妊娠期糖尿病相关孕期增重的研究进展

随着全球超重和肥胖女性人群快速增加和生育年龄延迟, 妊娠期糖尿病(GDM)的发生率居高不下。GDM与一系列妊娠期不良结局的发生相关, 而孕期增重与GDM的发生、发展相关。早孕期增重过多、GDM的发生风险升高, 这种影响在孕前体重指数正常的孕妇中最明显。既往GDM史、孕前超重肥胖、合并多囊卵巢综合征是GDM发生的高风险因素, 目前的研究显示妊娠期严格的体重管理并不能降低这些孕妇GDM的发生风险。一些以降低孕期增重为目标的饮食和(或)运动干预能有效预防GDM的发生。部分GDM孕妇在确诊时已存在增重过多的情况, GDM诊断后的孕期管理, 在控制血糖的同时建议将体重增长控制在美国医学研究所推荐范围的低限。     

妊娠期糖尿病发病机制及对母婴的影响

年龄、肥胖、种族、不良孕育史和糖尿病家族史是影响妊娠期糖尿病(gestational diabetes mellitus,GDM)的主要因素.胰岛索抵抗是其主要发病机制.GDM对母儿影响的严重程度与病情及血糖控制情况密切相关,主要表现为妊娠期高血压、羊水过多、巨大儿、早产、难产及软产道损伤、剖宫产等发生率明显增高,还可...     

妊娠期糖尿病的医学营养治疗

妊娠期糖尿病(Gestationaldiabetesmellitus,GDM)系指在妊娠期发生或首次发现的不同程度的糖代谢异常,近年来其发病率逐年升高。GDM会导致母、儿并发症的增加,如妊娠期高血压、先兆子痫、早产、羊水过多等。胎儿处于高血糖及高胰岛素状态时,其巨大儿、肩难产、新生儿产伤及低血糖等并发症也将增加。一系列关于GDM产后追访研究表明,GDM者产后2型糖尿病风险明显增加;其子代易发生胰岛素抵抗、糖耐量异常及成年2型糖尿病,同时,心血管疾病和肥胖的风险也增加。国外2005年一项前瞻性、随机对照研究表明,妊娠期的血糖控制可以明显降低GDM者…     

妊娠期糖尿病的影响因素及围生结局的研究分析

目的:通过对天津地区妊娠期糖尿病(GDM)的影响因素及围生结局进行回顾性分析,加深对GDM的认识,为其防治提供一定的研究依据。方法:选取2014年1—6月参加天津市GDM检测的孕妇47 118例,其中确诊GDM3 650例纳入GDM组,其余43 468例纳入非GDM组,对两组孕妇的相关资料进行比较分析。结果:GDM组年龄≥35岁、大专及以上学历、孕前超重和肥胖比例均高于对照组,差异有统计学意义(P<0.01);多因素Logistic回归分析显示,年龄大、城市户籍、文化程度高、孕前BMI高及多胎妊娠是GDM的危险因素。GDM组剖宫产、早产、妊娠期高血压疾病、巨大儿及低出生体质量儿的发生均高于非GDM组,差异有统计学意义(P<0.01)。结论:GDM发病与多种因素有关,应重视相关的危险因素,并加强GDM妊娠期管理,降低母婴并发症的发生。     

脂肪细胞型脂肪酸结合蛋白与妊娠期糖尿病及代谢综合征

妊娠期糖尿病(gestational diabetes mellitus,GDM)是指妊娠期发生的不同程度的糖代谢异常.胰岛素抵抗(insulin resistance,IR)是GDM发病的主要原因之一.脂肪细胞型脂肪酸结合蛋白(adipocyte fatty-acid binding protein,FABP4)主要表达在成熟的脂肪细胞内,可分泌至血循环中,是肥胖和IR相关的标志物,参与游离脂肪酸及其他类脂激素的运输,从而调节全身胰岛素敏感性和能量代谢,在GDM的发生发展中起重要作用.现就FABP4与GDM及代谢综合征发生发展的关系进行综述.     

妊娠期糖尿病早期预测标记物研究进展

妊娠期糖尿病(GDM)是妊娠期重要的并发症之一。GDM对孕产妇及围生儿均有较大危害:孕妇易并发妊娠期高血压疾病、胎膜早破、产后出血等,孕妇产后发生2型糖尿病的概率增加,胎儿巨大儿的发生率和畸形率高,新生儿窒息和低血糖发生率高,新生儿成年后罹患代谢性疾病及肥胖的概率增高。目前临床上GDM筛查是在孕24~28周通过糖耐量实验进行的。但对于孕早期患GDM的孕妇目前尚无很好的技术进行检测。随着GDM患者的不断增多,早期筛查越来越引起重视。目前已开展了关于GDM早期预测标记物的研究,这些预测标记物主要包括超敏C反应蛋白、性激素结合球蛋白、可溶性肾素/肾素原受体、糖基化纤连蛋白和甘丙肽等,对这些标记物的基本性质及其在预测GDM时的效果等方面的研究进展进行综述。     

妊娠期糖尿病的产后随访

妊娠期糖尿病(gestational diabetes mellitus,GDM)患者及其后代均是糖尿病(diabetes mellitus,DM)的高危人群[1-5],这些人群同时存在高血压及肥胖的风险[6-7].GDM产后随访工作,将有效减少或延缓DM及其合并症的发生.     

月经不调--妊娠期糖尿病可能的危险因素

妊娠期糖尿病(GDM)的高危因素包括：一级亲属患糖尿病、非白人种、巨大儿分娩史、不良孕产史、肥胖、高龄孕妇及PCOS等。目前一项研究表明：月经不调(常用作P—COS的代名词)也可能是GDM的高危因素之一。     

妊娠期糖尿病对女性远期糖代谢异常的影响

妊娠期糖尿病(GDM)是妊娠期常见合并症,血糖控制不佳者可导致严重的不良妊娠结局,威胁母儿健康.虽然患者产后大多可以恢复正常糖代谢水平,但有GDM史的患者再次妊娠发生糖代谢异常的风险增加,且随着生存时间的延长,发生肥胖、糖尿病和心血管疾病的风险也会明显增加.加强GDM患者产后糖代谢的研究,有助于减低女性远期糖尿病发生的...     

血清游离脂肪酸与妊娠期胰岛素抵抗的关系

妊娠期糖尿病（gestational diabetes mellitus，GDM）即妊娠期首次发生或发现的糖代谢异常，发病率约为1％～5％，并有逐年增高的趋势。目前GDM的发病机制尚不清楚，妊娠期胰岛素抵抗（insulin resistance，IR）在其病因学中占重要地位，近年研究表明血清游离脂肪酸（free fatty acids，FFA）在2型糖尿病／肥胖胰岛素抵抗中起重要作用， 本研究的目的亦在探讨血清FFA水平与GDM及正常妊娠的IR的关系。     

妊娠期糖尿病高危因素的研究进展

妊娠期糖尿病(gestational diabetes mellitus,GDM)是妊娠期常见的代谢并发症,严重危害母亲和婴儿健康,其患病率在过去的几十年里一直稳步上升,确切的病因和发病机制目前尚不完全清楚。通过妊娠前和妊娠早期预测GDM的高危因素并采取针对性预防措施,对控制GDM有重要意义。目前研究表明,GDM的发展涉及许多危险因素,较为公认的包括高龄、超重或肥胖等,同时越来越多的研究证明生活方式、多囊卵巢综合征史、血清维生素D水平、环境污染物以及遗传易感性与GDM发病密切相关。简要综述GDM高危因素的研究进展。     

Relationship of maternal body weight and gestational diabetes mellitus with large-for-gestational-age babies at birth in Taiwan: The TMICS cohort

ObjectiveTo determine if both gestational diabetes mellitus (GDM) and maternal overweight/obesity are independently associated with delivery of large-for-gestational-age (LGA) babies in Taiwan.Materials and methodsAnthropometric parameters were measured and 75-g oral glucose-tolerance tests were administered to a cohort of 1428 pregnant women at 24–28 weeks gestation at nine hospitals in Taiwan. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria. Reported pre-pregnancy BMI and measured BMI during pregnancy were recorded at the late stage of the second trimester and the third trimester. Neonatal anthropometrics were measured at delivery. Primary outcome was LGA, defined in this study as having a birth weight ≥90th percentile for gestational age defined by WHO or a Chinese growth reference, taking into consideration the racial/ethnic and environmental differences in growth around the world. Multiple logistic regression was used to examine associations of GDM and maternal overweight/obesity with outcomes.ResultsBased on WHO growth reference definition of LGA, subjects with pre-pregnancy BMI ≥24 and pregnancy BMI >28.4 were found to be 2.46 times (0.76–7.97) and 3.28 times (1.01–10.60), respectively, more likely to deliver LGA babies than subjects with normal pre-pregnancy and pregnancy BMIs. Compared to those without GDM, subjects with GDM were 7.55 (1.62–35.25) times more likely to deliver LGA babies. The odds ratios for delivering a baby with a birth weight ≥90th percentile were 11.40 (1.65–78.75) for those with GDM alone, 4.10 (1.07–15.65) for those with overweight/obesity alone and 15.75 (1.30–190.40) for those with both GDM and overweight/obesity, compared to those with no GDM and no overweightness. Women with both pre-pregnancy and pregnancy overweightness/obesity were 3.64 (1.07–12.34) times more likely to deliver LGA. The above results remained similar when analyzing data based on Chinese growth reference definition of LGA.ConclusionMaternal overweightness/obesity and GDM are independently associated with LGA. Their combination had a greater impact than either one alone.     

妊娠期糖尿病产后发展为2型糖尿病的相关因素研究进展

妊娠期糖尿病（GDM）是产科常见并发症,会增加妊娠风险。由于生活方式和饮食结构的改变,GDM发病率逐年上升。大部分GDM患者产后短期内血糖会恢复正常,但生活中远期发生2型糖尿病（T2DM）的风险并未降低,GDM妇女已经成为日后发生糖尿病、代谢综合征的潜在危险人群。GDM发展为T2DM的相关危险因素很多,如高龄、肥胖和糖尿病家族史,另外空腹血糖水平、孕期胰岛素治疗、早发型GDM也逐渐被重视。通过认识GDM发展为T2DM的相关危险因素和包括临床特征、生化指标、基因等多种早期预测标志物,预测T2DM发生的风险,以利于提高公众风险意识及GDM妇女产后随访,可以提前进行生活方式干预或药物治疗,预防和延缓T2DM的发生,改善健康结局。     

Irisin在妊娠合并糖尿病中的研究进展

妊娠合并糖尿病有两种情况,一种是原有糖尿病基础上合并妊娠,即糖尿病合并妊娠,另一种是妊娠期首次发生的糖尿病,即妊娠期糖尿病（GDM）。妊娠合并糖尿病易发生不良妊娠结局。肥胖在妊娠合并糖尿病的发生发展中起着至关重要的作用,而运动则通过减轻肥胖以改善妊娠合并糖尿病的病情。近年研究发现Irisin可能是运动改善糖脂代谢的调控因子。Irisin是一种由骨骼肌运动产生的肌肉因子,其主要作用于脂肪、肝脏及胰岛细胞等与糖脂代谢相关的靶器官。研究表明在肥胖、糖尿病、GDM患者中,Irisin与血糖、血脂、能量代谢水平、胰岛素抵抗及胰岛素分泌能力有关。Irisin具有促进脂肪细胞燃烧,抑制肝糖异生,增加胰岛细胞再生等作用。Irisin可能与肥胖相关的妊娠合并糖尿病的发生发展有关,亦可能通过改善肥胖,减少胰岛素抵抗而有望成为肥胖相关代谢性疾病的防治靶点。     

Interconception Care for Women With Prior Gestational Diabetes Mellitus

The diagnosis of gestational diabetes mellitus (GDM) signals greater pregnancy risk but also increased lifelong risk of developing diabetes and cardiovascular disease. In women with GDM, insulin resistance exceeds that observed in normal pregnancy and to varying degrees may persist or worsen after birth. Therefore, during postpartum and interconception periods, women with a history of GDM must be monitored for manifestations of increasing insulin resistance, hyperglycemia, dyslipidemia, hypertension, and increased adiposity. Care of women with prior GDM in the postpartum and interconception periods affords clinicians a unique opportunity for targeted screening and health promotion. The objective of this review was to synthesize evidence related to interconception care for women following a pregnancy complicated by GDM and to suggest principles of care: 1) case finding and multiple patient/clinician reminders for women with prior GDM are necessary so that screening occurs in the postpartum through interconception periods; 2) monitoring of metabolic (glucose) and cardiovascular risk (lipids, blood pressure, adiposity) should occur at regular intervals and more often in women with additional risk factors such as insulin use during pregnancy, early diagnosis of GDM, obesity, prediabetes, and dyslipidemia; 3) breastfeeding and use of long‐term contraception should be encouraged; and 4) lifestyle modifications that are effective in preventing and delaying disease should be encouraged.     

妊娠期糖代谢异常相关因素的研究

目的 探讨妊娠期糖尿病（GDM）及妊娠期糖耐量低减（GIGT）发病的高危因素。方法 采用前瞻性对照研究的方法,对2004年2月至8月,在北京大学第一医院妇产科门诊行产前检查诊断的糖代谢异常孕妇[其中GDM85例（GDM组）、GIGT63例（GIGT组）]和125例糖代谢正常孕妇（对照组）的临床资料进行单因素及多因素logistic回归分析,探讨各因素对GDM和GIGT发病的影响。结果 （1）GDM组及GIGT组孕妇平均年龄、孕前体重指数、确诊前孕妇平均每周体重增长均明显高于对照组（P〈0．05）。（2）GDM组及GIGT组孕妇每日主食及水果摄人量也明显高于对照组（P〈0．05）,而且GDM组与GIGT组比较,差异有统计学意义（P〈0．05）。（3）GDM组、GIGT组及对照组糖尿病遗传家族史发生率分别为42．4％、36．5％及19．2％;孕前月经不调发生率分别为16．5％、23．8％及6．4％;多囊卵巢综合征（PCOS）发生率分别为5．9％、3．2％及0;妊娠期外阴阴道念珠菌病（VVC）发生率分别为15．3％、17．4％及7．2％。GDM组及GIGT组以上各指标与对照组比较,差异均有统计学意义（P〈0．05）。（4）多因素logistic回归分析显示,孕妇年龄、月经不调、孕前体重指数、确诊前孕妇平均体重增加、自然流产史、VVC均为妊娠期糖代谢异常的高危因素。结论 孕妇年龄、月经不调、自然流产史、孕前肥胖、孕期体重增加过快、VVC,为GDM和GIGT发病的独立高危因素。PCOS、糖尿病家族遗传史对GDM发病有一定影响,但不是独立高危因素。     

Pregnancy outcome in obese and morbidly obese gestational diabetic women

OBJECTIVE: We sought to determine whether pregnancy outcome differs between obese and morbidly obese GDM patients and to assess pregnancy outcome in association with mode of treatment and level of glycemic control. METHODS: A cohort study of 4,830 patients with gestational diabetes (GDM), treated in the same center using the same diabetic protocol, was performed. Obesity was defined as prepregnancy BMI >30 and <35 kg/m(2); morbid obesity was defined as prepregnancy BMI >or=35 kg/m(2). Well-controlled GDM was defined as mean blood glucose <105 mg/dl. Pregnancy outcome measures included the rates of large for gestational age (LGA) and macrosomic babies, metabolic complications, the need for NICU admission and/or respiratory support, rate of shoulder dystocia, and the rate of cesarean section. RESULTS: Among the GDM patients, the rates of obesity and morbid obesity were 15.7% (760 out of 4830, BMI: 32.4+/-1.6 kg/m(2)) and 11.6% (559 out of 4830, BMI: 42.6+/-2.2 kg/m(2)), respectively. No differences were found with regard to maternal age, ethnicity, gestational age at delivery or oral glucose tolerance test (OGTT) results. Moreover, similar rates of cesarean section, fetal macrosomia, shoulder dystocia, composite outcome, and metabolic complications were noted. Insulin treatment was initiated for 62% of the obese and 73% of the morbidly obese GDM patients (P<0.002). Similar rates of obese and morbidly obese patients achieved desired levels of glycemic control (63% versus 61%, respectively). In both obese and morbidly obese patients who achieved a desired level of glycemic control (<105 mg/dl), no difference was found in pregnancy outcome except that both neonatal metabolic complications and composite outcomes were more prevalent in diet-treated subjects in comparison to insulin-treated GDM patients. CONCLUSION: In obese women with GDM, pregnancy outcome is compromised regardless of the level of obesity or treatment modality.     

Committee opinion no. 504: screening and diagnosis of gestational diabetes mellitus

Gestational diabetes mellitus (GDM), defined as carbohydrate intolerance that begins or is first recognized during pregnancy, is associated with increased maternal, fetal, and neonatal risks. The prevalence of GDM in the United States is increasing, probably because of increasing rates of overweight and obesity. A universal recommendation for the ideal approach for screening and diagnosis of GDM remains elusive. At this time, the Committee on Obstetric Practice continues to recommend a two-step approach to screening and diagnosis. All pregnant women should be screened for GDM, whether by patient history, clinical risk factors, or a 50-g, 1-hour glucose challenge test at 24–28 weeks of gestation. The diagnosis of GDM can be made based on the result of the 100-g, 3-hour oral glucose tolerance test, for which there is evidence that treatment improves outcome.     

Lived experiences of women with co-existing BMI≥30 and Gestational Diabetes Mellitus

Objectiveto explore the lived experiences of women with co-existing maternal obesity (BMI ≥ 30) and Gestational Diabetes Mellitus (GDM) during pregnancy and the post-birth period (<3 months post-birth).DesignA qualitative, sociological design was utilised. Data were collected using a series of sequential in-depth narrative interviews during pregnancy and post-birth and fieldnotes. Cross sectional thematic analysis of the data set was undertaken, alongside the construction/analysis of in-depth biographical longitudinal case profiles of individual participants.SettingParticipants were recruited from diabetic antenatal clinics at two NHS hospital trusts in the South West of England.Participants: 27 women with co-existing BMI ≥ 30 and GDM. Participants were predominantly of low socio-economic status (SES).FindingsWomen were experiencing a number of social and economic stressors that compromised their ability to manage pregnancies complicated by maternal obesity and GDM, and make lifestyle changes.Women perceived themselves to be stigmatised by healthcare professionals and the general public due to their obese and gestational diabetic status.Key conclusionsWomen of low SES with maternal obesity and GDM perceived healthcare professionals' recommendations with respect to lifestyle change as unrealistic given their constrained social/material circumstances. Frequent references to weight/lifestyle change by different HCPs were seen as stigmatising and may be counterproductive.Implications for practiceWomen would like more collaborative care which acknowledges/addresses their personal and financial circumstances. Multidisciplinary teams should give consideration to how, by whom, and the frequency with which issues of weight/lifestyle change are being discussed in order to avoid women feeling stigmatised.