsia in obese patients.     

Early nasoduodenal feeding for the post-biliary surgical patient.

The effects of early postoperative nasoduodenal feeding on nutrition and metabolic response were studied using 24 patients after biliary surgery. The patients were randomly divided into two groups with 12 in each group. Group I was fed via a nasoduodenal tube from the first postoperative day but control group II was not fed until the fourth postoperative day. The hospital blenderized tube feeding diet provided the enteric nutrition (17% protein, 33% fat and 50% carbohydrate). The nutritional status of the 2 groups was compared over a one week period. The changes in nitrogen balance were measured daily for 8 days. The group fed early had a significantly reduced negative nitrogen balance when compared to the group whose feeding was started later. (-1.91 +/- 1.05 g/day vs -5.84 +/- 0.48 g/day). There was no difference in serum albumin and transferrin levels, but serum prealbumin levels in the group fed early were more desirable than those of the control group (from 15.8 +/- 2.5 mg/dl to 28.9 +/- 3.8 mg/dl vs from 18.0 +/- 2.0 mg/dl to 25.9 +/- 3.9 mg/dl). Total lymphocyte count was also better in the group fed early than in the controls (from 1,325 +/- 204 cells/mm3 to 2,655 +/- 584 cells/mm3 vs from 1,277 +/- 188 cells/mm3 to 1,877 +/- 440 cells/mm3). All the patients in group I felt better than those in group II during the study course. These results indicated that those patients provided with early nasoduodenal feeding after a biliary operation displayed a better nitrogen balance, and a faster increase in short half life visceral protein and total lymphocyte count.     

Serum copper and zinc levels in patients with cervical cancer

The serum copper (SCL) and zinc (SZL) levels were measured in 99 patients with cervical cancer and 50 patients with uterine myoma as controls. The mean SCL in the control group was 109.4 +/- 17.4 micrograms/ml as compared to 117.1 +/- 14.6 micrograms/dl and was not significant (NS) in 17 carcinoma in situ (CIS) patients, 142.3 +/- 14.2 micrograms/dl in 30 stage I patients (p less than 0.001), 159.0 +/- 16.6 micrograms/dl in 22 stage II patients (p less than 0.001), 171.6 +/- 25.7 micrograms/dl in 10 stage III or IV patients (p less than 0.001), and 166.2 +/- 32.2 micrograms/dl in 20 recurrent patients (p less than 0.001). The SCL returned to control level 2 weeks after surgical treatment for the stage I and II patients (mean 110.6 +/- 19.6 and 108.7 +/- 20.4 micrograms/dl, respectively, p less than 0.001). The SZL was 97.2 +/- 15.8 micrograms/dl in control patients and only showed a significant decrease in stage III or IV and recurrent patients (67.2 +/- 16.6 and 70.4 +/- 17.2 micrograms/dl, respectively). Concerning the copper/zinc ratio, the control group was 1.13 +/- 0.07 as compared to 1.17 +/- 0.07 in CIS (p = 0.06), 1.51 +/- 0.24 in stage I (p less than 0.001), 1.85 +/- 0.37 in stage II (p less than 0.001), 2.66 +/- 0.61 in stage III or IV (p less than 0.001), and 2.50 +/- 0.75 in recurrent patients (p less than 0.001). Taking mean +/- 2.5 SD of the control values as cut off points, the percentages of the recurrent patients with abnormal SCL, SZL, and a Cu/Zn ratio were 65, 30 and 90%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy

In this study we sought to test the hypothesis that treatment of women with one abnormal oral glucose tolerance test value will result in reduction of adverse outcome. One hundred twenty-six women with one abnormal oral glucose tolerance test value and 146 women in the control group (normal oral glucose tolerance test values) participated in a prospective study during the third trimester of pregnancy. The subjects with one abnormal test result were randomized into treated (group 1) and untreated groups (group II). Group 1 subjects were treated with a strict diabetic protocol to maintain tight glycemic control by means of diet and insulin therapy. Group 2 subjects tested their capillary blood glucose for a baseline period. The study revealed that the level of glycemic control was similar before initiation of therapy (mean capillary blood glucose 118 +/- 14 vs. 119 +/- 15 mg/dl, p = NS) for groups 1 and 2, respectively. There was a significant difference in mean capillary blood glucose (95 +/- 10 vs. 119 +/- 15 mg/dl, p less than 0.0001), preprandial, and postprandial determinations between the treated and untreated groups. The overall incidence of neonatal metabolic complications (4% vs. 14%, p less than 0.05) and large infants (6% vs. 24%, p less than 0.03) was significantly lower in the treated group. Comparison between the control (normal oral glucose tolerance test) and the untreated groups showed a significantly higher incidence of large infants and metabolic complications. No difference was found between the normal and treated groups. Thus we conclude that treatment of individuals with one abnormal oral glucose tolerance test value will result in significant reduction in adverse outcome in pregnancy.     

Changes in lipids and lipoproteins with long-term estrogen deficiency and hormone replacement therapy

Cross-sectional data of the long-term effects of estrogens, androgens, and progestogens on lipids and lipoproteins were obtained in 556 postmenopausal women aged 24 to 85 years with follow-up for 1 to 44 years. Baseline values were obtained in 155 women from less than 1 year up to 30 years after menopause. Total cholesterol and low-density lipoprotein cholesterol tended to rise during the early postmenopausal years while high-density lipoprotein cholesterol did not change. Triglycerides were related to weight and were significantly different only between untreated women of normal weight (128.3 +/- 7.80 mg/dl) and hormone users weighing greater than 200 pounds (252.9 +/- 9.44 mg/dl), p less than or equal to 0.001. Although mean high-density lipoprotein cholesterol was lower with both C-21 progestogens (64.5 +/- 4.16 mg/dl) and C-19 progestogens (61.9 +/- 3.84 mg/dl), there were no statistically significant differences on comparison with levels in the unopposed estrogen users (67.0 +/- 3.94 mg/dl). Smoking significantly depressed high-density lipoprotein cholesterol in both hormone users (p less than or equal to 0.001) and untreated women (p less than or equal to 0.001). Added progestogens do not adversely affect lipids and lipoproteins over the long term when adequate dosages of estrogens are used.     

Effects of oral contraceptive pills on serum lipoproteins and triglycerides

Possible effects of a combined oral contraceptive (femenal) on blood triglycerides and high-density-lipoprotein-cholesterol (HDL-Chol) were studied in 25 women who had opted for hormonal contraception. Total serum triglycerides of 64.60 +/- 12.39 mg/dl (mean +/- SD) obtained prior to the commencement of hormonal contraception, did not reveal any statistical difference from the value of 65.49 +/- 7.96 mg/dl obtained after 9 months contraception. Similarly, precontraception HDL-Chol value of 58.05 +/- 6.58 mg/dl was also not statistically different from the treatment value of 58.82 +/- 5.42 mg/dl. Regression analysis of the values between control (precontraception) and treatment (9 months contraception) showed high correlation coefficients: (1) serum triglycerides, R2 = 0.5201; P less than 0.001; (2) serum HDL-Chol, R2 = 0.6590; P less than 0.001. Both the mean body weight and blood pressure of the study subjects remained unchanged after 9 months continuous use of femenal for contraception.     

孕妇外阴阴道假丝酵母菌病与糖代谢异常程度的关系

目的 探讨孕妇外阴阴道假丝酵母菌病（VVC）与糖代谢异常程度的关系。方法 选择2004年1月至2005年6月在北京大学第一医院产科行产前检查并分娩的401例妊娠期糖代谢异常孕妇为观察对象,其中妊娠期糖尿病244例,妊娠期糖耐量受损157例。401例中,51例孕期合并WC（VVC组）,其中16例孕期曾有VVC再次发作（反复VVC组）;350例未合并VVC（NVVC组）。比较3组孕妇的50g葡萄糖筛查试验（GCT）、75g葡萄糖耐量试验（OGTY）结果。结果 妊娠期糖尿病患者VVC的发病率（16％,39／244）高于妊娠期糖耐量受损（7．6％,12／157）者,两者比较,差异有统计学意义（P=0．014）;VVC组及NVVC组GCT分别为（9．6±2．0）、（9．3±1．6）mmol／L;OGTr空腹血糖分别为（5．4±1．1）、（5．3±0．9）mmol／L;1h血糖分别为（11．1±1．7）、（11．0±1．5）mmol／L;2h血糖分别为（9．4±1．8）、（9．2±1．6）mmol／L;分别比较,差异均无统计学意义（P〉0．05）。反复VVC组GCT为（10．4±1．2）mmoL／L;OGTr空腹、1、2h血糖分别为（5．3±0．6）mmol／L、（11．4±1．0）mmol／L和（9．4±1．4）mmol／L与NVVC组比较,差异均无统计学意义（P〉0．05）。结论 妊娠合并糖代谢异常伴VVC时,GCT、OGTr各点血糖水平无显著升高,但妊娠期糖尿病与妊娠期糖耐量受损孕妇比较,VVC发病率呈现上升趋势。     

Apolipoprotein levels in preeclamptic pregnancies]

Lipoprotein is known to increase during pregnancy but the factors responsible for the change have not been established. In addition, the lipoprotein concentration in preeclamptic pregnancy is significantly higher than in normal pregnancy. The apolipoproteins are an important determinant of metabolism and the structure of plasma lipoproteins. In normal pregnancies, non pregnancies and preeclamptic pregnancies the levels of blood apolipoproteins AI, AII, B and E were determined by TIA methods. (1) In normal pregnancies, the concentrations of apolipoproteins AI, AII, B and E were 182.6 +/- 20.9 mg/dl (n = 12, mean +/- S.D.), 33.3 +/- 5.7 mg/dl, 128.6 +/- 20.8 mg/dl, and 6.8 +/- 1.9 mg/dl, respectively. (2) In the pregnancies, the concentrations of apolipoproteins AI, AII, B and E were 135.6 +/- 9.3 mg/dl (n = 5), 30.8 +/- 1.9 mg/dl, 76.0 +/- 19.7 mg/dl, and 4.4 +/- 0.7 mg/dl, respectively. (3) In the preeclamptic pregnancy, the concentrations of apolipoproteins AI, AII, B and E were 181.0 +/- 27.6 mg/dl (n = 22), 33.2 +/- 4.8 mg/dl, 145.7 +/- 41.6 mg/dl and 5.8 +/- 1.4 mg/dl, respectively. The concentration of apolipoprotein B in preeclamptic pregnancy was significantly higher (p less than 0.001) and apolipoprotein E was significantly lower (p less than 0.01) than in normal pregnancies. These data suggest that the measurement of apolipoprotein is useful for the evaluation of preeclamptic pregnancy.     

The Two-Hour Glucose Screen for Gestational Diabetes

Universal screening for gestational diabetes (GD) using a 1-hr 50-g glucose screen yields a high sensitivity but a low positive predictive value (PPV), resulting in glucose tolerance tests (GTTs) performed on patients who do not have GD. Since the literature suggests that the 2-hr value of the antepartum GTT may be the most predictive of a later development of diabetes, a 2-hr glucose screen during pregnancy may be more predictive of the development of GD. Over a 2½-year period, 620 patients inadvertently underwent glucose determination 2 hr after a 50-g load, while 2,506 patients had the usual 1-hr glucose determination. All patients from both groups whose screen values were >130 mg/dl were given a GTT. The GTT data were analyzed using the Amankwah and NDDG criteria: fst: 100, 1-hr: 180, 2-hr: 160, 3-hr: 140; and fst: 105, 1-hr: 190, 2-hr: 165, and 3-hr: 145, respectively. The incidence of gestational diabetes using Amankwah's criteria was 4.4% for the 1-hr screens and 3.2% for the 2-hr screens; using the NDDG criteria, the incidence was 3.2% and 1.9%, respectively. The incidences between the 1- and 2-hr groups were not significantly different. Differences (P < 0.001) did exist in the PPV between the 1- and 2-hr screens for both the Amankwah criteria (14% vs. 34%) and the NDDG criteria (9.6% vs. 20.7%). Using the Amankwah criteria, the false-positive to true-positive GD ratio was 7:1 for the 1-hr screen and 1.9:1 for the 2-hr screen; using the NDDG criteria, the ratio was 9.2:1 and 3.8:1, respectively. The reduction in false-positives, without a significant change in ability to diagnose GD, results in a 41% cost savings using the 2-hr screen rather than the traditional 1-hr screen.     

Chronic oral terbutaline tocolytic therapy is associated with maternal glucose intolerance

Plasma glucose determinations were performed 1 hour after a 50 gm oral glucose load in 30 patients receiving long-term terbutaline therapy (20 to 40 mg/day for at least 1 week) and 247 normal control patients. A total of 63% of patients receiving terbutaline had an abnormal 1-hour value (greater than or equal to 140 mg/dl), an incidence much higher than that of control subjects (17.8%) (p less than 0.0001) for a relative risk of 3.54 (95% confidence intervals of 2.29 to 5.42). Mean 1-hour values were 112.1 mg/dl for control subjects and 149.8 mg/dl in the terbutaline group (p less than 0.0001). All abnormal values were followed by a 3-hour 100 gm oral glucose tolerance test. A total of 15.9% of the glucose tolerance tests performed in the control group (2.8% overall) were abnormal as opposed to 52.6% (33.1% overall) in patients receiving terbutaline (p less than 0.01). Nine patients were studied before and after terbutaline therapy. Results obtained during administration of terbutaline were significantly higher (102.2 mg/dl before therapy versus 145.2 mg/dl during therapy). We conclude that treatment with oral terbutaline appears to be associated with impairment of glucose tolerance in pregnancy.