The usefulness of HbA1c in postpartum reclassification of gestational diabetes

To investigate the role of HbA1c in postpartum reclassification of gestational diabetes (GDM) we studied 364 women with GDM attending the postpartum reclassification assessment of their glucose tolerance status. A 75-g oral glucose tolerance test (OGTT) was performed and HbA1c was determined. Diabetes was diagnosed in 12 (3.3%), 7 (1.9%) and 2 (0.6%) women according to the fasting plasma glucose (FPG) and/or the 2-hour OGTT, the FPG alone and HbA1c levels, respectively. The sensitivity and specificity for HbA1c to diagnose diabetes was 16.7% and 100%, respectively, for FPG and OGTT criteria. The combination of a cutoff value of 5.5% for HbA1c and FPG allowed us to identify 95.1% of women with any kind of glucose intolerance. We conclude that in the early postpartum period, the cutoff of 6.5% for HbA1c alone has low sensitivity for the diagnosis of diabetes compared with OGTT, but the combination of FPG and HbA1c at a lower cutoff value is very useful to identify women with any kind of glucose intolerance.     

Risk factors for postpartum glucose intolerance in women with gestational diabetes mellitus

Objectives: To determine the risk factors for glucose intolerance (GI) during the postpartum period in women with gestational diabetes mellitus (GDM).

Methods: This prospective cohort study included 72 Japanese women with GDM who underwent 75?g oral glucose tolerance tests (OGTT) at 12 weeks after delivery. These women were divided into the GI group and the normal group based on postpartum OGTT. Risk factors for GI, including levels of blood glucose (BG), area under the curve (AUC) of glucose, AUC insulin, HbA1c, homeostasis model assessment-insulin resistance (HOMA-IR), HOMA-β, insulinogenic index (II) and the oral disposition index (DI) in antepartum OGTT, were analyzed by logistic regression analyses.

Results: Of the 72 women, 60 (83.3%) were normal and 12 (16.7%) had GI. By univariate logistic regression analyses, fasting BG, AUC glucose, HOMA-β, II and oral DI were selected as risk factors for GI. Multivariate logistic regression analysis revealed that the level of II in antepartum OGTT was a significant factor that predicted GI after delivery (odds ratio, 0.008; 95% CI, 0.0001–0.9; p?Conclusions: II measured by OGTT during pregnancy might be a useful predictor of GI within the early postpartum period in women with GDM.     

Risk factors of abnormal carbohydrate metabolism after pregnancy complicated by gestational diabetes mellitus

Objective: In gestational diabetes mellitus (GDM) abnormal glucose metabolism normalizes soon after delivery. However, the history of GDM predisposes to carbohydrate intolerance in the future. The aim of the study was to explore risk factors and to evaluate risk of glucose intolerance and diabetes mellitus in women with a history of GDM. Methods: 155 patients entered this case-control study. Participants fulfilled the inclusion criteria: a history of GDM, perinatal care in the study center. Medical and family history and laboratory findings were analyzed. Oral glucose tolerance test (OGTT) was performed. Results: 18.1% of patients presented impaired fasting glucose during the study, 20% presented impaired glucose tolerance and 23.2% presented diabetes mellitus. Gestational age at diagnosis of GDM, the results of OGTT during pregnancy, serum HbA1c concentration at 2nd and 3rd trimester, serum fructosamine concentration, symptoms of diabetic fetopathy in the neonate, the need for insulin therapy after delivery, maternal age at diagnosis of GDM and maternal body mass index before pregnancy were the significant risk factors of impaired glucose tolerance or diabetes in the future. Conclusion: GDM increases the risk of diabetes mellitus. Several risk factors of impaired carbohydrate metabolism can be distinguished in patients with a history of GDM.     

Relationship of maternal serum resistin and visfatin levels with gestational diabetes mellitus

Introduction: Adiponectin, resistin and visfatin are thought to play role in the pathophysiology of gestational diabetes (GDM). In this study, we aimed to investigate the association of maternal second trimester serum resistin and visfatin levels with GDM.

Materials and methods: Screening and diagnosis for GDM was performed between the 24–28th gestational weeks. About 40 women diagnosed with GDM and 40 non-diabetic women constituted the study and control groups, respectively. Groups were compared for second trimester maternal serum resistin, visfatin and HbA1c levels, HOMA-IR and postpartum 75?g OGTT results.

Results: Mean serum resistin (p?=?0.071) and visfatin (p?=?0.194) levels were similar between the groups. However, mean BMI (p?=?0.013), HOMA-IR (p?=?0.019), HbA1c (p?p?=?0.037) were significantly higher in GDM group compared to controls. Type 2 diabetes and impaired glucose tolerance were detected in 2 (5%) and 7 (20%) women in the GDM group, respectively, with 75?g OGTT performed at the postpartum 6th week. Resistin levels of patients with GDM and postpartum glucose intolerance were higher than those with GDM but no postpartum glucose intolerance (p?=?0.012). Visfatin levels in the GDM group showed a positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length (p?Conclusion: Maternal serum resistin and visfatin levels are unchanged in GDM. In patients with GDM, second trimester resistin levels may be predictive for postpartum glucose intolerance and second trimester visfatin levels may be related with fetal biometric measurements. Further larger studies are needed.     

Diagnostic of gestational diabetes mellitus and the prevalence of LGA (Large for Gestational Age)

OBJECTIVES: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance, first time detected in pregnancy. Early diagnosis of the disease may reduce fetal exposure to maternal hyperglycemia and decrease the risk of LGA. The aim of the study was to examine the influence of time and diagnostic method of GDM on the prevalence of LGA and pregnancy outcome among patients with gestational diabetes. MATERIAL AND METHODS: The study was conducted among 211 women with gestational diabetes mellitus, the patients of 1st Clinic of Obstetrics and Gynecology at the Medical University in Warsaw. We have reviewed the results of fasting plasma glucose, 50-g glucose screening test (GCT) and 2 hour 75-g glucose tolerance test in GDM patients with LGA and eutrophic newborns. The t-student or the Mann-Whitney test was used in order to compare both groups. P<0.05 was deemed statistically significant. RESULTS: LGA was diagnosed in 10.4% of patients. We did not find any significant differences in gestational age when GDM was diagnosed, results of fasting glucose GCT and OGTT among LGA (M) and control (K) group. However, when we compared the percentage of LGA in groups of women with different time of GDM diagnosis, the highest prevalence was noted in the group of first trimester diagnosis and between 28 and 32 weeks of pregnancy, which we found interesting. We compared the women and the results of the diagnostic tests with the group of standard time of GDM diagnosis (24-28 week of pregnancy) and the only difference was the late diagnosis. If 75-g glucose tolerance test had not included 1-hour after load glucose assignment, GDM would not have been diagnosed at all in 18.2% of female patients with LGA. We have not found any correlations between the results of the diagnostic tests, the time of the diagnosis or the mode of treatment GDM (diet alone or with insulin) and the birth weight. CONCLUSIONS: 1. Results of fasting glucose and glucose tolerance tests are not useful in the prediction of LGA in GDM pregnancies. 2. Diagnosis of GDM during the recommended period (between 24 and 28 weeks of pregnancy) may decrease the prevalence of LGA (comparing to later diagnostics). 3. 75-g glucose tolerance test should provide fasting, 1 and 2-hour after load glucose assignment.     

Postpartum assessment of the beta cell function and insulin resistance for Chinese women with previous gestational diabetes mellitus

Gestational diabetes mellitus (GDM) imparts a high risk of developing postpartum diabetes and is considered to be an early stage of type 2 diabetes mellitus (T2DM). In this study, a 75-g oral glucose tolerance test was performed on 472 women with GDM at 6–8 weeks after delivery. The clinical and metabolic characteristics were compared between the patients with normal glucose tolerance (NGT) and abnormal glucose metabolism (AGM). These data were then compared between pre-diabetic and diabetic patients. A total of 37.7% of the women with GDM continued to have abnormal glucose levels after delivery. Compared with the women who reverted to normal, HOMA-IR was significantly higher in AGM. A multiple stepwise regression analysis revealed that age, the postpartum body mass index (BMI), low density lipoprotein-cholesterol (LDL-C), 2?h glucose load plasma glucose (2?h PG), triglycerides (TG), hemoglobin A1c (HbA1c), 1?h glucose load plasma insulin (INS) level, and 2?h INS level were independent risk factors for the development of insulin resistance after delivery. This study has identified a high prevalence of AGM after GDM. Insulin resistance appears to be the major contributor. Any treatment to reduce the postpartum BMI and lipids level may be beneficial to decrease insulin resistance.     

Postpartum diabetes screening in women with a history of gestational diabetes

OBJECTIVE: Women with a history of gestational diabetes mellitus (GDM) are at high risk for developing type 2 diabetes (diabetes mellitus, DM). The American Diabetes Association recommends regular postpartum diabetes screening for women with a history of GDM, but the American College of Obstetricians and Gynecologists (ACOG) is not as directive. We sought to examine postpartum glycemic testing in women diagnosed with GDM. METHODS: We conducted an observational cohort study of women diagnosed with GDM at one of two large academic medical centers between 2000 and 2001. Kaplan-Meier estimates of the time from delivery to the first postpartum DM screening tests were determined, and predictors of postpartum DM screening were examined using Cox proportional hazards testing. RESULTS: Only 37% of eligible women underwent the postpartum diabetes screening tests recommended by the American Diabetes Association (fasting glucose or oral glucose tolerance test [OGTT]), with a median time from delivery to the first such testing of 428 days. By comparison, 94% of women underwent postpartum cervical cancer screening using a Papanicolaou (Pap) test, with a median time from delivery to Pap testing of 49 days. Even when random glucose testing was included in a broad definition of postpartum DM screening (random or fasting glucose, glycosylated hemoglobin, or OGTT), only two thirds of women (67%) received a postpartum glycemic assessment. CONCLUSION: In the population studied, only 37% of women with a history of GDM were screened for postpartum DM according to guidelines published by the American Diabetes Association. Efforts to improve postpartum DM screening in this high-risk group are warranted.     

Normal secretion of the incretin hormones glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 during gestational diabetes mellitus.

BACKGROUND AND AIM: Gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (DM2) are suggested to be caused by the same metabolic disorder. Defects in gut hormone-dependent regulation of beta-cell function (entero-insular axis) have been proposed to contribute to the pathogenesis of DM2. The aim of study was to evaluate whether an impaired secretion of glucagon-like peptide-1 (GLP-1) and/or glucose-dependent insulinotropic polypeptide (GIP) could play a role in the development of carbohydrate disorders during pregnancy. SUBJECTS AND METHODS: The study group (GDM) consisted of 13 gestational women with diabetes mellitus in whom GDM was diagnosed according to the World Health Organization criteria (75-g oral glucose tolerance test (OGTT)). The control group consisted of 13 pregnant women with normal glucose tolerance (NGT), matched according to age and duration of pregnancy. For all patients, plasma glucose, insulin, GLP-1 and GIP concentrations were evaluated after an OGTT, i.e. at 0, 30, 60, 90 and 120 min after glucose load. RESULTS: Fasting plasma glucose concentrations were similar in both groups, but the 0-120 min area under the curve (AUC) for glucose was significantly greater in the GDM group than in the NGT group (p < 0.0005). Fasting insulin concentration was higher (p < 0.05) and the 2-h insulin response (AUCtotal) was significantly greater (p = 0.01) in the GDM group than in the NGT group. Insulin resistance was significantly higher in GDM compared with control women (homeostasis model assessment, p = 0.003). Fasting GLP-1 concentrations were higher in the GDM group (p = 0.05), but no differences were observed in GLP-1 response (AUC) between the studied groups. Fasting and stimulated GIP response did not differ between groups at any time of the study (p > 0.05). Positive correlations were observed between fasting GLP-1 and insulin concentration (r = 0.56, p < 0.004) and between fasting GLP-1 and insulin resistance (r = 0.43, p < 0.029). CONCLUSION: An impaired secretion of GLP-1 and GIP does not seem to play a major role in the pathogenesis of GDM.     

Subclinical abnormalities of glucose metabolism in Brazilian women with a history of gestational diabetes mellitus

BACKGROUND: To evaluate insulin release and insulin sensitivity in women with prior gestational diabetes mellitus (GDM) to gain a better understanding of type 2 diabetes pathogenesis. METHODS: GDM women were individually matched for age, body mass index, and waist/hip ratio with those who were normal glucose tolerant in a previous pregnancy (NGT). All women presented with normal glucose tolerance. Twenty pairs were submitted to the oral glucose tolerance test (OGTT) with plasma glucose, insulin, and C-peptide determinations. Of the 20 pairs, 18 participated in hyperglycemic (10.0 mmol/l) clamp experiments with frequent plasma glucose and insulin determinations, allowing us to calculate first- and second-phase insulin release and the insulin sensitivity index. GDM and NGT women were compared using Student's t-test, the Mann-Whitney U-test, Friedman's non-parametric test, and the two proportion test for independent groups. RESULTS: GDM women showed higher glycosylated hemoglobin values; at OGTT, they showed late insulin peak with increased plasma insulin levels only during the second hour, and a similar plasma C-peptide response despite a higher plasma glucose curve; during hyperglycemic clamp procedures, they showed similar biphasic insulin release and insulin sensitivity index. Considering that a woman with previous GDM had a defect in insulin release and/or insulin sensitivity, if its magnitude was at least 25% lower than that of the matched NGT woman, 43.8% showed impairment of first-phase insulin release and 55.6% insulin resistance. CONCLUSIONS: GDM women showed some degree of glucose intolerance. It is therefore necessary to follow them for a longer time.     

Role of A1c in the postpartum screening of women with gestational diabetes

Abstract

Objective: This study aimed to determine whether A1c detects a different prediabetes prevalence in women with a history of gestational diabetes mellitus (GDM) compared to those diagnosed with oral glucose tolerance test (OGTT) and the influence of haemoglobin concentrations on A1c levels.

Design and patients: We evaluated carbohydrate metabolism status by performing OGTT and A1c tests in 141 postpartum women with prior GDM in the first year post-delivery.

Results: The overall prevalence of prediabetes was 41.8%. Prevalence of isolated A1c 5.7–6.4%, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) was 10.6%, 7.1%, and 9.2%, respectively. Isolated A1c 5.7–6.4% was associated with Caucasian origin (66.7% versus 32.6%, p?=?0.02) and with higher LDL cholesterol concentrations (123?±?28.4?mg/dl versus 101.6?±?19.2?mg/dl, p?=?0.037) compared with patients diagnosed by OGTT (IFG or IGT). Women with postpartum anaemia had similar A1c levels to those with normal haemoglobin concentrations (5.5%?±?0.6% versus 5.4%?±?0.4%, p?=?0.237).

Conclusions: Use of A1c in postpartum screening of women with GDM detected an additional 10.6% of patients with prediabetes and a more adverse lipid profile. Haemoglobin concentrations did not influence A1c values.     

妊娠期糖尿病孕妇分娩后血糖异常的相关因素分析

目的　探讨妊娠期糖尿病 (GDM)孕妇分娩后 2个月的 75g葡萄糖耐量试验 (OGTT)结果 ,及其与血糖异常的相关因素。方法　对 2 94例GDM孕妇于分娩后 2个月行OGTT ,按世界卫生组织标准进行再分类 ,即 2型糖尿病 (2型DM)、糖耐量低减 (IGT)和血糖正常。并对其相关因素进行分析。结果　 (1) 2 94例孕妇中 160例 (5 4 4% )血糖正常 (血糖正常组 ) ,75例 (2 5 5 % )IGT (IGT组 ) ,5 9例 (2 0 1% ) 2型DM(2型DM组 )。 (2 ) 2型DM组的诊断孕周早于其他两组 (P <0 0 1) ;5 0g葡萄糖负荷试验 (GCT)的血糖、OGTT中的空腹血糖、以及诊断时的糖化血红蛋白 (HbA1c)均明显高于其他两组(P <0 0 1) ;胰岛素治疗的孕周最早 ,胰岛素使用率高于血糖正常组 (P <0 0 5 ) ,胰岛素的剂量也明显大于其他两组 ;分娩后 1周内的空腹和餐后 2h血糖仍明显高于其他两组 (P <0 0 1)。 (3 ) 3组孕妇间体重、年龄、家族史等比较 ,差异无显著性 (P >0 0 5 )。结论　GDM孕妇中约有 1/ 4为IGT ,1/ 5为 2型DM ;后者在孕期表现为发病早 ,空腹血糖高 ,使用胰岛素机会多     

妊娠期糖尿病产后糖代谢异常的危险因素

目的通过对妊娠期糖尿病(GDM)患者进行产后随访,回顾性分析影响GDM患者产后糖代谢变化的高危因素。方法收集2009年1月至2011年6月在河北省沧州市中心医院门诊产前检查并分娩的GDM患者236例,产后42d回访者158例,记录其孕前和孕期信息,包括:孕期年龄、身高、孕前体重、有否糖尿病家族史、孕期使用胰岛素情况、孕期并发症及合并症情况、新生儿出生时情况;并按OGTT试验结果分为研究组和对照组,进行高危因素筛查。结果研究组为60例糖耐量异常者,包括39例IGT/IFG患者和21例DM患者;对照组为98例糖耐量正常者,比较两组患者孕前、孕期和妊娠结局情况,结果可见高龄、糖尿病家族史、孕期应用胰岛素、合并子痫前期、早产是产后发生糖代谢异常的高危因素,差异有统计学意义(P<0.05)。结论存在高危因素的GDM患者产后糖代谢异常发生率较高,应针对性地对GDM患者进行产后临床筛查和随访。     

妊娠期糖尿病IADPSG诊断标准的探讨

目的:探讨国际糖尿病与妊娠关系研究协会(IADPSG)推荐的妊娠期糖尿病(GDM)新标准(2011年ADA诊断标准)是否适用于我国。方法:选取2011年6月至2012年2月在暨南大学附属第一医院妇产科产检的孕妇1101例,于妊娠24～28周行葡萄糖耐量实验(OGTT)。结果:(1)纳入研究的1054例孕妇OGTT空腹、1h、2h血糖的95%医学参考值分别为5.2、10.7、9.1 mmol/L;90%医学参考值分别为5.0、9.9、8.5mmol/L。(2)2011年ADA诊断标准诊断GDM的发病率为18.7%,显著高于第7版《妇产科学》诊断标准(4.2%)、日本诊断标准(4.4%)及本研究95%参考值(10.3%)(P'均<0.005);(3)空腹血糖与餐后1h血糖、餐后2h血糖的相关性较低;依据第7版《妇产科学》及2011年ADA诊断标准诊断为GDM者分别为44例和197例,其中空腹血糖≤4.4mmol/L者分别为11例(25%)和66例(33.5%)。结论:(1)在获得我国相关临床研究数据之前,IADPSG诊断标准在我国的全面推广会显著增加GDM发病率,值得商榷;(2)不建议使用空腹血糖排除GDM,即使空腹血糖≤4.4mmol/L。     

糖化血红蛋白检测在妊娠合并糖尿病诊疗中的价值

妊娠合并糖尿病包括孕前糖尿病(PGDM)和妊娠期糖尿病(GDM),与母儿近远期并发症有关。糖化血红蛋白(HbA1c)可反映近2~3个月血糖水平,近年来用作非妊娠期糖尿病的诊断标准之一。很多学者对不同妊娠时期HbA1c水平能否预测GDM的发生、母儿不良妊娠结局和母亲产后糖尿病发生风险以及不同种族HbA1c水平差异、HbA1c水平的影响因素等方面进行了大量研究,多数认为HbA1c作为GDM的诊断指标敏感度不高,可能增加漏诊率,但其单独或与更多指标联合是筛查和诊断GDM的有力补充,可以减少口服葡萄糖耐量试验(OGTT)的检测。孕期不同时点的HbA1c水平均可能与妊娠结局有关,而产前HbA1c水平对识别可能进展为2型糖尿病的高危GDM孕妇也有一定的价值。不过,对HbA1c的截断值、包含HbA1c的不同筛查诊断策略意见尚不统一,仍需更多的研究进一步明确。     

妊娠期糖尿病孕妇产后糖代谢异常的研究

目的　了解妊娠期糖尿病（ＧＤＭ） 患者产后糖代谢异常情况、筛出预测产后糖代谢异常的高危因素及ＧＤＭ 患者远期糖尿病发生情况。　方法　收集１９８２ 年１１ 月～１９９８ 年４ 月在我院分娩并产后随访的９７ 例ＧＤＭ 孕妇,其中远期随访１～８ 年者３３ 例。　结果　ＧＤＭ 产后近期随访诊断为显性糖尿病者２３ 例,糖耐量减低１１ 例,列为产后糖代谢异常组。与产后糖代谢正常组（４１ 例） 进行比较发现：糖尿病家族史、孕期血糖异常出现时间、糖筛查血糖高、空腹血糖升高以及糖尿病孕期治疗情况两组间存在明显差异。远期追踪３３ 例中显性糖尿病１０ 例,糖耐量减低３ 例。　结论　ＧＤＭ产后仍有部分患者糖代谢不能恢复正常,尤其有糖尿病家族史,在妊娠２４ 周以前确诊ＧＤＭ,糖筛查血糖较高,空腹血糖升高,孕期需胰岛素治疗者更应重视产后血糖检查,以便及时发现产后糖代谢异常。产后近期糖代谢正常者,仍需进行远期随访     

Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test

BACKGROUND: The objective of the present study was to determine prevalence of gestational diabetes mellitus (GDM) in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), and the value of traditional anamnestic risk factors for predicting outcome of the oral glucose tolerance test (OGTT). METHODS: A prospective population-based study in a defined geographic area in Sweden. All pregnant nondiabetic women (n = 4918) attending maternal health care from July 1994 to June 1996 were offered a 75g OGTT in gestational weeks 28-32. Traditional anamnestic risk factors, as well as results of the OGTT in terms of fasting-B-glucose and 2h-B-glucose, were registered. RESULTS: 3616 (73.5%) women agreed to perform the OGTT. Sixty-one (1.7%) of those had GDM [47 (1.3%) had impaired glucose tolerance and 14 (0.4%) had diabetes mellitus]. 15.8% fulfilled traditional risk factor criteria. Traditional anamnestic risk factors as an indicator to perform an OGTT identified 29/61 GDM women and 9/14 women with DM. Among primiparas, 4/21 with gestational diabetes mellitus were detected. CONCLUSION: Using traditional risk factors as an indicator to perform an OGTT gives a low sensitivity to detect GDM and even DM especially among primiparas.     

Insulin secretion at the diagnosis of gestational diabetes is lower in multiparas than in primiparas

Gestational diabetes mellitus (GDM) has heterogeneous ethiopathogenesis, pathophysiology and clinical features. OBJECTIVES: The aim of the study was to evaluate some of anthropometric parameters, clinical features and indices of insulin resistance and beta cell function in GDM women in first pregnancy and in GDM women in third and following pregnancies. MATERIAL AND METHODS: 877 GDM women, aged 18-48 years were studied. Both groups were compared according to age, BMI before pregnancy, week of GDM diagnosis, weight gain during pregnancy, fasting blood glucose, fasting serum insulin level, HbA1c, insulin resistance and beta-cell function indices. All parameters except BMI were evaluated at GDM diagnosis. RESULTS: Multiparas were older, with higher BMI and lower beta-cell function indices. CONCLUSION: At the moment of GDM diagnosis, insulin secretion evaluated by HOMA indices are lower in multiparas in comparison to primaparas.     

Serum YKL-40 levels in gestational diabetes mellitus

Objective: Serum YKL-40 levels are elevated in patients with type 1 and 2 diabetes. However, the correlation between YKL-40 and gestational diabetes mellitus (GDM) remains unknown. The present study compared serum YKL-40 levels in pregnant women with GDM and those with normal glucose tolerance and evaluated the relationship between YKL-40 and insulin-resistant syndrome.

Methods: Thirty-five patients with GDM and 43 age-matched healthy pregnant women at 24–28 weeks of gestation were studied. In addition to anthropometric assessments, serum glucose, insulin, YKL-40, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein and glycated hemoglobin were measured in all subjects. All subjects underwent a 2-h 75-g oral glucose tolerance test (OGTT). Body mass index (BMI) and the homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.

Results: Fasting and 2?h serum YKL-40 levels were significantly higher in pregnant women with GDM compared with controls (77.3?±?29.3 versus 50.9?±?16.7 ng/mL, p?<?0.001, fasting concentrations; 63.5?±?20.1 versus 40.6?±?10.7 ng/mL, p?=?0.009, 2?h concentrations). OGTT had no effect on YKL-40 levels in either group (p?>?0.05). There were significant correlations between YKL-40 and glycated hemoglobin (β?=?0.37, p?=?0.006), fasting insulin (β?=?0.49, p?=?0.001) and HOMA-IR (β?=?0.18, p?=?0.015) in the GDM group.

Conclusions: Serum YKL-40 levels are elevated in patients with GDM but are unaffected by OGTT. YKL-40 levels are related to glycated hemoglobin, fasting insulin and HOMA-IR. These results suggest that YKL-40 may be a major contributor to GDM.     

Use of oral glucose tolerance test in early pregnancy to predict late-onset gestational diabetes mellitus in high-risk women

AIM: To evaluate if any single plasma glucose level from the four values of the normal 100-g oral glucose tolerance test (OGTT) in early pregnancy (< or =20 weeks of gestation) could predict gestational diabetes mellitus (GDM) diagnosed from a second OGTT in late pregnancy (28-32 weeks). METHODS: Glucose levels of pregnant women at high-risk for GDM, who had had a normal early OGTT, and who underwent the second test in late pregnancy, were studied. Each of the four plasma glucose values of the early OGTT was determined for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The receiver operating characteristic curves of these four OGTT values were then constructed to find the optimal value to predict late-onset GDM. RESULTS: Of 193 pregnant women who had had a normal early OGTT, 154 also had a normal OGTT in late pregnancy while 39 had an abnormal test and were diagnosed with GDM. Among the four glucose values of the early OGTT, the 1-h value yielded the best diagnostic performance to predict late-onset GDM. The sensitivity, specificity, PPV, NPV, and area under the curve achieved from its optimal cutoff level of > or =155 mg/dL (8.6 mmol/L) were 89.7%, 64.3%, 38.9%, 96.1%, and 0.77, respectively. CONCLUSIONS: A 1-h glucose value > or =155 mg/dL at the early OGTT yielded the best diagnostic performance. However, the low specificity and PPV rendered it suboptimal to predict late-onset GDM. Nevertheless, a considerable number of high-risk women could avoid the second OGTT in late pregnancy due to its high sensitivity and NPV.     

妊娠期糖尿病病史妇女远期血清胰岛素水平观察

目的　测定妊娠期糖尿病（ Ｇ Ｄ Ｍ） 病史妇女,远期未发生糖尿病者的血糖和血清胰岛素水平,间接了解胰岛β细胞功能。方法　对远期未发生糖尿病的 Ｇ Ｄ Ｍ 病史者３０ 例（ 观察组） ,口服糖耐量试验（ Ｏ Ｇ Ｔ Ｔ） 单项异常史者２９ 例（ 异常史组） ,正常孕妇３８ 例（ 对照组） 进行追访,复查空腹血糖并行７５ｇ 糖负荷试验,同时测定胰岛素水平。结果　（１） 服糖后２ 小时观察组血糖为（６ ．１ ±１ ．７）ｍｍｏｌ／ Ｌ,异常史组血糖为（５ ．５ ±１ ．２） ｍｍｏｌ／ Ｌ,均高于对照组的（４ ．８ ±０ ．５） ｍ ｍｏｌ／ Ｌ,尤以观察组为著（ Ｐ＜０ ．００１） 。（２） 服糖后２ 小时,观察组的血清胰岛素水平为（６０ ．７ ±３８ ．６） ｍ Ｕ／ Ｌ,高于对照组的（３８ ．４ ±１６ ．２）ｍ Ｕ／ Ｌ,两组比较,差异有极显著性（ Ｐ＜ ０ ．００１） 。结论　远期未发生糖尿病者,仍存在着胰岛素抵抗,有可能是以后发生糖尿病的信号。