Acute Caffeine Ingestion and Glucose Tolerance in Women With or Without Gestational Diabetes Mellitus

ObjectiveRecent work showing that caffeine impairs glucose tolerance may be of particular concern in pregnancy because of a possible negative effect on fetal outcome. The current study sought to assess the effect of acute caffeine ingestion on glucose tolerance in women with or without gestational diabetes mellitus (GDM).MethodsNineteen women whose routine GDM test was negative (control) and eight women with an initial positive GDM screen completed two trials one week apart in a double-blind randomized crossover study. Following an overnight fast, subjects ingested caffeine (3 mg/kg pre-pregnancy body weight) or an identical-appearing placebo (gelatin) capsule and one hour later began a 75 g 2-hour oral glucose tolerance test.ResultsIn the control group, caffeine did not significantly affect blood glucose, insulin, or C-peptide. In the GDM group, glucose area under the curve (AUC) was greater (P < 0.01), C-peptide AUC was greater (P < 0.05), and insulin sensitivity index was lower (18%, P < 0.05) after caffeine than after placebo.ConclusionCaffeine impaired insulin sensitivity in women with GDM. Additional research regarding more specific dietary caffeine recommendations for women with GDM is warranted.     

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     

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.     

妊娠中期妇女血25-羟维生素D3与妊娠期糖尿病的关系

目的：探讨妊娠13～16周妇女血25-羟维生素D3水平和妊娠期糖尿病发病的关系。方法：选择2011年9月在同济医科大学附属第一妇婴保健院产科产检并分娩的妊娠期糖尿病患者44例,正常妊娠妇女88例,除外双胎妊娠、经产妇、子痫前期和妊娠前糖尿病等。测定妊娠13～16周妇女血25-羟维生素D3水平。按百分位数法进行分析,分别计算25-羟维生素D3值在不同百分位时妊娠期糖尿病发生率、敏感度、特异度、约登（Youden’s）指数、阴性预测值（PPV）、阳性预测值（NPV）、OR值（95% CI）。结果：①妊娠期糖尿病妇女血25-羟维生素D3水平低于对照组[（49.8±22.0） nmol/L vs. （63.1±22.4） nmol/L,P＜0.01]。②血25-羟维生素D3处于P35时（25-羟维生素D3值45.201 0 nmol/L）,Youden’s指数最高（22.73）,OR值0.375（95% CI： 0.176～0.797）。③妊娠期糖尿病组中,糖耐量试验1 h血糖异常的妇女25-羟维生素D3值低于糖耐量试验1 h血糖正常者[（42.56±17.04） nmol/L vs.（55.32±23.93） nmol/L,P＜0.05]。结论：妊娠13～16周血25-羟维生素D3水平低下的妇女发生糖尿病的风险增加,25-羟维生素D3水平低下与糖耐量试验后1 h血糖升高有明显的相关性。     

Prevalence of Gestational Diabetes Mellitus Utilizing Two Definitions

The Journal of Obstetrics and Gynecology of India -     

Studies of Postnatal Diabetes Mellitus in Women Who Had Gestational Diabetes

Summary: This study investigated the prevalence of undiagnosed diabetes in women in the reproductive age group in a Victorian population by analysis of the results of glucose tolerance testing in 57,563 pregnancies. Gestational diabetes (GD) was diagnosed in 4,243 pregnancies and in 2,957 (69.7%) of these, postnatal glucose tolerance testing was performed. Diabetes mellitus was diagnosed within 26 weeks of delivery in 59 women, 55 of whom were diagnosed by the postnatal glucose tolerance test (GTT). There were 4 women with GD who developed diabetic ketosis during pregnancy (3) or within 12 weeks of delivery (1). By consideration of the results of the antenatal and postnatal GTTs, it was deduced that 53% (31 of 59) of the women with diabetes diagnosed after delivery may have had unrecognized prepregnancy diabetes. Consideration of the entire glucose-tolerance tested population led to the conclusion that approximately 1 in 1,031 women in the reproductive age group in our community have unrecognized prepregnancy diabetes mellitus.     

Barriers to Exclusive Breastfeeding Among Women With Gestational Diabetes Mellitus in the United States

Objective

To identify differences in breastfeeding-related knowledge, attitudes, beliefs, and experiences between women with gestational diabetes mellitus (GDM) and women without GDM.

孕妇TT病毒感染及基因型的研究

目的了解孕妇孕期TT病毒感染的状况和基因型分布特征;研究HBV和TT病毒感染传播的相关性;探讨TT病毒经母乳传播的可能性.方法采用巢式PCR技术检测孕妇血清和乳汁中的TT病毒DNA及基因型.结果160例孕妇血清和乳汁标本各160份,TT病毒DNA阳性率分别为40.0%和37.5%.其中HBV标志物阳性组和阴性组血清和乳汁中TT病毒DNA的阳性率分别为50.0%、43.0%和13.6%、22.7%.两组比较有显著性差异(x2值分剐为16.09和4.38,P值均＜0.05).124份TT病毒DNA阳性血清或乳汁标本,其病毒核酸基因型均为Ⅰ型.结论孕妇中存在TT病毒感染,HBV感染孕妇是TT病毒感染的高危人群.提示TT病毒感染途径与HBV传播具有相关性;母乳喂养是传播TT病毒的重要途径;孕妇中TT病毒感染的基因以Ⅰ型为主.     

Association of Thyroid Dysfunction and Autoimmunity in Pregnant Women with Diabetes Mellitus

Purpose

This study was undertaken to find out the proportion of women with thyroid dysfunction in pregnancy complicated by diabetes mellitus; to find out the association, if any, of thyroid dysfunction and of antithyroid peroxidase (anti-TPO) antibodies during pregnancy in women with pregestational (PGDM) and gestational diabetes mellitus (GDM); and to find out the maternal and perinatal outcomes of pregnancies complicated by both diabetes mellitus and thyroid dysfunction.

Methods

A cross-sectional observational study was conducted in a tertiary care teaching hospital in Kolkata, India, for a period of 1 year. Sixty-four pregnant women with diabetes, both PGDM and GDM, were recruited from the antenatal clinic. They were managed and followed up till 6 weeks postpartum. Their plasma glucose levels were estimated, and thyroid function was evaluated periodically. All relevant data were recorded and analyzed statistically.

Results

Most (81.25%) women had GDM. Forty percent women suffered from some form of thyroid disorder, mostly (37.5%) hypothyroidism. Thyroid dysfunction was not associated with the type of diabetes mellitus (GDM or PGDM) (p > 0.05). The higher rate of anti-TPO titers was observed in pregnancies with PGDM compared to pregnancies with GDM; however, this difference was not statistically associated (p > 0.05). All pregnant women with combined endocrinopathy delivered by cesarean section, and the most common neonatal complication observed was jaundice.

Conclusions

Thyroid disorders are quite common during pregnancy complicated by diabetes mellitus. The study findings warrant routine screening for thyroid abnormalities in diabetic pregnant women. These women have increased rate of maternal and neonatal complications.

     

控制血糖对改善妊娠期糖尿病孕妇妊娠结局的意义

目的:探讨控制妊娠期糖尿病孕妇血糖对减少母体及围生儿并发症和改善妊娠结局的意义.方法:将70例妊娠期糖尿病孕妇根据治疗后血糖控制情况分成血糖控制满意组(A组,54例)与血糖控制不满意组(B组,16例),同80例正常孕妇的妊娠过程进行比较,分析在孕产妇和围生儿并发症方面有无差异.结果:经临床治疗后,A组只有妊娠期高血压疾病发生率高于对照组孕妇(P＜0.05),B组妊娠期高血压疾病、羊水过多、巨大儿、早产及新生儿窒息发生率均高于对照组(P＜0.05).结论:重视血糖筛查,及时诊断和治疗妊娠期糖尿病,选择合适的时间和方式终止妊娠可以有效的降低母儿并发症的发生率.     

脂联素基因单核苷酸多态性与妊娠期糖尿病(GDM)及妊娠结局的关系研究

目的:探讨脂联素基因单核苷酸多态性+ 45 T/G及+276G/T与妊娠期糖尿病(GDM)及妊娠结局的关系.方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术对158例GDM孕妇(GDM组)、128例妊娠期糖耐量异常孕妇(GIGT组)及120例糖耐量正常孕妇(对照组)脂联素基因启动子多态性位点(+ 45 T/G和+276 G/T)进行分析,并随访分析脂联素基因单核苷酸多态性与相应妊娠结局的关系.结果:①单核苷酸多态性+45 T/G:3组基因型频率比较,差异均无统计学意义(P＞0.05);GDM组和GIGT组的G等位基因频率均高于对照组(P＜0.05);携带G等位基因(杂合子TG型+纯合子突变GG型)的GDM组和GIGT组孕妇,其新生儿低血糖、巨大儿及新生儿窒息的发生率均明显高于未携带G等位基因(野生TT型)者(P＜0.05);②单核苷酸多态性+ 276 G/T:3组间的基因型及等位基因频率分布比较,差异均无统计学意义(P＞0.05);3组间携带突变T基因(杂合子GT型+纯合子突变TT型)的巨大儿、新生儿低血糖及新生儿窒息发生率与无突变T基因(野生GG型)者相比,差异均无统计学意义(P＞0.05).结论:脂联素基因单核苷酸多态性+45 T/G与GDM的发生存在一定关联,亦与其妊娠结局有关;单核苷酸多态性+276 G/T与GDM的发生及妊娠结局无明显关联.     

动态监测妊娠期糖尿病患者餐后血糖的变化规律

目的:利用动态血糖监测系统探讨妊娠期糖尿病(GDM)患者餐后血糖变化规律。方法:对我院门诊产检孕妇进行GDM筛查,采用两步法进行诊断,选取15例GDM患者利用动态血糖监测系统(CGMS)进行连续72小时血糖监测。取餐后03、0、60、90、120、150、180分钟数据进行分析。结果:15例GDM孕妇早餐后血糖升幅较午餐及晚餐明显,进餐前血糖为最低时段(5.15±0.01)mmol/L。餐后3小时内平均血糖值5.96±1.63 mmol/L,餐后血糖峰、谷值分别为9.58±1.38 mmol/L、3.36±0.47 mmol/L;血糖波动最大幅度10.3 mmol/L。餐后2小时血糖≥7.2mmol/L者占47%(7例),餐后2小时血糖≥11.1 mmol/L者占6%(1例),餐后2小时、3小时血糖≤3.9 mmol/L者占27%(4例)。结论:CGMS系统有助于动态观察GDM患者餐后血糖水平,可为临床GDM患者饮食、运动、药物治疗的选择提供依据。     

妊娠期糖尿病空腹血糖筛查的意义及其对妊娠结局的影响

妊娠期糖尿病(gestational diabetes mellitus,GDM)的发生率逐年上升,不良妊娠结局与血糖水平相关,即使妊娠妇女的血糖水平在正常范围,随着血糖水平的升高,大于胎龄儿、剖宫产率、新生儿低血糖、新生儿高胰岛素血症及生后糖尿病的发生等母儿不良预后的发生率增加,尽早诊断及治疗GDM有助于改善不良妊娠结局。利用空腹血糖(fasting plasma glucose,FPG)筛查GDM越来越受关注。其具有操作简单,价格低廉,可重复率高并且容易被妊娠妇女接受等优点。近年来许多研究证实,妊娠早期FPG与葡萄糖负荷试验(glucose challenge test,GCT)及口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)的血糖水平呈正相关,且显著降低了需要行OGTT检查的人数。故FPG筛查对GDM有较高的价值。     

vaspin与妊娠期糖尿病的研究现状

妊娠期糖尿病是指在妊娠期首次发生或发现不同程度的糖代谢异常的一种内分泌疾病,其是严重威胁母儿健康的妊娠期常见并发症,其发病机制复杂,近年研究表明脂肪细胞因子分泌异常导致胰岛素抵抗增加可能是妊娠期糖尿病的发病机制之一。内脏脂肪特异性丝氨酸蛋白酶抑制剂(visceral adipose tissue-derived serine protease inhibitor,vaspin)是新近发现的脂肪细胞因子,具有增加胰岛素敏感性,改善胰岛素抵抗等作用,与2型糖尿病及妊娠期糖尿病的关系密切,可能在妊娠期糖尿病的发生、发展中发挥重要作用。目前已有部分关于vaspin与妊娠期糖尿病关系的研究,但结果差异较大。本文综述vaspin在妊娠期的变化及其与妊娠期糖尿病的研究现状。     

Amniotic Fluid Insulin Values in Women with Gestational Diabetes as a Predictor of Emerging Diabetes Mellitus

Summary: Amniotic fluid insulin levels were estimated in 30 women with insulin-dependent diabetes, 216 with gestational diabetes and 27 with normal glucose tolerance. Results were correlated with birth-weight, incidences of fetal macrosomia and neonatal hypoglycaemia, and the risk of the mothers with gestational diabetes developing diabetes mellitus on follow-up.
The women with prepregnaney diabetes had significantly higher amniotic fluid insulin values and showed a significant correlation between raised liquor insulin values (>97th percentile) and hypoglycaemia in the infant (p = 0.039).
In the gestational diabetic pregnancies there were highly significant associations between elevated liquor insulin values and macrosomia (p <0.0045) and birth-weight (p <0.00004), and a weak correlation with neonatal blood glucose levels (p = 0.042).
Women with gestational diabetes who later developed permanent diabetes mellitus had higher mean amniotic fluid insulin levels than those whose glucose tolerance remained normal on follow-up (p ≤0.0072) and more of them had a level greater than the 97th percentile than those whose glucose tolerance remained normal (odds ratio 6.48, 95% confidence interval 1.51–27.8, p = 0.0094). However a high amniotic fluid insulin level was of less clinical value for detection of women destined to develop diabetes (7 of 25, 28%) than was the need for insulin therapy during pregnancy (18 of 39, 46%) .