Insulin sensitivity and B-cell responsiveness to glucose during late pregnancy in lean and moderately obese women with normal glucose tolerance or mild gestational diabetes

We used the minimal model technique to obtain concurrent measurements of whole-body insulin sensitivity and pancreatic B-cell responsiveness to glucose during the third trimester of pregnancy. Insulin sensitivity in normal pregnant women (n = 8) was reduced to only one third that of a group of nonpregnant women (n = 7) of similar age and relative weight. This marked insulin resistance was compensated by reciprocal enhancement of the first and second-phase insulin responses to intravenous glucose, which were increased threefold as compared with the nonpregnant women. Women with gestational diabetes mellitus (n = 16) had mean insulin sensitivity that was similar to that of the normal pregnant group, which indicates that insulin action was appropriate for the late phase of pregnancy in the gestational diabetic group. By contrast, the mean first-phase insulin response was significantly reduced in women with gestational diabetes mellitus, as compared with that of normal pregnant women (p less than 0.001). However, approximately one fifth of the group with gestational diabetes mellitus had first-phase responses that did not fall below the 95% confidence interval for the mean in normal pregnant women. The mean second-phase response was also lower in the group with gestational diabetes, although the difference was of borderline statistical significance (p less than 0.09). Our findings reveal the quantitative nature of the reciprocal changes in insulin sensitivity and B-cell function that normally accompany late pregnancy. They further indicate that during the third trimester, mild gestational diabetes is characterized by an impairment of pancreatic B-cell function rather than an exaggeration of the normal insulin resistance of late pregnancy.     

Plasma visfatin levels in pregnant women with normal glucose tolerance,gestational diabetes and pre-gestational diabetes mellitus

Objective.?Visfatin, an adipocytokine, is a peptide predominantly expressed in and secreted from visceral adipose. In this study, we aimed to compare visfatin levels in gestational (GDM) and pre-gestational diabetic (pre-GDM) women with healthy pregnant women. We also sought to determine whether there was a correlation between visfatin levels and serum glucose levels at 1?h after the 50-g oral glucose challenge test in pregnant women with GDM and normal glucose tolerance.

Methods.?The study consisted of 65 pregnant women: 21 patients with GDM (Group 1), 20 patients with pre-GDM (Group 2) and 24 gestational age and BMI-matched healthy pregnant women (Group 3) were enrolled.

Results.?Plasma visfatin levels in Groups 1 and 2 were significantly higher than in Group 3 (P?<?0.001). Plasma visfatin levels in Groups 1 and 2 were similar (P?>?0.05). There was no significant correlation between visfatin levels and serum glucose levels at 1?h after the glucose tolerance test in both Groups 1 and 3 (P?>?0.05).

Conclusions.?Our results support the literature indicating higher visfatin levels in women with GDM compared to women with normal glucose tolerance. Interestingly, we found similarly high visfatin levels in women with pre-GDM.     

Twin pregnancy outcomes for women with gestational diabetes mellitus compared with glucose tolerant women

OBJECTIVE: To examine pregnancy outcomes for women with gestational diabetes mellitus (GDM) and a twin pregnancy compared with glucose tolerant women with a twin pregnancy. DESIGN: Comparison of selected pregnancy outcomes. SETTING: Wollongong, New South Wales, Australia. POPULATION: Women with GDM seen over a 10-year period by an endocrinologist, and women from a selected year of an obstetric database including Wollongong and Shellharbour Hospitals. METHODS: Examination of pregnancy outcome data from the two sources. MAIN OUTCOME MEASURES: Fetal birthweights and method of delivery. RESULTS: There were 28 GDM women with a twin pregnancy from 1229 consecutive referrals (2.3%) of women with GDM for medical management. For comparison there were 29 glucose tolerant women with twin pregnancies evaluable who had delivered over a 1-year period. For the women with GDM and a twin pregnancy there were no significant differences in demographics or outcomes except for a higher rate of elective Caesarean section. CONCLUSION: The higher rate of Caesarean section appeared to be related to the combination of a twin pregnancy and GDM rather than the twin pregnancy or the GDM independently.     

妊娠期糖尿病产后糖代谢异常的危险因素

目的通过对妊娠期糖尿病(GDM)患者进行产后随访,回顾性分析影响GDM患者产后糖代谢变化的高危因素。方法收集2009年1月至2011年6月在河北省沧州市中心医院门诊产前检查并分娩的GDM患者236例,产后42d回访者158例,记录其孕前和孕期信息,包括:孕期年龄、身高、孕前体重、有否糖尿病家族史、孕期使用胰岛素情况、孕期并发症及合并症情况、新生儿出生时情况;并按OGTT试验结果分为研究组和对照组,进行高危因素筛查。结果研究组为60例糖耐量异常者,包括39例IGT/IFG患者和21例DM患者;对照组为98例糖耐量正常者,比较两组患者孕前、孕期和妊娠结局情况,结果可见高龄、糖尿病家族史、孕期应用胰岛素、合并子痫前期、早产是产后发生糖代谢异常的高危因素,差异有统计学意义(P<0.05)。结论存在高危因素的GDM患者产后糖代谢异常发生率较高,应针对性地对GDM患者进行产后临床筛查和随访。     

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.     

Use of oral glucose tolerance test in early pregnancy to predict late-onset gestational diabetes mellitus in high-risk women

AIM: To evaluate if any single plasma glucose level from the four values of the normal 100-g oral glucose tolerance test (OGTT) in early pregnancy (< or =20 weeks of gestation) could predict gestational diabetes mellitus (GDM) diagnosed from a second OGTT in late pregnancy (28-32 weeks). METHODS: Glucose levels of pregnant women at high-risk for GDM, who had had a normal early OGTT, and who underwent the second test in late pregnancy, were studied. Each of the four plasma glucose values of the early OGTT was determined for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The receiver operating characteristic curves of these four OGTT values were then constructed to find the optimal value to predict late-onset GDM. RESULTS: Of 193 pregnant women who had had a normal early OGTT, 154 also had a normal OGTT in late pregnancy while 39 had an abnormal test and were diagnosed with GDM. Among the four glucose values of the early OGTT, the 1-h value yielded the best diagnostic performance to predict late-onset GDM. The sensitivity, specificity, PPV, NPV, and area under the curve achieved from its optimal cutoff level of > or =155 mg/dL (8.6 mmol/L) were 89.7%, 64.3%, 38.9%, 96.1%, and 0.77, respectively. CONCLUSIONS: A 1-h glucose value > or =155 mg/dL at the early OGTT yielded the best diagnostic performance. However, the low specificity and PPV rendered it suboptimal to predict late-onset GDM. Nevertheless, a considerable number of high-risk women could avoid the second OGTT in late pregnancy due to its high sensitivity and NPV.     

Postpartum metabolism and autoantibody markers in women with gestational diabetes mellitus diagnosed in early pregnancy

OBJECTIVE: Our purpose was to study postpartum metabolism and autoantibody markers of type 1 diabetes mellitus in women with gestational diabetes mellitus diagnosed in early pregnancy. STUDY DESIGN: Thirty women with gestational diabetes diagnosed in early pregnancy were compared with 72 women who had gestational diabetes diagnosed in late pregnancy. Glucose tolerance, parameters of carbohydrate and lipid metabolism, and antibodies to glutamic acid decarboxylase and to islet cells were measured. RESULTS: The percentages of overt diabetes and abnormal glucose tolerance were significantly higher in the early-pregnancy group (26.7% vs 1.4%; P =.0002; and 40% vs 5.56%; P <.0001; respectively). Only 1 woman had positive test results for antibodies to the islet cells. The rate of positive test results for antibodies to glutamic acid decarboxylase was similar in both groups (13.7% vs 9.3%). CONCLUSIONS: Women with early gestational diabetes have an increased risk of postpartum diabetes mellitus, whereas those with late-onset gestational diabetes have a minimal risk. In women predisposed to type 1 diabetes, gestational diabetes develops either early or late in pregnancy.     

Serum hepcidin is associated with parameters of glucose metabolism in women with gestational diabetes mellitus

Abstract

Objectives: Hepcidin is considered a major regulator of iron metabolism. Despite previous studies showing elevated ferritin and hepcidin levels in type 2 diabetes mellitus (DM), no study has investigated hepcidin levels in pregnant women with gestational DM (GDM).

Methods: A case-control study was conducted in 30 cases of GDM, 47 pregnant women with impaired glucose tolerance (IGT) and 72 pregnant women with normal glucose tolerance (control) between April 2009 and July 2011. Serum hepcidin and other iron metabolism parameters were analyzed in all groups.

Results: Serum ferritin and serum iron were significantly elevated in the GDM group compared to controls (p?=?0.014, p?=?0.018, respectively) and to the IGT group (p?=?0.021, p?=?0.008, respectively). Hepcidin levels were elevated significantly in the diabetic patients compared to the IGT group (p?=?0.011) and controls (p?=?0.002). We found no correlation between hepcidin and other iron metabolism parameters (Hb, serum iron and ferritin), whereas positive correlations were found between hepcidin and parameters of glucose metabolism (fasting blood glucose, fasting insulin level and glucose value response to glucose challenge test).

Conclusions: Serum hepcidin concentrations were increased in pregnant women with IGT and GDM and this was not related to inflammation parameters.     

妊娠合并糖代谢异常孕妇的体重适宜增长

目的 探讨适合糖代谢异常孕妇妊娠期适宜体重增长范围.方法 对2005年1月至2007年12月在北京大学第一医院分娩的妊娠合并糖代谢异常的足月单胎且病历资料完整的孕产妇661例进行回顾性分析.根据孕前体重指数(BMI)将研究对象分为低体重组(BMI<18.5)40例(Ⅰ组);正常体重组(BMI 18.5～23.9)400例(Ⅱ组);超重组(BMI 24～27.9)162例(Ⅲ组);肥胖组(BMI≥28.0)59例(Ⅳ组).分析孕前不同BMI组正常出生体重儿和巨大儿母亲的孕期增重,并计算出新生儿出生体重在3000～3500 g产妇的孕期平均增重,作为各孕前BMI组孕期适宜的体重增长.结果 孕前不同BMI组分娩巨大儿者孕期增重明显大于分娩正常体重儿者的孕期增重,Ⅱ组孕期平均增重分别为(17.0±5.2)kg和(14.1±4.7)kg,m组孕期平均增重分别为(16.8±7.3)kg和(11.9±5.1)kg,Ⅳ组孕期平均增重分别为(18.3±6.7)kg和(11.2±5.4)kg,差异有统计学意义(P<0.05).各组孕妇孕期平均体重增长和适宜增重范围:Ⅰ组(15.6±3.3)kg,(14.0～18.O)kg,Ⅱ组(13.9±4.6)kg,(11.0～16.5)kg,Ⅲ组(11.5±5.2)kg,(9.0～15.0)ks,Ⅳ组(10.1±2.9)kg,(7.0～12.7)kg.结论 对孕前不同体重的糖代谢异常孕妇进行血糖监测的同时,使其妊娠期体重增长在各自适宜的范围,有助于获得理想出生体重的新生儿.     

血糖控制满意的妊娠期糖尿病孕妇血清性激素结合球蛋白水平与妊娠结局的关系

目的 探讨血糖控制满意的妊娠期糖尿病(GDM)孕妇血清性激素结合球蛋白(SHBG)水平与妊娠结局的关系.方法 选择2005年3月至2010年3月在中国医科大学附属盛京医院产科门诊确诊的妊娠24～28周GDM孕妇251例,其中经单纯饮食控制(169例)或加用胰岛素治疗(47例)后血糖控制满意的216例为血糖控制满意组;经单纯饮食控制或加用胰岛素治疗后血糖控制不满意的35例为血糖控制不满意组.选取同期妊娠24～28周的192例健康孕妇为健康对照组.分别于妊娠24～28周和妊娠＞36周两次测定孕妇血清SHBG水平和稳态模型的胰岛素抵抗(HOMA-IR)指数.依据美国糖尿病资料小组的GDM诊断标准采用"两步法"诊断GDM.记录并观察3组孕妇的妊娠结局.测定孕妇空腹血糖(FPG)和空腹胰岛素(FINS)水平.结果 (1)妊娠结局比较:血糖控制满意组孕妇的妊娠期高血压疾病(10.6%,23/216)、早产(8.3%,18/216)、大于胎龄儿(8.8%,19/216)、新生儿窒息(3.7%,8/216)和新生儿低血糖(2.3%,5/216)的发生率明显低于血糖控制不满意组[分别为42.9%(15/35)、34.3%(12/35)、31.4%(11/35)、22.9%(8/35)和11.4%(4/35)],两组分别比较,差异均有统计学意义(P＜0.05或P＜0.01);而两组孕妇羊水过多、产褥感染、产后出血和新生儿高胆红素血症的发生率比较,差异均无统计学意义(P＞0.05).血糖控制满意组孕妇早产、产褥感染(3.2%,7/216)、产后出血(5.1%,11/216)、新生儿窒息(3.7%,8/216)和新生儿低血糖(2.3%,5/216)的发生率,与健康对照组[分别为7.3%(14/192)、2.1%(4/192)、4.2%(8/192)、2.1%(4/192)和1.6%(3/192)]比较,差异均无统计学意义(P＞0.05).(2)妊娠24～28周与妊娠＞36周孕妇血清SHBG等项指标检测结果比较:血糖控制满意组孕妇血清SHBG水平[分别为(384±88)及(457±48)nmo]/L]均明显高于血糖控制不满意组[分别为(313±45)及(401±73)nmol/L];血糖控制满意组孕妇HOMA-IR指数(分别为5.3±1.1及5.5±1.1)均明显低于血糖控制不满意组(分别为7.0±1.3及7.6±1.7),两组分别比较,差异均有统计学意义(P＜0.01);血糖控制满意组孕妇血清SHBG水平均明显低于健康对照组[分别为(492±95)及(565±40)nmol/L];而HOMA-IR指数均明显高于健康对照组(分别为3.6±0.6及3.9±0.5),两组分别比较,差异均有统计学意义(P＜0.01);血糖控制满意组孕妇FPG水平[分别为(5.84±0.28)及(5.16±0.13)mmol/L]明显低于血糖控制不满意组[分别为(6.13±0.16)及(5.68±1.14)mmol/L],两组分别比较,差异均有统计学意义(P＜0.01);血糖控制满意组孕妇FINS水平[分别为(20.4±2.1)及(24.1±4.2)mmol/L]明显低于血糖控制不满意组[分别为(24.7±4.5)及(29.9±2.7)mmol/L],两组分别比较,差异均有统计学意义(P＜0.01).(3)相关性分析:妊娠24～28周时,3组孕妇(共443例)血清SHBG水平与HOMA-IR指数呈负相关(r=-0.952,P＜0.01);其中血糖控制满意组216例孕妇血清SHBG水平与HOMA-IR指数也呈负相关(r=-0.903,P＜0.01).结论 血糖控制满意的GDM孕妇并不能完全改善妊娠结局,GDM孕妇血清SHBG水平降低和高IR对其妊娠结局有一定影响.

Abstract：

Objective To explore the relationship between sex hormone-binding globulin (SHBG) of gestational diabetes mellitus ( GDM ) pregnant women with well-controlled glucose and pregnancy outcomes. Methods Two hundred and fifty-one GDM pregnant women of 24 - 28 weeks in Shengjing Hospital of China Medical University were recruited from Mar. 2005 to Mar. 2010. Two hundred and sixteen cases of GDM with well-controlled glucose were defined as glycemic satisfied group, and they were treated by diet therapy ( 169 cases) or insulin therapy (47 cases) . Thirty-five cases with unsatisfied glucose were defined as glycemic unsatisfied group. One hundred and ninety-two healthy pregnant women of 24 - 28 weeks were defined as healthy control group. Serum SHBG and homeostasis model analysis of insulin resistance ( HOMA-IR) at 24 - 28 weeks and above 36 weeks were measured. GDM was diagnosed by " two-step" method according to the National Diabetes Data Group ( NDDG) criteria. The pregnancy outcomes and complications of the three groups were recorded. Results ( 1 ) Comparison of pregnancy outcomes and complications: glycemic satisfied group was less likely to develop hypertensive disorders in pregnancy ( 10. 6% ) , premature birth(8. 3% ) ,large for gestational age ( LGA) (8. 8% ) , neonatal asphyxia(3. 7% ) and neonatal hypoglycemia ( 2. 3% ) compared to glycemic unsatisfied group ( 42. 9% , 34. 3% , 31. 4% , 22. 9% and 11. 4% ,respectively). And the difference was statistically significant (P ＜0. 05 or P ＜0. 01). There was no significant difference for incidence of polyhydramnios, pueperal infection, postpartum hemorrhage, neonatal hyperbilirubinemia between the two groups ( P＞ 0. 05 ) . When compared to healthy control group(7. 3% ,2. 1% ,4. 2% ,2. 1% and 1. 6% ) ,no significant difference was found for incidence of premature birth( 8. 3% ) , pueperal infection ( 3. 2% ) , postpartum hemorrhage (5. 1% ) , neonatal asphyxia (3. 7% )and neonatal hypoglycemia(2. 3% ,P ＞0. 05). (2) Comparison of results of 24 - 28 weeks and above 36 weeks: serum SHBG of glycemic satisfied group [( 384 ± 88 ) , (457 ± 48 ) nmol/L]was significantly higher than that of glycemic unsatisfied group[(313 ±45) ,(401 ±73) nmol/L];HOMA-IR of glycemic satisfied group (5. 3 ±1.1,5.5 ±1.1) was significantly lower than that of glycemic unsatisfied group (7. 0 ± 1. 3 ,7. 6 ± 1. 7 ; P ＜ 0. 01). Serum SHBG of glycemic satisfied group was significantly lower than that of healthy control group [( 492 ± 95 ) , (565 ± 40 ) nmol/L]; and HOMA-IR of glycemic satisfied group(5. 3 ± 1. 1,5. 5 ± 1. 1) was significantly higher than that of healthy control group (3. 6 ±0. 6,3. 9 ± 0. 5 ;P ＜ 0. 01 ) . FPG of glycemic satisfied group [( 5. 84 ± 0. 28 ) , ( 5. 16 ± 0. 13 ) mmol/L]was significantly lower than that of glycemic unsatisfied group [(6. 13 ± 0. 16 ) , ( 5. 68 ± 1. 14) mmol/L; P ＜ 0. 01]. FINS of glycemic satisfied group [( 20. 4 ± 2. 1 ) , ( 24. 1 ± 4. 2 ) mmol/L]was significantly lower than that of glycemic unsatisfied group [(24. 7 ± 4. 5 ) , ( 29. 9 ± 2. 7 ) mmol/L; P ＜ 0. 01]. ( 3 ) Correlation analysis. Between 24 - 28 weeks, SHBG was negatively correlated with HOMA-IR in the three groups ( r = -0. 952, P ＜0. 01) ; and SHBG was negatively correlated with HOMA-IR in glycemic satisfied group ( r = -0. 903, P ＜0. 01). Conclusions Well-controlled glucose can not completely improve maternal and fetal outcomes of GDM pregnant women. High insulin resistance and low serum SHBG can influence pregnancy outcomes.     

Low gestational weight gain improves infant and maternal pregnancy outcomes in overweight and obese Korean women with gestational diabetes mellitus

Objective.?The aim of the study was to retrospectively assess what was the optimal gestational weight gain to have better maternal and neonatal outcomes in overweight and obese Korean women with gestational diabetes mellitus (GDM) who maintained normoglycemia throughout pregnancy by dietary modification, exercise, and/or insulin treatment.

Study design.?We performed a hospital-based study of 215 GDM women with prepregnancy BMI?≥?25 kg/m². Body weight, glucose homeostasis, lipid profiles, insulin treatment, and maternal outcomes were collected as predictors of neonatal birth weight. We divided the subjects into three groups according to modified Institute of Medicine (IOM) guidelines for weight gain during pregnancy: inadequate (n?=?42), normal (n?=?96), and excessive (n?=?77) groups.

Results.?Excessive weight gain resulted in increased macrosomia, HbA_1c at delivery, and postprandial blood glucose levels, but fasting blood glucose levels were not significantly different among the groups. The inadequate weight gain group (2.4?kg weight gain during pregnancy) had better neonatal outcomes and better maternal glycemic control with fewer requiring insulin treatment.

Conclusion.?Minimal weight gain, well below IOM recommendations, and tight control of blood glucose levels during pregnancy with proper medical management and dietary modification may eliminate most of the adverse pregnancy outcomes experienced by obese GDM Asian women.     

Prolactin and glucose tolerance in normal and gestational diabetic pregnancy

The relationship between the deterioration of glucose tolerance and plasma prolactin (PRL) levels was investigated in 15 normal pregnant women and in 15 women with gestational diabetes mellitus. Oral glucose tolerance tests were performed in late pregnancy and postpartum, and the insulin, glucagon, and PRL responses were measured. In late pregnancy the gestational diabetics revealed significantly elevated fasting glucose levels compared with the normal pregnant women and after the glucose challenge their insulin responses were significantly diminished and the suppression of glucagon less pronounced. These differences in glucose metabolism were markedly reduced early postpartum. There was no difference in basal PRL concentrations between the two groups neither in pregnancy nor postpartum. The PRL levels were not altered during the oral glucose tolerance tests and no correlation between the deterioration of glucose tolerance and the PRL concentrations could be demonstrated in either group. These results indicate that abnormal PRL levels are not of pathophysiologic importance for the development of gestational diabetes mellitus.     

Subclinical abnormalities of glucose metabolism in Brazilian women with a history of gestational diabetes mellitus

BACKGROUND: To evaluate insulin release and insulin sensitivity in women with prior gestational diabetes mellitus (GDM) to gain a better understanding of type 2 diabetes pathogenesis. METHODS: GDM women were individually matched for age, body mass index, and waist/hip ratio with those who were normal glucose tolerant in a previous pregnancy (NGT). All women presented with normal glucose tolerance. Twenty pairs were submitted to the oral glucose tolerance test (OGTT) with plasma glucose, insulin, and C-peptide determinations. Of the 20 pairs, 18 participated in hyperglycemic (10.0 mmol/l) clamp experiments with frequent plasma glucose and insulin determinations, allowing us to calculate first- and second-phase insulin release and the insulin sensitivity index. GDM and NGT women were compared using Student's t-test, the Mann-Whitney U-test, Friedman's non-parametric test, and the two proportion test for independent groups. RESULTS: GDM women showed higher glycosylated hemoglobin values; at OGTT, they showed late insulin peak with increased plasma insulin levels only during the second hour, and a similar plasma C-peptide response despite a higher plasma glucose curve; during hyperglycemic clamp procedures, they showed similar biphasic insulin release and insulin sensitivity index. Considering that a woman with previous GDM had a defect in insulin release and/or insulin sensitivity, if its magnitude was at least 25% lower than that of the matched NGT woman, 43.8% showed impairment of first-phase insulin release and 55.6% insulin resistance. CONCLUSIONS: GDM women showed some degree of glucose intolerance. It is therefore necessary to follow them for a longer time.     

Serum adiponectin during pregnancy and postpartum in women with gestational diabetes and normal controls

Aims. To investigate changes in serum adiponectin during pregnancy and postpartum and assess its relationship with insulin resistance as measured by homeostasis model assessment (HOMA-IR).

Methods. Twenty-two normal pregnant women were compared with 22 women diagnosed with gestational diabetes mellitus (GDM). Serum adiponectin levels were measured at the time of the glucose challenge test as well as in the immediate postpartum period and the correlation of adiponectin to HOMA-IR was performed.

Results. Adiponectin was significantly lower in women with GDM than in controls during pregnancy (5381 vs. 8449 ng/dl, p = 0.004), as well as postpartum (3278 vs. 6958 ng/ml, p = 0.002). A significant reduction in adiponectin (3278 vs. 5381 ng/ml, p = 0.002) was observed postpartum in GDM women but not in controls. Using a lower cut-off value of 5253 ng/ml, maternal adiponectin could exclude GDM with a sensitivity of 86.4% and a specificity of 59.1% (area under the curve = 0.752, standard error = 0.77, 95% confidence interval 0.601–0.903, p = 0.004). Adiponectin levels during pregnancy were negatively correlated with HOMA-IR (r = ?0.375, p = 0.012).

Conclusion. GDM is associated with decreased serum adiponectin levels both in pregnancy as well as postpartum. Adiponectin is negatively correlated to HOMA-IR. A reduction in maternal adiponectin after delivery indicates a significant placental contribution to adiponectin production.     

Physiologic and molecular alterations in carbohydrate metabolism during pregnancy and gestational diabetes mellitus

Recent progress suggests that postreceptor mechanisms that contribute to insulin resistance of pregnancy appear to be multifactorial, but are exerted at the beta-subunit of the insulin receptor and at the level of IRS-1. Gestational diabetes mellitus represents the combination of acquired and intrinsic abnormalities of insulin action. The resistance to insulin-mediated glucose transport appears to be greater in skeletal muscle from GDM subjects than from pregnancy alone. There is also a modest but significant decrease in maximal insulin receptor tyrosine phosphorylation in muscle from obese GDM subjects. Results also suggest that increased insulin receptor serine/threonine phosphorylation and PC-1 could underlie the insulin resistance of pregnancy and pathogenesis of GDM. Whether additional defects are exerted further downstream from IRS-1 remains to be investigated.     

Accelerated starvation in late pregnancy: a comparison between obese women with and without gestational diabetes mellitus

We compared the glucose, insulin, free fatty acid, and 3-hydroxybutyrate responses to a briefly extended overnight fast during the third trimester of pregnancy between two groups: obese women with normal glucose tolerance (n = 10) and age- and weight-matched women with gestational diabetes mellitus (n = 10). After a 12-hour overnight fast, plasma glucose (95 +/- 4 vs. 78 +/- 2 mg/dl; p less than 0.01), insulin (32 +/- 5 vs. 17 +/- 2 microU/ml; p less than 0.02), and free fatty acid (860 +/- 63 vs. 639 +/- 79 mmol/L; p less than 0.05) levels were higher in the patients with gestational diabetes mellitus. 3-Hydroxybutyrate levels were similar in the two groups at that time (0.23 +/- 0.04 vs. 0.18 +/- 0.03 mmol/L; p greater than 0.3). When the fast was extended to 18 hours by having the patients skip breakfast, glucose levels fell more rapidly in the group with gestational diabetes mellitus but remained elevated compared with the nondiabetic women. Insulin levels declined at a similar rate in the two groups. Free fatty acid levels did not increase significantly in the group with gestational diabetes mellitus during the extended fast. In contrast, free fatty acid levels increased by 44% in the normal pregnant women, reaching the level observed in the group with gestational diabetes mellitus after 18 hours. 3-Hydroxybutyrate levels remained virtually identical in the two groups throughout the brief fast. Thus, compared with that of normal pregnant women, the response of obese women with gestational diabetes mellitus to brief caloric deprivation during late pregnancy was characterized by a greater fall in plasma glucose values without a greater propensity to ketosis. Our findings may have important implications for the dietary management of obese patients with gestational diabetes mellitus.     

妊娠期糖代谢异常孕妇血清瘦素水平及其与胰岛素和血糖关系的研究

目的　探讨妊娠期糖代谢异常孕妇血清瘦素水平及其与胰岛素和血糖的关系。方法　采用放射免疫法 ,测定 36例妊娠期糖代谢异常孕妇 (糖代谢异常组 )和 2 4例正常孕妇 (正常妊娠组 )的空腹及口服 50g葡萄糖后 3h的血清瘦素水平 ;采用电化学发光法测定两组孕妇的空腹血清胰岛素水平 ;采用低压液相色谱分析法测定两组孕妇的糖化血红蛋白 ;采用葡萄糖氧化酶法测定两组孕妇的口服 50g葡萄糖后 1h的血糖水平。结果　 (1 )糖代谢异常组孕妇血清瘦素水平为 (1 4 9± 4 3) μg/L ,正常妊娠组为 (1 0 0± 1 8) μg/L ,两组比较 ,差异有极显著性 (P <0 0 1 ) ;(2 )糖代谢异常组孕妇空腹血清胰岛素、糖化血红蛋白、服糖后 1h血糖水平分别为 (1 2 9± 4 3)mU/L、 (6 1± 1 1 ) %、(1 1 0±1 4)mmol/L ;正常妊娠组孕妇分别为 (8 6± 3 2 )mU/L、(4 5± 1 0 ) %、(7 8± 1 2 )mmol/L。糖代谢异常组孕妇血清瘦素水平与空腹血清胰岛素、糖化血红蛋白、服糖后 1h的血糖水平呈明显的正相关关系 ,相关系数 (r)分别为 0 835、0 758、0 561。结论　妊娠期糖代谢异常孕妇空腹血清瘦素水平升高 ,其瘦素水平的高低与空腹血清胰岛素及血糖水平相关     

肥胖妊娠期妇女的糖耐量减低与糖尿病

妊娠期糖代谢的生理变化容易使妊娠期妇女发生糖耐量的减低，所以近年来妊娠期妇女糖代谢的异常受到诸多关注。因为妊娠期妇女糖耐量的减低不仅影响到母体，引起其代谢紊乱或者发展为妊娠期糖尿病，而且影响胎儿发育，以致发生胎儿的先天性畸形，发育异常，死亡率增加等一系列问题。如果在肥胖这个高危因素作用下，将会加重妊娠期妇女糖耐量减低的程度，甚至使其发展为妊娠期糖尿病的几率大大增加。着重对肥胖影响母体糖耐量的相关研究进行综述。