脂联素基因多态性与妊娠期糖尿病的相关性研究

目的:探讨脂联素基因启动子区单核苷酸多态性与妊娠期糖尿病(GDM)的相关性。方法:采用基质辅助激光解吸电离飞行时间质谱(MALDI-TOFMS)技术,检测103例GDM孕妇和97例正常孕妇脂联素基因启动子区-11426A>G及-11377C>G多态位点,并测定40例未经任何治疗的GDM孕妇FINS、FPG、TC、TG、HDL-C、LDL-C、脂联素水平,同时计算稳态模型的胰岛素抵抗指数。结果:(1)GDM孕妇脂联素基因-11426A>G位点的AG、GG基因型频率显著高于对照组(χ2=8.822,P=0.012),G等位基因频率明显高于对照组(χ2=10.283,P=0.001)。-11377C>G位点基因型频率及等位基因频率在二组孕妇中分布无显著差异(P>0.05)。(2)GDM孕妇脂联素-11426A>G多态性位点AG+GG基因型组甘油三酯水平高于AA基因型组(P=0.023),血清脂联素水平低于AA基因型组(P=0.024)。结论:脂联素基因-11426A>G位点多态性可能与GDM的发生有关,G等位基因在GDM孕妇中分布频率增加,A→G突变可能通过降低血清脂联素水平参与GDM的发生。     

Decreased perinatal mortality among women with diet-controlled gestational diabetes mellitus

Objective

To examine pregnancy outcomes associated with diet-controlled gestational diabetes mellitus (GDM A1).

Methods

A retrospective cohort study compared pregnancy characteristics of women with and without GDM A1 at a center where GDM A1 patients are routinely induced at 40 weeks.

Results

Higher rates of complications such as shoulder dystocia, congenital malformation, and macrosomia were observed in GDM A1 patients. A lower incidence of perinatal mortality was present in GDM A1 women compared with women without GDM A1. This association lost its significance when controlled for maternal age, ethnicity, induction, cesarean delivery, and birth weight in a multivariate model. Although the stillbirth rate before 40 weeks of gestation was identical among all participants, after 40 weeks it was significantly higher in women without GDM A1.

Conclusion

Induction of women with GDM A1 at 40 weeks may play a role in lowering perinatal mortality to below that of the general population.     

Comparison of serum concentrations of humanin in women with and without gestational diabetes mellitus

Abstract

Humanin (MT-RNR2) is an endogenous polypeptide that is involved in many diseases, including T2DM. Gestational diabetes mellitus (GDM) is defined as hyperglycemia during pregnancy. The aim of this study was to evaluate serum humanin levels in women with or without GDM and to elucidate possible correlations with anthropometric parameters, metabolic parameters and the incidence of GDM. Eighty-four women with GDM and 73 control women were enrolled in this study. The clinical and biochemical parameters of all subjects were determined. Serum humanin levels were measured by an ELISA. Serum humanin levels were significantly lower in women with GDM than in control women. Moreover, humanin levels were significantly negatively correlated with the presence of GDM, body weight, BMI at 24?weeks of gestation, TG, FPG, 1 hPG, 2 hPG, FINS, and HOMA-IR. In contrast, humanin levels were significantly positively correlated with FT3 and FT4. A binary logistic analysis showed that humanin levels were associated with the incidence of GDM. Additional follow-up studies are needed to highlight whether and how decreased humanin levels play an important role in GDM.     

Total plasma homocysteine correlates in women with gestational diabetes

AIM: We aim to assess serum total homocysteine (tHcy) associations with metabolic syndrome components and B-vitamins in women with gestational diabetes mellitus (GDM). METHODS: We studied 61 consecutive pregnant women, 44 with GDM and 17 with normal glucose tolerance (CG). Serum homocysteine levels were analyzed by ELISA, using Bio-Rad reagents. Serum folates and vitamin B(12) concentrations were determined by chemiluminescent immunoassay, free fatty acids (FFA) and lipids enzymatically. RESULTS: Serum homocysteine levels were similar in both the GDM and the CG groups (8 +/- 2.0 vs 7.4 +/- 1.1 mumol/l, respectively). Women with GDM in comparison to CG women were characterized by higher values of homeostasis model of insulin resistance (HOMA-IR) (2.8 +/- 1.7 vs 1.6 +/- 0.9, P < 0.01), serum triglycerides (2.7 +/- 0.9 vs 1.9 +/- 0.5 mmol/l, P < 0.01) and FFA (0.6 +/- 0.2 vs 0.46 +/- 0.2 mmol/l, P < 0.05). In GDM women serum tHcy correlated with vitamin B(12) (r = -0.47, P < 0.01) and folates (r = -0.51, P < 0.001); in CG women with HOMA-IR, a marker of insulin resistance (r = -0.49, P < 0.05). In multiple regression analysis with serum tHcy as a dependent variable, folate and vitamin B(12) entered the analysis in GDM women (beta = -0.42 and -0.34, respectively, P < 0.05), whereas in CG cystatin C and HOMA-IR entered the analysis (P < 0.05). CONCLUSIONS: In women with GDM, serum homocysteine is significantly associated with vitamin B(12) and folate levels, while in healthy pregnant women with HOMA-IR and with kidney function. The results suggest the importance of the B-group vitamins in regulation of serum tHcy levels in women with insulin resistance/gestational diabetes, what might be relevant in protection against pregnancy complications associated with elevated tHcy in GDM women.     

Evaluation of body composition of large-for-gestational-age infants of women with gestational diabetes mellitus compared with women with normal glucose tolerance levels

OBJECTIVE: The purpose of this study was to determine whether there is a difference in body composition and the factors that are associated with fat mass in the large-for-gestational-age infants of women with gestational diabetes mellitus compared with the large-for-gestational-age infants of women with normal glucose tolerance levels. STUDY DESIGN: Large for gestational age was defined as weight >90th percentile for gestational age, race, and sex on the basis of our population's normative data. Anthropometric measurements and/or total body electrical conductivity estimated body composition that included fat mass, percent body fat, and lean body mass were obtained. Multiple stepwise regression was used to determine factors correlating with fat mass. RESULTS: Fifty cases of women with gestational diabetes mellitus and 52 cases of women with normal glucose tolerance levels were evaluated. Infants of mothers with gestational diabetes mellitus had increased fat mass (662 vs 563 g; P = .02) and percent body fat (16.2% vs 13.5%; P = .002) but decreased lean body mass (3400 vs 3557 g; P = .0009), as compared with infants of mothers with normal glucose tolerance levels, despite similar birth weights. Stepwise regression on all 102 women showed gestational age and a diagnosis of gestational diabetes mellitus correlated with fat mass (r2 = 0.11; P = .001). For gestational diabetes mellitus alone, both gestational age and fasting value of the oral glucose tolerance test correlated with fat mass and percent body fat (r2 = 0.33 [P = .0009] and r2 = 0.26 [P = .005], respectively). CONCLUSION: Large-for-gestational-age infants of mothers with gestational diabetes mellitus have increased fat mass and decreased lean body mass compared with infants of mothers with normal glucose tolerance levels. In gestational diabetes mellitus, gestational age and fasting value of the oral glucose tolerance test correlated best with fat mass.     

PPAR-gamma2 Pro12Ala polymorphism is associated with weight gain in women with gestational diabetes mellitus

OBJECTIVE: The polymorphisms of peroxisome proliferator-activator receptor-gamma2 (PPAR-gamma2) have been suggested to affect glucose metabolism and weight gain. Both conditions show great variations during pregnancy that makes pregnancy a suitable condition to detect any metabolic abnormalities related to PPAR-gamma2 polymorphisms. The objective of this study is to investigate the prevalence and metabolic impacts of PPAR-gamma2 polymorphism in control pregnant women and in patients with gestational diabetes mellitus (GDM). METHODS: In this case-control study, anthropometric and metabolic variables of 100 non-diabetic pregnant women and of 62 women who were diagnosed as having GDM according to 100 g oral glucose tolerance test (OGTT) were compared on the basis of PPAR-gamma2 polymorphism by univariate analysis of covariance. RESULTS: There were no statistically significant differences in baseline characteristics and the mean 50 g glucose challenge test values of pregnant women in both groups on the basis of PPAR-gamma2 genotype, although patients with Pro12Ala polymorphism were significantly taller in GDM group. The Pro12Ala polymorphism had no effect on 100 g OGTT results of patients with GDM. However, patients with GDM who had Pro12Ala polymorphism gained significantly more weight during their pregnancy. CONCLUSION: The PPAR-gamma2 Pro12Ala polymorphism was observed to have no effect on glucose metabolism in normal pregnant women and women with GDM. However, only the patients with GDM who had this polymorphism gained significantly more weight during their pregnancy. It seems that Pro12Ala polymorphism plays a dynamic and interactive role in the regulation of BMI and glucose homeostasis.     

Screening for gestational diabetes mellitus in adolescent pregnancies

Objective: Our purpose was to determine the incidence of gestational diabetes mellitus in an adolescent population and to determine the cost of screening. Study Design: A retrospective review of 509 adolescent pregnancies was performed. The incidence of gestational diabetes mellitus was determined and the cost of screening analyzed. Results: Five hundred nine adolescent pregnancies were screened for gestational diabetes mellitus with a 1-hour, 50 gm oral glucose challenge test. Twenty-three of the screens (4.5%) had positive results at a plasma glucose level of ≥140 mg/dl. Three-hour 100 gm oral glucose tolerance tests were performed on screen-positive women, six of whom were diagnosed with gestational diabetes mellitus, for an incidence of 1.18%. The cost per case diagnosed was $2733. Conclusions: The incidence of gestational diabetes mellitus in an adolescent population is low. The cost of universal screening may be prohibitive in this population. Large prospective studies are needed to better analyze outcome data and efficacy of screening in adolescent pregnancies. (Am J Obstet Gynecol 1998;178:1251-6.)     

妊娠糖尿病胰岛素治疗与围生儿预后

目的 探讨在妊娠糖尿病（GDM）治疗中胰岛素、饮食以及开始治疗时间早晚对围生儿预后的影响。方法 选择诊断为妊娠糖尿病者109例，其中采用饮食加胰岛素治疗22例，单纯饮食控制组低于应用胰岛素组，差异显著（P＜0.05）。围生儿结局显示：巨大儿发生率、红细胞增多症发生率三组为34周后饮食控制组＞34周前饮食控制组＞胰岛素治疗组。结论 GDM要早诊断、早治疗，尤其是应用胰岛素正规治疗对降低围生儿病率、巨大发生率以及控制孕妇血糖水平有重要意义。     

妊娠期糖尿病的筛查

目的 对妊娠期糖尿病(GDM)筛查的必要性、适宜时间、临界值及巨大儿的发生进行探讨。方法 回顾性分析1997年10月至1999年9月在北京协和医院行产前检查及分娩的1935例初产妇,孕1～4次。结果 妊娠期糖耐量低减(IGT)及GDM的发生率在孕24周以后无差异。OGT异常者分娩巨大儿较葡萄糖负荷试验(OGT)正常者高。50g糖筛查值在7.8～8.3mmol/L(140～149 mg/dl)的159例孕妇,只有2例诊为IGT,无一例为GDM。结论 在孕24周以后尽可能早地对孕妇进行50g糖筛查是必要的。对于OGT异常者应予以重视,对IGT及GDM者应积极控制血糖。对于高危人群必要时重复筛查。     

糖化血红蛋白在妊娠期糖尿病诊断中的意义

目的:探讨糖化血红蛋白在妊娠期糖尿病(GDM)诊断中的意义。方法:对正常妊娠组44例、糖耐量异常组26例及糖尿病组28例进行空腹血糖(FPG)、糖化血红蛋白(HbAlc)及口服50g葡萄糖筛查试验(GCT)测定。结果:GDM组FPG、GCT、HbAlc较正常妊娠组均显著增高(P<0.05)。正常妊娠组与糖耐量异常组比较,FPG及GCT无差异(P>0.05)。GDM组FPG、GCT、HbAlc阳性率分别为42.9%、89.3%和92.9%。GDM的并发症随HbAlc的增高而增多。结论:HbAlc在妊娠期糖尿病的筛查诊断及并发症的检测方面有一定的意义。     

妊娠期糖尿病孕妇甲状腺功能减退的临床分析

目的:探讨妊娠期糖尿病(GDM)患者甲状腺功能减退(甲减)的情况,以及GDM并发甲减对妊娠结局的影响。方法:(1)根据75g糖耐量试验结果,将2011年9月至2013年3月在产科门诊常规产检的妊娠中期妇女分为GDM组(244例)及对照组(674例)。比较两组患者的甲状腺功能;(2)将2011年9月至2013年3月收入院的妊娠晚期GDM患者分为单纯GDM组(Ⅰ组,370例)、GDM并发甲减组(Ⅱ组,79例),回顾分析两组患者的妊娠结局。结果:(1)与对照组相比,妊娠中期GDM组患者的低甲状腺素血症发生率较高(P0.05),血清游离甲状腺素(FT4)显著降低(P0.01)。两组妇女的促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、抗甲状腺过氧化物酶抗体(TPOAb)无显著差异,但TPOAb阳性的妊娠妇女TSH平均值高于正常值上限,且显著高于TPOAb阴性妇女(P0.05);(2)GDM并发甲减组的子痫前期、巨大儿、剖宫产发生率均显著高于单纯GDM组(P0.05)。结论:GDM妊娠妇女更易引发甲减,且GDM并发甲减将进一步加重不良妊娠结局。     

应用基因重组人胰岛素治疗妊娠期糖尿病32例分析

目的　观察妊娠期糖尿病应用基因重组人胰岛素 (RI)治疗前后其血糖变化及对母儿预后的影响。方法　 3 2 2例妊娠期血糖异常者均经饮食控制 ,其中 2 84例 ( 88 2 0 % )经饮食治疗有效 ,6例 ( 1 86% )加用运动锻炼 ,3 2例 ( 9 94 % )需加用胰岛素治疗 ,其胰岛素用量按BMI正常者于妊娠中期 0 3～ 0 5U×DBW (理想体重 ) ,妊娠晚期 0 5～ 0 7U×DBW ,根据治疗后血糖情况及相关病情将此 3 2例患者分为A、B两组 ;其中A组 17例经胰岛素治疗血糖控制满意 ,B组 15例因胰岛素应用较晚或治疗不规范致血糖控制不满意。结果　胰岛素治疗前后血糖水平变化均极显著 (P <0 0 0 1)。在胰岛素治疗过程中 ,2例发生一过性血糖偏低 ,无其他副反应发生。B组因孕期血糖控制不良 ,母儿并发症明显增高 ,尤其是巨大儿发生率高达 4 0 % (P <0 0 5 ) ,因头盆不称而行剖宫产 ,两组相比亦有显著差异 ( P <0 0 5 )。结论　妊娠期糖尿病凡具有胰岛素治疗指征者 ,应及时合理的使用人胰岛素治疗 ,使血糖维持正常化 ,以减少母儿并发症     

Elevated second trimester serum homocysteine levels in women with gestational diabetes mellitus

Objective Our aim was to investigate the association between total serum homocysteine, vitamin B12 and folate levels in pregnant women with gestational diabetes mellitus (GDM), glucose intolerance and compare them with those of glucose tolerant pregnant women.Materials and methods Serum homocysteine, vitamin B12 and serum folate levels were prospectively measured in a total of 223 pregnant women who were grouped according to their status of glucose tolerance as gestational diabetes (abnormal 1-h and 3-h glucose tolerance test; n = 30), glucose intolerant (abnormal 1-h, but normal 3-h glucose tolerance test; n = 46) or normal controls (normal 1-h glucose test; n = 147). Results Mean serum homocysteine concentration of women in gestational diabetes, glucose intolerants and normal controls at 24–28 weeks of gestation was 9.0 ± 3.1, 8.1 ± 2.5 and 7.4 ± 1.6 μmol/l, respectively. The only statistically difference in homocysteine levels was observed between women with gestational diabetes and normal controls (P < 0.01). However, no difference was observed for vitamin B12 and folate levels.Conclusion Second trimester serum homocysteine concentrations are higher among women with GDM, as compared to normal controls.     

Insulin detemir versus glyburide in women with gestational diabetes mellitus

Aim: To evaluate the safety, efficacy and pregnancy outcomes of insulin detemir (IDet) versus glyburide treatment in women with gestational diabetes mellitus (GDM).

Methods: We conducted a retrospective cohort study of women with GDM who were treated with either glyburide or IDet for GDM in a university-affiliated tertiary hospital.

Results: Ninety-one patients with GDM were enrolled, 62 were administered glyburide and 29 IDet. Maternal age, pregestational body mass index (BMI) and rate of abnormal oral glucose tolerance test (OGTT) blood glucose values were not significantly different between groups. Good glycemic control rates were comparable. Hypoglycemic episodes were reported only in the glyburide group (19.4% versus 0%, p?=?0.01). Maternal weight gain during pregnancy was significantly higher among women in the glyburide group (8.8?±?5.1?kg, p?p?=?0.71).

Conclusions: To the best of our knowledge, this is the first study on IDet treatment in patients with GDM. By our preliminary results, IDet is a viable treatment option in women with GDM. Further large prospective studies are needed to determine the efficacy and safety of IDet in GDM patients.     

What we have learned about treating mild gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes, with risks not only associated with more severe forms of GDM, but milder forms of GDM as well. Treatment of mild GDM with dietary intervention and insulin when necessary has proven to be effective in reducing the risks of several, but not all, adverse perinatal outcomes. Less is known about the long-term benefits of mild GDM treatment. This article will review the benefits of mild GDM treatment, and related risk factors, on short-term and long-term maternal and neonatal/child outcomes, with an emphasis on research conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network.     

An appropriate test for diagnosis of gestational diabetes mellitus

Early diagnosis of GDM is necessary to reduce maternal and fetal morbidity and mortality. As all approaches to diagnosis of GDM are costly and difficult, we meant to find an appropriate and simple way to perform this test. One-thousand six-hundred and fifty-three pregnant women were screened for GDM at 24–28 weeks of gestation. Initial screening was done by a glucose challenge test with 50?g glucose. If the 1-h blood glucose level exceeded 130 mg/dl, then a 3-h oral glucose tolerance test (OGTT) with 100?g glucose was performed, and diagnosis was established according to ADA criteria. For determining which plasma glucose level is the best test for diagnosis of GDM, we used receiver operative characteristic cures (ROC) by plotting sensitivity versus one minus specificity at different times of plasma glucose levels in OGTT. In 732 pregnant women with a positive GCT, a 2-h plasma glucose level above 150 mg/dl was the most powerful test for detecting GDM, which revealed a sensitivity and specificity of 0.84 (0.81–0.86) and 0.94 (CI: 0.92–0.96), respectively. The results of this study suggest that 2-h 100?g OGTT could be an appropriate approach to diagnose GDM, which is cost-effective and could reduce laboratory workload.     

饮食控制对妊娠糖尿病的治疗作用

目的 研究饮食控制对妊娠糖尿病（ＧＤＭ）的治疗作用。方法 分析１７８例妊娠合并糖尿病患者病例,收集经营养门诊及病房会诊指导后的ＧＤＭ患者的血糖值（包括空腹血糖和早餐后２小时血糖）和未经营养指导ＧＤＭ患者的血糖值。结果 营养指导后的ＧＤＭ患者的血糖水平明显低于非指导组,且营养指导后血糖水平低于指导前。结论 饮食控制对妊娠糖尿病具有治疗作用。     

Elevated mean platelet volume is associated with gestational diabetes mellitus

The mean platelet volume (MPV) is an indicator of the average size and activity of platelets. Elevated MPV values are associated with larger and more active platelets and perceived as a new independent cardiovascular risk factor. The aim of this study was to determine the MPV in women with gestational diabetes mellitus (GDM) and to determine the correlation of MPV with metabolic parameters in GDM. We retrospectively analyzed 30 women with GDM and 38 body mass index-matched women with healthy pregnancies as controls. MPV and platelet counts were recorded in the third trimester and at postpartum 6–12 months for GDM group and in the third trimester for control group. Third-trimester MPV was significantly higher in GDM group compared to control group (8.8?±?1.0 versus 8.1?±?0.7?fl, p?=?0.002). In women with GDM, there was a significant decrease in MPV in the postpartum period (8.8?±?1.0 versus 8.1?±?0.8?fl, p?r?=?0.346, p?=?0.007 and r?=?0.346, p?=?0.02, respectively). Our results indicate that MPV is increased in GDM. Monitoring MPV, which is widely available in clinical practice, may potentially identify women who will develop gestational diabetes during pregnancy.