妊娠期糖代谢异常患者产后6～12周糖代谢转归的随访研究

目的探讨北京地区妊娠期糖代谢异常患者产后6～12周糖代谢转归。方法产后6～12周复诊女性193例（6例糖尿病妊娠,187例孕期糖代谢异常）。内分泌科与产科协作行妊娠糖尿病（GDM）随诊,询问体重变化,测腰围、臀围;行OGTT检测各时间点血糖和胰岛素;检测TG、TC、HDL-C、LDL-C。结果（1）产后6～12周26．2％存在糖耐量异常（IGT）,2．1％发生T2DM。（2）22％存在高TG血症,45．7％高TC血症,55．3％高LDL-C血症。（3）多因素分析显示孕期需要应用胰岛素、产前BMI大、产后6～12周高TC血症及HDL-C水平偏低为产后糖代谢异常的危险因素。结论妊娠期糖代谢异常患者产后6～12周仍普遍存在糖代谢异常,应重视对这一群体的随访,预防或延缓其向T2DM的进展。     

妊娠糖尿病:产后管理减少发生2型糖尿病的风险

妊娠糖尿病(GDM)不仅增加围产期孕妇和胎儿患病的风险,而且增加孕妇产后发生2型糖尿病(T2DM)的风险.GDM发展为T2DM有很多危险因素,关键是重视对GDM妇女产后随访和血糖的筛查,以及产后的各种干预措施如健康的生活方式、母乳喂养和必要时药物干预.这对减少Tr2DM发生的风险有重要意义.     

妊娠糖尿病患者产后家庭护理干预相关研究进展

近年来,随着人们生活水平的提高,妊娠糖尿病及糖耐量异常的患者逐渐增多,并由此引发围产儿死亡率、围产儿患病率增高及产科合并症增多。该文就妊娠糖尿病的发生率、结局、转归以及针对妊娠糖尿病患者产后家庭护理干预措施等进行综述。     

分析营养均衡饮食疗法在妊娠糖尿病患者产后护理中的应用

目的探究在妊娠糖尿病患者产后护理中运用用营养均衡饮食疗法的效果。方法研究对象:该院收治的70例妊娠糖尿病患者;收治时间:2018年2月-2019年2月期间;分组方式:将2018年2-8月期间收治的35例患者纳入参照组,采用常规护理措施;将2018年9月-2019年2月期间收治的35患者纳入研究组,实施营养均衡饮食疗法。观察两组护理满意率,并对比两组产后1个月、3个月及6个月的血糖、营养指标变化。结果研究组护理满意率高于参照组;研究组产后1个月、3个月、6个月的FBG、2 h PBG、HbAlc水平均低于参照组;两组产后1个月、3个月、6个月的ALB、PA、TRF比较,研究组高于参照组,TC、TG低于参照组(P<0.05)。结论营养均衡饮食疗法应用在妊娠糖尿病产后护理中,能控制患者血糖水平,改善其营养状况,并能提高护理满意的,有助于改善护患关系。     

妊娠合并糖尿病产妇的产后综合护理干预分析

目的 探讨妊娠合并糖尿病产妇的产后综合护理干预方法与效果.方法 选取2019年4月—2020年4月期间在该院分娩的妊娠合并糖尿病患者76例作为研究对象,随机分为对照组(36例)和观察组(40例).对照组产后给予血糖管理、健康指导等常规干预.观察组增加产后综合护理,观察两组患者产后不同时间段血糖变化,并监测两组焦虑、抑郁...     

脂蛋白相关磷脂酶A2与妊娠期糖尿病患者产后糖代谢异常的相关性

目的 通过产前脂蛋白相关磷脂酶A2（Lp-PLA2）检测评估妊娠期糖尿病（GDM）患者产后糖代谢异常的发生风险.方法 收集2009年1月至2012年8月系统产检并住院分娩的GDM患者190例作为研究组,同期健康孕妇261例作为对照组.并于妊娠24～28周抽取外周血检测血糖、血脂以及血清Lp-PLA2等.于2012年11月至2013年4月进行随访,其中GDM患者172例,健康孕妇249例,进行口服葡萄糖耐量试验（OGTT）及糖化血红蛋白（HbA1c）.分类计数资料比较采用x2检验.Lp-PLA2与GDM产后糖代谢异常的相关性采用logistic回归分析和ROC曲线分析.结果 （1）GDM患者产后2型糖尿病（T2DM） [4.65％（8/172）比0（0/249）]、糖尿病前期[39.53％ （68/172）比12.45％（31/249）]发生率比健康孕妇高.（2）与健康孕妇相比,GDM患者产后空腹血糖（FBG）[（4.5±0.7）比（4.2±0.3） mmol/L; t=5.6,P＜0.01],空腹胰岛素（FINS）[（9.7±4.9）比（8.7±4.2） mmol/L;t=2.3,P＜0.05],稳态模型胰岛素抵抗指数（HOMA-IR）[（2.0±1.3）比（1.7±1.1）;t=2.6,P＜0.05]均明显升高（P＜0.05）.（3）GDM患者产前血清Lp-PLA2活性明显高于健康孕妇[（33±1 1）比（24±8） nmol·min^-1·ml^-1;t=9.4,P＜0.05].（4）Lp-PLA2活性与GDM产后糖代谢异常显著正相关（OR=1.35,95％CI 1.07～1.66,P=0.001）;受试者工作特征（ROC）曲线分析,以Lp-PLA2活性27.96 nmol· min^-1·ml^-1为产后糖代谢异常诊断切值,其灵敏度为71.3％,特异度为82.1％.结论 GDM患者产后糖代谢异常发生风险显著升高,Lp-PLA2是GDM产后糖代谢异常发生的独立风险因子,对预测GDM产后发生糖代谢异常有一定价值.     

观察在妊娠糖尿病患者产后应用营养均衡饮食疗法的干预效果

目的探讨在妊娠糖尿病患者产后应用营养均衡饮食疗法的干预效果。方法纳入该院2018年1月-2019年3月接收的妊娠糖尿病分娩患者64例为研究对象,用单盲法将研究对象分成两组,各32例:用常规方法干预对照组患者,而观察组患者接受营养均衡饮食疗法。比较两组的干预效果。结果干预12~24周时,观察组的FBG和2 h PBG、HbAlc水平降低程度比对照组显著,ALB、PA和TRF水平上升程度比对照组显著(P<0.05)。结论妊娠糖尿病患者产后接受营养均衡饮食疗法干预,对其血糖降低和蛋白升高有着积极作用。     

营养均衡饮食疗法在妊娠糖尿病患者产后护理中的应用价值探讨

目的:研究营养均衡饮食疗法在应用于妊娠糖尿病患者的产后护理,对其价值进行分析.方法:筛选妊娠糖尿病患者84例,随机分为两组,分别为对照组和观察组.对照组进行常规的护理措施,观察组在此基础上进行营养均衡饮食疗法.实验结束后将两组结果进行对比,进行总结和分析.结果:经过相关护理后,观察组患者自主生活能力与健康标准的差距以及...     

妊娠期糖代谢异常的妊娠结局分析与产后随访研究

了解99例妊娠期糖代谢异常患者的妊娠结局以及糖筛查试验（GCT）和BMI与OGTT异常的联系，探讨产后糖代谢异常组与正常组的差异。提示孕期GCT数值、BMI越高，OGTT异常项数越多、孕期用胰岛素患者OGTT异常项次主要分布在第二、三项，产后糖代谢异常组TG明显高于正常组。所以对妊娠期糖代谢异常患者不仅要加强妊娠期母儿监测，还应重视产后随访研究。     

妊娠合并糖尿病产妇的产后综合护理干预措施探讨

目的 分析针对妊娠合并糖尿病(Gestational Diebetes Mellitus,GDM)产妇进行产后综合护理干预的应用效果。方法 选取2021年6月—2022年5月厦门市中医院收治的83例妊娠合并糖尿病产妇为研究对象,根据产后护理模式分组,A组(综合护理干预)41例,B组(常规产后护理)42例,比较两组血糖控制水平、产妇心理状态、母乳喂养情况、产后并发症、生活质量。结果 干预后,A组FPG、2 hPG、HbA1c水平均低于B组,差异有统计学意义(P<0.05);干预后,A组SAS评分、SDS评分均低于B组,差异有统计学意义(P<0.05);A组初次泌乳时间早于B组,A组母乳喂养频率高于B组,差异有统计学意义(P<0.05);A组产后并发症发生率[4.88%(2/41)]低于B组[47.62%(20/42)],差异有统计学意义(P<0.05);干预后,A组SF-36量表[(85.13±8.24)分]高于B组[(72.10±7.36)分],差异有统计学意义(P<0.05)。结论 产后护理期间实施综合护理干预措施可促进糖尿病产妇血糖控制,改善产妇心态,...     

Prevalence and predictors of postpartum glucose intolerance in Italian women with gestational diabetes mellitus

Aims

To determine the prevalence of both prediabetes and type 2 diabetes mellitus (T2DM) by postpartum oral glucose tolerance test (ppOGTT) in Italian women diagnosed with gestational diabetes mellitus (GDM), and identify antepartum predictors of glucose intolerance.

Methods

Retrospective study of 454 Caucasian women that underwent a 75 g OGTT between 6 and 12 weeks postpartum in Calabria (Southern Italy) between 2004 and 2012. Prediabetes and T2DM were diagnosed according to the American Diabetes Association (ADA) criteria. Data were examined by univariate analysis and multiple regression analysis.

Results

290 women (63.9%) were normal, 146 (32.1%) had prediabetes (85 impaired fasting glycemia; 61 impaired glucose tolerance), and 18 (4.0%) had T2DM. Of the continuous variables, pre-pregnancy body mass index (BMI), age at pregnancy, fasting plasma glucose (FPG) at gravid OGTT, and week at diagnosis of GDM were associated with prediabetes and T2DM, whereas the parity was associated with T2DM only. For categorical traits, pre-pregnancy BMI ≥25 and previous diagnosis of polycystic ovary syndrome (PCOS) emerged as the strongest predictors of prediabetes whereas the strongest predictors of T2DM were FPG ≥100 mg/dl (5.6 mmol/l) at GDM diagnosis and pre-pregnancy BMI ≥25. Moreover, FPG at GDM screening was a good predictor of T2DM after receiver-operating-characteristic analysis.

Conclusions

Our findings confirm the high prevalence of glucose intolerance in the early postpartum period in women with previous GDM. PCOS emerges as a new strong antepartum predictor of prediabetes.     

Predictors of postpartum glucose metabolism disorders in women with gestational diabetes mellitus

Background and aimsPostpartum glucose metabolism disorders are a common problem in women with gestational diabetes mellitus (GDM). They are often underdiagnosed since many patients do not attend the postpartum screening. This study aims to assess predictors of postpartum glucose metabolism disorders and type 2 diabetes mellitus (T2DM) after GDM.Material and methodsRetrospective study in women with GMD who underwent postpartum screening for glucose metabolism disorders (n = 2688). Logistic regression was used in the statistical analysis.Results24.6% of women had postpartum glucose metabolism disorder. In multivariate analysis, pre-pregnancy body mass index (BMI) 25–30 kg/m² (OR 1.46, 95%CI 1.05 to 2.02) or BMI ≥30 kg/m² (OR 2.62, 95%CI 1.72 to 3.96), diagnosis of GDM before 20 weeks of pregnancy (OR 2.33, 95%CI 1.57 to 3.46), fasting plasma glucose after diagnosis of GDM ≥90 mg/dl (OR 2.12, 95%CI 1.50 to 2.98), postprandial glucose ≥100 mg/dl (OR 1.47, 95%CI 1.09 to 2.99), and HbA1c in the third trimester of pregnancy ≥5.3% (2.04, 95%CI, 1.52 to 2.75) were independent predictors for any postpartum glucose metabolism disorder.Conclusionpostpartum screening for T2DM should be performed in all women with GDM, and it is especially important not to lose follow-up in those with one or more predictive factors.     

Follow-up of postpartum women with gestational diabetes mellitus (GDM)

AimThe incidence of type 2 diabetes in postpartum women with gestational diabetes mellitus (GDM) is high, and blood glucose screening for postpartum women is recommended. Follow-up procedures for women with GDM in the postnatal period need to be improved. We investigated the incidence of GDM and the follow-up of women with GDM in Tianjin, China.MethodsPostpartum women who delivered at Tianjin Obstetrics and Gynecology Hospital from January 1st, 2008 to December 31st, 2010 were interviewed by telephone about their blood glucose screening. Thirty obstetricians were interviewed to evaluate awareness about the importance of follow-up.ResultsThe incidence rate of GDM increased from 6.9% in 2008, to 8.8% in 2009, and 9.9% in 2010. A total of 2152 women were interviewed, including 282 women (13.1%) screened for blood glucose. The top three reasons for failed blood glucose screening included: not being informed by their physicians, believing that GDM would disappear after delivery, and being occupied with the baby. Methods for GDM screening included testing of random blood glucose levels, fasting blood glucose levels, oral glucose tolerance, and glycosylated hemoglobin. Of the 30 obstetricians interviewed, 25 were aware of the need for blood glucose screening for women with GDM after delivery, but only 15 of them had informed their patients.ConclusionIn China, most women with GDM are not screened for type 2 diabetes after delivery. Standard clinical procedures that will enable and encourage all women to return for glucose screening following GDM are needed.     

Clinical utility of 1-month postpartum random plasma glucose and glycated hemoglobin combined with pre-pregnancy body mass index for detecting postpartum glucose intolerance in Japanese women with gestational diabetes

During the coronavirus disease 2019 pandemic, the Japanese Society of Diabetes and Pregnancy proposed the use of random plasma glucose and glycated hemoglobin measured 1 month after delivery combined with pre-pregnancy body mass index to detect postpartum glucose intolerance instead of carrying out the oral glucose tolerance test in women with gestational diabetes. We retrospectively evaluated the clinical utility of this strategy to detect postpartum glucose intolerance evaluated by the oral glucose tolerance test after delivery. A total of 275 Japanese women with gestational diabetes were included in the present study. The specificity of 1-month postpartum random plasma glucose and glycated hemoglobin combined with pre-pregnancy body mass index to predict postpartum glucose intolerance was 98.0%, with a negative predictive value of 72.6%. However, sensitivity was 6.4%, with a positive predictive value of 55.6%. In conclusion, this Japanese Society of Diabetes and Pregnancy strategy showed high specificity, but low sensitivity, for detecting glucose intolerance postpartum.     

Screening for gestational diabetes mellitus and its prevalence in Bangladesh

Background

The prevalence of gestational diabetes mellitus (GDM) has important health complications for both mother and child and is increasing all over the world. Although prevalence estimates for GDM are not new in developed and many developing countries, data are lacking for many low-income countries like Bangladesh.

Objective

To evaluate the prevalence of GDM in Bangladesh.

Research design and methods

This cross-sectional study included 3447 women who consecutively visited the antenatal clinics with an average gestation age of 26 weeks. GDM was defined according to WHO criteria (fasting plasma glucose [FPG] ≥7.0 mmol/L or 2-h ≥7.8 mmol/L) and the new ADA criteria (FPG ≥5.3 mmol/L or 2-h ≥8.6 mmol/L OGTT). We also calculated overt diabetes as FPG ≥7.0 mmol/L.

Results

Prevalence of GDM was 9.7% according to the WHO criteria and 12.9% according to the ADA criteria in this study population. Prevalence of overt diabetes was 1.8%. Women with GDM were older, higher educated, had higher household income, higher parity, parental history of diabetes, and more hypertensive, compared with non-GDM women.

Conclusion

This study demonstrates a high prevalence of GDM in Bangladesh. These estimates for GDM may help to formulate new policies to prevent and manage diabetes.     

Correlations of serum visfatin and metabolisms of glucose and lipid in women with gestational diabetes mellitus

Aims/Introduction

Visfatin is a newly discovered adipocytokine hormone, which exerts an insulin‐like effect by binding to the insulin receptor‐1. However, the role of visfatin in human gestational diabetes mellitus (GDM) remains controversial. The purpose of the present study was to investigate the correlation between serum visfatin and metabolism of glucose and lipid in GDM.

Materials and Methods

This was a prospective study. A total of 38 GDM patients and 35 age‐ and body mass index‐matched controls were studied between January 2012 and October 2013. Fasting serum levels of visfatin, fasting plasma glucose, hemoglobin A1c and lipid profile were measured. Two‐tailed t‐tests and Pearson''s correlation coefficient were used to analyze the data.

Results

Perinatal visfatin levels were negatively correlated with fasting plasma glucose, insulin resistance index and triglycerides in controls (r = −0.47, −0.51, −0.57, respectively; P < 0.05), and positively correlated with high‐density lipoprotein cholesterol (r = 0.32, P < 0.05). A positive correlation with visfatin level only appeared in weight gain and body mass index in women with GDM (r = 0.36, 0.45, respectively; P < 0.05).

Conclusions

Visfatin appears to be involved in glucose and lipid metabolism regulation and insulin resistance, suggesting a role in GDM pathogenesis.     

妊娠糖尿病的危险因素

妊娠糖尿病是糖尿病分型中的一种独立类型.目前,妊娠糖尿病公认的危险因素包括年龄大于25岁、孕前体重指数大于25 kg/m2、非高加索白人、糖尿病家族史等.近年研究证实,妊娠糖尿病还与其他一些因素相关,如多囊卵巢综合征、身高偏矮、携带HBsAg、高血压等.及早的发现和干预这些高危因素,对于改善孕妇及子代的预后,减少人群中糖尿病的发病率有深远影响.     

Chemerin expression in Chinese pregnant women with and without gestational diabetes mellitus

ObjectivesThe aim of this study was to determine the effect of obesity, gestational diabetes mellitus (GDM) on circulating chemerin concentrations and chemerin gene expression of adipotissue in pregnancy women.Material and methodsTotally 42 normal glucose tolerant (NGT) women and 48 women with GDM were included in this study. Their clinical features and biochemical parameters were analyzed. The NGT and GDM women were subgrouped by prepregnancy BMI as normal-weight group, overweight group, and obese group, respectively. Serum chemerin and tumor necrosis factor α (TNF-α) of these individuals were determined by ELISA methods, and subcutaneous adipose tissues’ mRNA expressions of chemerin and CMKLR1 (encoding the receptor of chemerin) were analyzed by real-time PCR.ResultsSerum chemerin in obese-NGT group and normal-weight-GDM group was significantly higher than that of normal-weight-NGT group. Chemerin and CMKLR1 mRNA expression of subcutaneous adipose tissue was lower in the obese-NGT group than normal-weight-NGT group. There was no significant difference of CMKLR1 mRNA expression between normal-weight-NGT and normal-weight-GDM group. Serum chemerin significantly and positively correlated with triglycerides (TG) and homeostasis model assessment of insulin resistance (HOMA-IR) assessed both by uni- and multivariate.ConclusionsGestational obesity, GDM may contribute to the elevating serum chemerin. Serum chemerin in pregnancy was associated with insulin resistance and triglycerides. Chemerin gene may play a role both in obese and GDM patients. CMKLR1 might exert its action only in obese individuals, not in GDM patients before delivery.     

Effect of 1,25-dihydroxycholecalciferol on glucose metabolism in gestational diabetes mellitus

Summary The effect of 1,25-dihydroxyvitamin D supplement on glucose metabolism was evaluated in 12 women with gestational diabetes mellitus (GDM). All women had an oral glucose tolerance test (OGTT) performed at inclusion in the study. Thereafter, each patient was instructed to continue their normal diet during the following 2 days, after which they received 2 μg/m² Etalpha i. v. 2 h prior to the second OGTT. During the next 14 days each patient received 0.25 μg Etalpha orally, after which a third OGTT was performed. On average the level of 1,25-dihydroxyvitamin D₃ at inclusion at baseline significantly increased after i. v. 1,25-dihydroxyvitamin D₃ (from 92 to 138 ng/l [p < 0.001]), but returned to the baseline level after 2 weeks of oral Etalpha (85 ng/l). Simultaneously, the glucose level decreased from 5.6 to 4.8 mmol/l (p < 0.01) after i. v. treatment with 1,25-dihydroxyvitamin D₃, but did not differ significantly from inclusion following 2 weeks of oral Etalpha. There was no difference between the glucose concentrations during OGTT prior to and after i. v. or oral 1,25-dihydroxyvitamin D₃, in contrast to the insulin levels which tended to be lower after both i. v. and oral supplementation. In a multiple regression model including 1,25-dihydroxyvitamin D₃, insulin , weight and height against glucose, only 1,25-dihydroxyvitamin D₃ and insulin were selected for the final model (r ² = 0.73, p < 0.0001). Our results suggest that supplements of 1,25-dihydroxyvitamin D₃ influence glucose metabolism in patients with GDM probably by increasing the insulin sensitivity. [Diabetologia (1997) 40: 40–44] Received: 9 July 1996 and in revised form: 12 September 1996