Plasma adiponectin, insulin sensitivity, and subclinical inflammation in women with prior gestational diabetes mellitus

OBJECTIVE: Women with prior gestational diabetes mellitus (pGDM) are at increased risk of developing type 2 diabetes and associated vasculopathy. Because increased fat mass and inflammatory processes are angiopathic risk factors, the relationship between insulin sensitivity, parameters of subclinical inflammation, and plasma concentrations of adipocytokines was investigated in pGDM both at 3 months and 12 months after delivery. RESEARCH DESIGN AND METHODS: Insulin sensitivity (through a frequently sampled intravenous glucose tolerance test) and plasma concentrations of ultrasensitive C-reactive protein (CRP), adiponectin, plasminogen activator inhibitor (PAI)-1, tumor necrosis factor-alpha, leptin, and interleukin-6 were measured in 89 pGDM (BMI 26.9 +/- 0.5 kg/m(2), age 32 +/- 0.5 years) and in 19 women with normal glucose tolerance during pregnancy (NGT) (23.7 +/- 0.9 kg/m(2), 31 +/- 1.3 years). RESULTS: pGDM showed lower (P < 0.0001) plasma adiponectin (6.7 +/- 0.2 microg/ml) than NGT (9.8 +/- 0.6 microg/ml) and a decreased (P < 0.003) insulin sensitivity index (S(i)) and disposition index (P < 0.03), but increased plasma leptin (P < 0.003), PAI-1 (P < 0.002), and CRP (P < 0.03). After adjustment for body fat mass, plasma adiponectin remained lower in pGDM (P < 0.004) and correlated positively with S(i) (P < 0.003) and HDL cholesterol (P < 0.0001) but negatively with plasma glucose (2-h oral glucose tolerance test [OGTT]) (P < 0.0001), leptin (P < 0.01), CRP (P < 0.007), and PAI-1 (P < 0.0001). On regression analysis, only HDL cholesterol, postload (2-h OGTT) plasma glucose, and S(i) remained significant predictors of plasma adiponectin, explaining 42% of its variability. Of note, adiponectin further decreased (P < 0.05) only in insulin-resistant pGDM despite unchanged body fat content and distribution after a 1-year follow-up. CONCLUSIONS: Lower plasma adiponectin concentrations characterize women with previous GDM independently of the prevailing insulin sensitivity or the degree of obesity and are associated with subclinical inflammation and atherogenic parameters.     

Increased visfatin concentrations in women with gestational diabetes mellitus

The recently discovered adipocytokine visfatin has insulin-like properties. It lowers blood glucose and improves insulin sensitivity; however, clinical data on visfatin are limited. To evaluate the role of visfatin in GDM (gestational diabetes mellitus), we determined visfatin levels in women with GDM and in healthy pregnant controls. Furthermore, visfatin concentrations were investigated longitudinally during pregnancy and after delivery in a subgroup of women with GDM. Blood for measurement of visfatin and metabolic parameters was obtained from 64 women with GDM [median week of gestation, 34 (interquartile range, 27-36) weeks] and 30 healthy pregnant controls [median week of gestation, 34 (interquartile range, 28-36) weeks]. In a subgroup of 24 women with GDM, visfatin, leptin and metabolic parameters were investigated twice during pregnancy (28-30 and 38-40 weeks of gestation) and 2 weeks after delivery. In the cross-sectional analysis, median visfatin levels were significantly elevated in women with GDM [64.0 (interquartile range, 50.9-74.8) ng/ml] compared with controls [46.0 (interquartile range, 36.9-54.6) ng/ml; P<0.0001]. In women with GDM, visfatin correlated with week of gestation at the time of blood draw (R=0.35, P=0.005). No association with fasting glucose, insulin, homoeostasis model assessment-insulin resistance or body mass index was observed. According to the longitudinal analysis, visfatin increased during pregnancy (P=0.002) and rose further after delivery (P=0.014), whereas leptin and insulin levels decreased after parturition (both P<0.001). In conclusion, visfatin is elevated in women with GDM and increases during the course of pregnancy as well as after delivery. Furthermore, visfatin shows no association with insulin and leptin in women with GDM.     

Early postpartum metabolic assessment in women with prior gestational diabetes.

OBJECTIVE: To present the results of early postpartum metabolic assessment in women with gestational diabetes mellitus (GDM), to determine predictive factors for subsequent diabetes, and to investigate the association of postpartum glucose tolerance with other components of the metabolic syndrome. RESEARCH DESIGN AND METHODS: A total of 788 women were evaluated 3-6 months after a GDM pregnancy. A 75-g oral glucose tolerance test (OGTT) was performed. Cholesterol, HDL cholesterol, triglycerides, blood pressure, BMI, and body fat distribution were assessed. Clinical and obstetric history, baseline variables at the diagnosis of GDM, metabolic control during pregnancy, and index pregnancy outcome were compared in women with diabetes and women without diabetes (American Diabetes Association [ADA] criteria) after pregnancy. Multivariate logistic regression analysis was used to ascertain independent predictors of subsequent diabetes. Correlation coefficients were assessed between postpartum glucose tolerance and lipid levels, blood pressure, BMI, and body fat distribution. RESULTS: According to ADA criteria, 588 (74.6%) women were normal, 46 (5.8%) had impaired fasting glucose, 82 (10.4%) had impaired glucose tolerance, 29 (3.7%) had both impaired fasting glucose and impaired glucose tolerance, and 43 (5.4%) had diabetes. Prepregnancy obesity, recurrence of GDM, gestational age at diagnosis of GDM, glucose values in the 100-g OGTT, number of abnormal values in the 100-g OGTT, fasting C-peptide levels in pregnancy, C-peptide/glucose score in pregnancy, insulin requirement in pregnancy, 3rd trimester HbA1c levels, and macrosomia differed significantly in women with subsequent diabetes. Independent predictors of postpartum diabetes were prepregnancy obesity, C-peptide/glucose score during pregnancy, and the number of abnormal values in the 100-g diagnostic OGTT. The area under the postpartum glucose curve was positively associated with BMI, waist circumference, waist-to-hip ratio, triglycerides, and systolic and diastolic blood pressures. CONCLUSIONS: Low C-peptide/glucose score during pregnancy together with prepregnancy obesity and severity of GDM (number of abnormal values in the 100-g diagnostic OGTT) are independent predictors of subsequent diabetes. Our data suggest that regardless of obesity and severity of GDM, a beta-cell defect increases the risk of postpartum diabetes. The association of postpartum glucose tolerance with triglyceride levels, blood pressure, obesity, and regional distribution of body fat suggests that postpartum glucose intolerance anticipates a high-risk cardiovascular profile that comprises other risk factors besides diabetes.     

妊娠期糖尿病合并亚临床甲减对妊娠结局的影响研究

目的观察和研究妊娠期糖尿病(GDM)合并亚临床甲状腺功能减退(SCH)对妊娠结局的影响。方法选取200例GDM孕妇作为GDM组,200例SCH孕妇作为SCH组,100例GDM合并SCH孕妇作为GDM合并SCH组,200例正常妊娠孕妇作为对照组。对4组孕妇的妊娠并发症及新生儿的不良妊娠结局的发生率进行观察和比较。结果 GDM组孕妇羊水过多、产后出血的发生率高于其他3组(χ~2=4.127~13.328,P0.05),GDM合并SCH组孕妇妊娠期高血压疾病、妊娠期蛋白尿、剖宫产的发生率高于其他3组(χ~2=11.812~22.414,P0.05);GDM合并SCH组新生儿早产、低出生体质量发生率高于其他3组(χ~2=5.838~14.747,P0.05)。结论 GDM合并SCH可导致孕妇及其子代不良妊娠结局的发生率上升。     

超声在妊娠期糖尿病孕妇胎儿检查中的应用

随着医疗诊断技术和人们生活水平的提高,妊娠期糖尿病(GDM)的发病率呈逐年上升趋势。通过超声对胎儿生长发育等方面的监测,可评估GDM对围生儿的影响,为GDM诊断、治疗提供一种更加直接、有效、无创的方法。     

标准化糖尿病护理路径在妊娠合并糖尿病孕妇围产期中的应用

目的:探讨标准化糖尿病护理路径在妊娠合并糖尿病孕妇围产期中的应用效果。方法:选取2011年5月~2014年5月妊娠合并糖尿病孕妇50例,将其随机等分为对照组和观察组,对照组予常规护理,观察组予标准化护理路径护理,观察护理后在围产期血糖、产程监护相关指标上变化情况。结果:观察组护理后空腹血糖、餐后2 h血糖、糖化血红蛋白、并发症发生率低于对照组(P0.05);两组患者妊娠结局比较,观察组优于对照组(P0.05)。两组新生儿并发症发生率差异无统计学意义(P0.05)。结论:标准化护理能降低妊娠合并糖尿病孕妇围产期血糖值,保证产程安全。     

妊娠糖尿病孕妇血管性假血友病因子检测的意义

目的探讨妊振糖尿病(GDM)孕妇血浆血管性假血友病因子(vWF)变化及意义。方法采用酶联免疫吸附测定(ELISA)法检测20例GDM、32例正常妊娠及22例非妊娠妇女血浆vWF浓度。结果与非妊娠对照组相比,正常妊娠组空腹血浆vWF浓度明显升高,GDM组血浆vWF浓度又显著高于正常妊娠组及非妊娠对照组[(329.43±83.67)%vs(205.14±49.25)%vs(108.62±37.58)%],其差异均有统计学意义(P<0.001)。结论GDM孕妇存在较正常孕妇更为严重的血管内皮功能受损。     

Characteristics of bone turnover markers in women with gestational diabetes mellitus

BackgroundBone turnover markers (BTMs) can be applied to the assessment of bone formation and bone resorption activity. The aim of this study was to investigate the changes in BTMs in women with gestational diabetes mellitus (GDM).MethodsOne hundred and five women with gestational diabetes mellitus defined as the GDM group and 46 healthy pregnant women with normal glucose tolerance selected as the control group were enrolled in this study. Serum samples were collected during regular obstetric examinations and the serum levels of total procollagen type 1 N-terminal propeptide (P1NP), N-terminal midfragment of osteocalcin (N-MID), and β-C-terminal telopeptide of type 1 collagen (β-CTX) were measured. An independent-sample t-test, the Mann–Whitney U test, and a Pearson correlation analysis were performed for data analyses.ResultsSerum β-CTX levels in the GDM group were significantly higher than those in the control group (296.00 [235.00–369.00] pg/mL vs. 218.5 [165.25–292.50] pg/mL, p < 0.05), while P1NP and N-MID levels did not differ between the two groups. The Pearson correlation analysis revealed that β-CTX level was correlated with blood glucose level.ConclusionsThe difference in β-CTX levels indicated that bone resorption in patients with GDM diabetes was higher than that in pregnant women with normal glucose tolerance. No obvious differences in bone formation markers P1NP and N-MID were found between the two groups.     

产后管理干预在妊娠期糖尿病妇女中的应用

[目的]探讨产后管理干预对妊娠期糖尿病(GDM)产妇的影响,为降低GDM妇女远期患糖尿病的风险研究提供依据。[方法]选取GDM产后妇女作为研究对象,分为干预组(150例)和对照组(100例),对干预组妇女进行糖尿病教育、膳食指导、制定运动方案、电话随访个性指导等产后管理干预;对照组只做常规管理,两组妇女均在产后3d、42d及12周、半年、1年共5个时段监测体质指数(BMI)、空腹及餐后血糖、糖化血红蛋白、脂蛋白、75g口服葡萄糖耐量试验(OGTT)筛查、疾病认知程度等指标。[结果]本组GDM发病率为9.9%;干预组产后12周至产后1年BMI、空腹血糖值、餐后血糖值低于对照组;两组GDM妇女干预前后对疾病认知情况比较差异有统计学意义(P0.05)。[结论]对患GDM的妇女进行产后管理干预能提高妇女对GDM的疾病认知,能够有效地降低GDM妇女的BMI、控制血糖,改善糖代谢。     

妊娠期糖尿病产妇分娩新生儿低血糖的危险因素分析

目的探讨妊娠期糖尿病（GDM）产妇分娩新生儿发生低血糖的危险因素。 方法将229例GDM产妇分娩的新生儿根据产后24 h内血糖是否<2.2 mmol/L分为低血糖组（63例）及对照组（166例）。比较两组GDM产妇的年龄、分娩方式（平产、急诊剖宫产、择期剖宫产）及羊水清洁度,新生儿的体质量、喂养方式（母乳喂养及混合喂养）。采用Logistic回归模型分析影响GDM产妇分娩的新生儿低血糖发生的相关危险因素。 结果两组新生儿体质量及产妇分娩方式间的比较,差异均有统计学意义（t = 2.821,P = 0.006;χ² = 32.616,P = 0.001）,而GDM产妇年龄及羊水清洁度,新生儿喂养方式间的比较,差异均无统计学意义（t = 0.864,P = 0.389;χ² = 14.822,P = 0.641;χ² = 4.775,P = 0.092）。通过多因素Logistic回归模型发现,体质量[比值比（OR）= 3.025,95%置信区间（CI）（1.263,7.244）,P = 0.013]、急诊剖宫产[OR = 5.227,95%CI（2.049,13.330）,P = 0.001]、择期剖宫产[OR = 8.237,95%CI（2.967,22.869）,P<0.001]均是影响GDM产妇分娩新生儿发生低血糖的危险因素。 结论体质量、急诊剖宫产、择期剖宫产均是影响GDM产妇分娩新生儿发生低血糖的危险因素。     

Impaired cardiac autonomic function in women with prior gestational diabetes mellitus

BACKGROUND: Cardiac autonomic neuropathy is a common dysfunction in manifest diabetes mellitus and is associated with duration of diabetes and/or an inadequate glycaemic control. Heart rate variability (HRV) reflects autonomic heart function. The aim of the present study was to investigate whether in women with prior gestational diabetes (GD; pre-type 2 diabetes) alterations of cardiac autonomic function can be observed after delivery in relation to insulin sensitivity and glycaemic control. MATERIALS AND METHODS: Forty-eight healthy women with prior GD were consecutively admitted to the study. HRV was analysed by both time, as well as frequency, domain methods using 24-h Holter monitoring. In addition, 20 women with normal glucose tolerance during and after pregnancy were investigated as control subjects. All women underwent a frequently sampled intravenous glucose tolerance test (FSIGT) for measurement of insulin sensitivity. RESULTS: Time domain analysis (standard deviation of normal RR intervals; SDNN) showed a reduced HRV in 25 out of the 48 (52%) women with prior GD. Frequency domain analysis revealed that in these 25 subjects both low and high frequency components of power spectral density (reflecting mainly sympathetic respectively parasympathetic activity) were reduced, indicating that sympathetic as well as parasympathetic functional impairment may be assumed. However, a relative predominance of the sympathetic over parasympathetic cardiac function was observed. The impairment of cardiac autonomic function (reduced SDNN) was correlated with HbA1c values and the 2-h blood glucose concentration (oral glucose tolerance test) but not with insulin sensitivity. CONCLUSION: The present results demonstrate that in 52% of the women examined who had prior GD, an impairment of cardiac sympathetic as well as parasympathetic function was present, which related to glycaemic control, but not to insulin sensitivity. This infers that functional autonomic changes could be an early prognostic indicator in pre-type 2 diabetes.     

Understanding exercise beliefs and behaviors in women with gestational diabetes mellitus

OBJECTIVE: The purpose of this study was to examine the exercise beliefs and behaviors of postpartum women who had gestational diabetes mellitus (GDM) during a recent pregnancy. RESEARCH DESIGN AND METHODS: Postpartum women with GDM (n = 28) completed a mail survey assessing their self-reported exercise beliefs (advantages, barriers, and important social influences) and behaviors. RESULTS: We found that 1) the strongest perceived advantage of exercise during pregnancy was controlling blood glucose and postpartum it was controlling weight, 2) the most common barrier to exercise during pregnancy was fatigue and postpartum it was a lack of time, 3) women's husband/partner most strongly influenced their exercise during pregnancy and postpartum, 4) women exercised more during the postpartum period than before or during pregnancy, and 5) the number of exercise advantages was positively associated with women's pregnancy and postpartum exercise behavior. CONCLUSIONS: To increase exercise behavior and reduce the risk of type 2 diabetes in women with GDM, researchers and health care professionals are encouraged to use women's exercise beliefs, that is, advantages, social influences, and perceived barriers to exercise, as a framework for designing effective diabetes treatment and prevention programs.     

糖尿病孕妇分娩近期的血糖随访

妊娠期糖尿病(gestational diabetes mellitus,GDM)是指孕妇在妊娠期发生或发现不同程度的糖耐量异常,其中包含部分孕前即有糖代谢异常的妇女。大多GDM孕妇分娩后糖代谢正常,但亦有分娩后糖代谢异常持续存在。分娩后胰岛素抵抗被解除,糖代谢异常得到改善,但该类患者糖尿病(DM)的发生率仍很高,所以对其血糖随访仍非常重要,本研究对31例GDM孕妇产后7d做了随访,并对产后血糖异常的发生率、高危因素以及随访管理进行分析。材料和方法一、研究对象2004年1～8月在我院分娩的31例GDM孕妇,中位年龄为28岁(22～43岁),均为单胎妊娠。孕妇高龄4例…     

妊娠期糖尿病妇女产后2型糖尿病发生及预防的研究进展

随着糖尿病(diabetes mellitus,DM)发病率及相关病死率在全球范围内的不断上升,严重威胁人类健康,DM预防已成为世界各国共同关注的健康问题。同时,文献显示妊娠期     

妊娠期糖尿病患者血清 adropin 表达及意义

目的：研究妊娠期糖尿病(GDM)患者血清中 adropin 的表达水平。方法应用1∶1配对的病例对照研究方法,43例 GDM 孕产妇及43例健康孕产妇参与本次研究,匹配的因素为民族、体质量、身高、年龄、孕周。应用酶联免疫吸附试验检测孕产妇血清中 adropin 的浓度,评估 adropin 水平与临床各代谢指标间的相关性。结果 GDM组血清 adropin 水平显著低于对照组(P <0.05);与对照组相比,血清胰岛素稳态指数、空腹胰岛素、甘油三酯及胆固醇水平显著升高(P <0.05);孕产妇血清的 adropin 水平与孕产妇临床各代谢指标间具有明显的相关性,但与新生儿体质量无明显的关系。结论低水平的 adropin 可能参与了 GDM 的病理机制。     

产后护理干预对妊娠期糖尿病妇女的影响

[目的]研究产后护理干预对妊娠期糖尿病(GDM)产妇的影响。[方法]将进行分娩的80例GDM产妇按随机数字表法分为观察组和对照组各40例,观察组由研究人员进行糖尿病教育、膳食指导、制订个性化运动方案、电话随访、家庭随访辅助指导等产后护理管理干预,对照组实施一般常规护理,比较两组产妇护理前、产后3d、42d及12周体重指数(BMI)、空腹血糖、糖化血红蛋白(HbA1c)以及疾病认知程度等指标。[结果]护理后3d、42d、12周观察组BMI、空腹血糖及HbA1c水平均显著低于对照组(P均0.05);护理后观察组GDM定义以及临床表现、妊娠期糖代谢特点、GDM诊断、GDM正确处理等疾病认知情况答题正确率显著高于对照组(P均0.05)。[结论]合理的产后护理干预能有效降低GDM产妇产后BMI、空腹血糖以及HbA1c水平,同时提高产妇对疾病认知程度。