Aims
Gestational diabetes mellitus (GDM) and different time-point glucose levels might have different effects on fetal birth weight. The aim of this study was to further evaluate the associations of GDM and different time-point blood glucose levels with fetal birth weight in a prospective cohort study.Methods
This prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from August 2011 to May 2015. 1232 pairs of singleton, full-term newborns and their mothers without other pregnant and perinatal complications were selected as participants.Results
Of the 1232 women, 234 had GDM. GDM was positively associated with birth weight (β?=?99.5?g, P?=?0.0002), gestational age-specific Z-score of birth weight (β?=?0.23, P?=?0.0003), and an increased risk of large for gestational age (LGA; OR?=?1.79, 95%CI: 1.11–2.89) and macrosomia (OR?=?2.13, 95%CI: 1.34–3.40). Compared with abnormal fasting plasma glucose (FPG) during the second trimester, abnormal postload glucose in oral glucose tolerance test had significantly higher birth weight and gestational age-specific Z-score of birth weight, and an increased risk of macrosomia. Abnormal FPG and abnormal postload glucose had significantly joint effect on birth weight (β?=?161.4?g, P?=?0.0192), gestational age-specific Z-score of birth weight (β?=?0.42, P?=?0.0121) and risk of macrosomia (OR?=?3.24, 95%CI: 1.21–8.67) and LGA (OR?=?5.73, 95%CI: 2.20–14.90). Compared with abnormal blood glucose during the first trimester, GDM had significantly higher birth weight and gestational age-specific Z-score of birth weight. Abnormal blood glucose during the first trimester and GDM had significantly joint effect on birth weight (β?=?125.8?g, P?=?0.0010), gestational age-specific Z-score of birth weight (β?=?0.30, P?=?0.0013) and risk of macrosomia (OR?=?2.34, 95%CI: 1.28–4.30) and LGA (OR?=?2.53, 95%CI: 1.37–4.67). However, we did not find blood glucose during the first trimester independently associated with birth weight.Conclusions
GDM was significantly associated with higher birth weight and an increased risk of LGA and macrosomia. Fetal growth was mostly influenced by postload glucose levels, rather than FBG. Moreover, different time-point blood glucose levels had significantly joint effects on birth weight and risk of LGA and macrosomia. 相似文献Introduction and objective
The role of metformin in gestational diabetes mellitus (GDM) is also increasing. However, almost half of metformin-treated women required additional insulin. Therefore, identifying the characteristics of these women may help define optimal therapeutic strategy.Methods
This is a retrospective cohort study done in a District General Hospital, UK. GDM was diagnosed by 75?g OGTT test between 24 and 28 weeks of gestation with fasting levels of ≥6.1?mmol/l and/or 2?h postprandial (PP) level of ≥7.8?mmol/l. Logistic regression and receiver operator curves (ROC) were performed to identify the predictors of metformin failure.Results
Out of 228 women with GDM included, 46/228 (20.2%) and 151/228 (66.2%) received insulin and metformin as first-line medication respectively. Among the metformin-treated, 13 stopped treatment and were excluded from analysis. Of the included 138 metformin-treated women, 77 (55.8%) required supplementary insulin (metformin failure). Metformin failure group had higher maternal age and fasting glucose level at OGTT, HbA1c at OGTT and earlier gestational age (GA) at medication initiation. Metformin failure was predicted if fasting OGTT level >4.8?mmol/l (69% sensitivity and 62% specificity). If the fasting levels of IADPSG (International Association of Diabetes and Pregnancy Study Groups) criteria and NICE (National Institute of Health and Care Excellence) were used, the positive predictive value was 78% and 77% respectively.Conclusion
As women with higher fasting glucose levels have higher chance of necessitating insulin in later pregnancies, appropriate addition of insulin at metformin initiation for these women could help better glycaemic control throughout pregnancy. 相似文献Aim
To investigate the relationship between maternal and cord blood irisin in gestational diabetes mellitus (GDM).Methods
Twenty women with GDM and 20 pregnant women with uncomplicated pregnancies were recruited for this case–control study. Maternal serum irisin and cord blood irisin levels were measured by enzyme-linked immunosorbent assay kit at the time of birth. The association of maternal serum and cord blood irisin levels with metabolic parameters was analyzed.Results
Women with GDM had significantly lower mean serum irisin levels compared to control group (258.3 ± 127.9 vs. 393 ± 178.9 ng/ml, p < 0.05). Mean cord blood irisin levels for GDM and control groups were not significantly different (357.2 ± 248.0 vs. 333.2 ± 173.4 ng/ml, p > 0.05). No significant differences were found in terms of maternal age, gestational week at birth, BMI at birth, birth weight, neonatal height, systolic and diastolic blood pressure between the groups as well (p > 0.05). Serum irisin level was negatively correlated with BMI at birth and HOMA-IR (r = −0.401, p = 0.010; r = −0.395, p = 0.012, respectively). No correlations between irisin levels and others parameters were found in both groups.Conclusions
Maternal serum irisin levels of patients with GDM are significantly lower compared with non-GDM controls. However, no significant difference was found between cord blood irisin levels of patients with GDM and healthy pregnant women. 相似文献Aims/hypothesis
We aimed to investigate the impact of maternal gestational weight gain (GWG) during dietary treatment on fetal growth in pregnancies complicated by gestational diabetes (GDM).Methods
This was a retrospective cohort study of 382 women consecutively diagnosed with GDM before 34 weeks’ gestation with live singleton births in our centre (Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark) between 2011 and 2017. The women were stratified into three groups according to restricted (53%), appropriate (16%) and excessive (31%) weekly GWG during dietary treatment (using the Institute of Medicine guidelines) to estimate compliance with an energy-restricted ‘diabetes diet’ (6000 kJ/day [1434 kcal/day], with approximately 50% of energy intake coming from carbohydrates with a low glycaemic index, and a carbohydrate intake of 175 g/day). Insulin therapy was initiated if necessary, according to local clinical guidelines.Results
Glucose tolerance, HbA1c, weekly GWG before dietary treatment (difference between weight at GDM diagnosis and pre-pregnancy weight, divided by the number of weeks) and SD score for fetal abdominal circumference were comparable across the three groups at diagnosis of GDM at 276?±?51 weeks (gestation time is given as weeksdays). The women were followed for 100?±?51 weeks, during which 54% received supplementary insulin therapy and the average (mean) GWG during dietary treatment was 0 kg, 3 kg and 5 kg in the three groups, respectively. Excessive weekly GWG during dietary treatment, reflecting poor dietary adherence was associated with increasing HbA1c (p?=?0.014) from diagnosis of GDM to late pregnancy and infants with a birthweight-SD score of 0.59?±?1.6. In contrast, restricted weekly GWG during dietary treatment, reflecting strict dietary adherence, was associated with decreasing HbA1c (p?=?0.001) from diagnosis of GDM to late pregnancy and infants with a birthweight-SD score of 0.15?±?1.1, without increased prevalence of infants born small for gestational age. Excessive GWG during dietary treatment and late-pregnancy HbA1c were identified as potentially modifiable clinical predictors of infant birthweight-SD score (p?=?0.02 for both variables) after correction for confounders.Conclusions/interpretation
Restricted GWG during dietary treatment was associated with healthier fetal growth in women with GDM. GWG during dietary treatment and late-pregnancy HbA1c were identified as potentially modifiable clinical predictors of infant birthweight-SD score.The purpose was to characterize the hemostatic changes in women with gestational diabetes mellitus (GDM). In this case–control study, 50 women with newly diagnosed GDM at 24–28 weeks of pregnancy and 41 normal pregnant women, matched for age, body mass index, and gestational age, were enrolled. Anthropometric, metabolic patterns, coagulation parameters, and plasminogen were measured in each subject. Plasma fibrinogen levels, plasminogen, and von Willebrand factor (vWF) activities were significantly higher in patients with GDM as compared to normal pregnant women (p < 0.001, p < 0.001, and p < 0.05, respectively). Although protein S was significantly elevated in diabetic group (p < 0.05), free protein S was similar in both groups. Coagulation factors VIII and IXa were significantly higher in patients with GDM (p < 0.001 and p < 0.01, respectively). In the group with GDM, factor VIII was positively correlated with HbA1c (r = 0.192, p < 0.001). A weak but significant negative correlation was observed between protein S and fasting glucose (r =−0.006, p < 0.05). GDM potentiates the alteration in coagulation and fibrinolysis during normal pregnancy. The question of whether the hemostatic balance is unchanged or shifts toward a hypercoagulable status remains unanswered.
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