膳食脂肪对妊娠期糖尿病孕妇发病的影响

目的探讨膳食脂肪对妊娠期糖尿病(GDM)发病的影响。方法选择GDM孕妇85例(GDM组),及正常孕妇159例(正常妊娠组)为调查对象。饮食治疗前对GDM组孕妇和正常妊娠组孕妇进行膳食调查。比较两组孕妇膳食结构中三大营养素供能百分比,特别是膳食脂肪、脂肪酸类型等。结果(1)GDM组孕妇每日摄入总热卡为(8970±2115)kJ,正常妊娠组为(8799±1785)kJ,两组比较,差异无统计学意义(P>0·05)。(2)GDM组孕妇碳水化合物、蛋白质和脂肪供能百分比分别为(51·9±7·2)%、(17·5±0·9)%和(30·6±1·3)%,正常妊娠组分别为(53·6±8·1)%、(18·3±1·1)%和(28·1±2·3)%。GDM组脂肪供能百分比高于正常妊娠组,两组比较,差异有统计学意义(P<0·05);两组碳水化合物和蛋白质供能百分比比较,差异无统计学意义(P>0·05)。(3)GDM组孕妇饱和脂肪酸、多不饱和脂肪酸和单不饱和脂肪酸供能百分比分别为(15·2±0·4)%、(8·3±0·5)%和(7·1±0·5)%,正常妊娠组饱和脂肪酸、多不饱和脂肪酸和单不饱和脂肪酸供能百分比分别为(11·7±0·6)%、(10·1±0·4)%和(6·3±0·3)%。GDM组饱和脂肪酸供能百分比高于正常妊娠组,两组比较,差异有统计学意义(P<0·05);GDM组多不饱和脂肪酸供能百分比低于正常妊娠组,两组比较,差异有统计学意义(P<0·05);两组单不饱和脂肪酸供能百分比比较,差异无统计学意义(P>0·05)。结论孕妇高脂肪、高饱和脂肪酸和低多不饱和脂肪酸饮食可能是GDM发病的外部原因之一。     

妊娠期糖尿病孕妇的脂代谢变化

高脂血症与动脉粥样硬化的发生、发展有关,同时影响肾病、糖尿病等。妊娠时,由于周围环境激素的变化,血浆脂类和脂蛋白无论在质量和数量上均发生变化。在妊娠合并糖尿病时,脂代谢紊乱将进一步加重,主要表现为高甘油三酯血症[1]。本文就妊娠和妊娠期糖尿病孕妇的脂代谢变化做一综述。     

妊娠期糖尿病患者妊娠晚期血脂水平变化与新生儿出生体重的关系

目的探讨妊娠期糖尿病患者妊娠晚期血脂水平变化与新生儿出生体重的关系。方法采用酶法测定40例妊娠期糖尿病孕妇(妊娠期糖尿病组)、30例1型糖尿病孕妇(1型糖尿病组)、30例2型糖尿病孕妇(2型糖尿病组)及30例正常孕妇(正常妊娠组)妊娠晚期血脂水平。同时测定4组孕妇所分娩的新生儿出生体重。结果(1)妊娠期糖尿病组、1型糖尿病组、2型糖尿病组及正常妊娠组血清甘油三酯水平分别为(40±14)mmol/L、(29±08)mmol/L、(41±25)mmol/L及(27±09)mmol/L;总胆固醇水平分别为(65±30)mmol/L、(62±28)mmol/L、(64±32)mmol/L及(60±31)mmol/L;低密度脂蛋白胆固醇水平分别为(33±13)mmol/L、(32±13)mmol/L、(33±11)mmol/L及(32±10)mmol/L;高密度脂蛋白胆固醇水平分别为(16±05)mmol/L、(14±05)mmol/L、(15±04)mmol/L及(16±04)mmol/L。妊娠期糖尿病组及2型糖尿病组甘油三酯水平明显高于正常妊娠组及1型糖尿病组(P<001)。(2)妊娠期糖尿病组、1型糖尿病组、2型糖尿病组及正常妊娠组的新生儿出生体重分别为(4108±544)g、(3323±457)g、(4111±263)g及(3463±516)g。(3)妊娠期糖尿病组、1型糖尿病组、2型糖尿病组新生儿出生体重,与血清甘油三酯水平呈明显的正相关(r=039,P<001)。结论妊娠期糖尿病及2型糖尿病孕妇     

妊娠期糖尿病孕妇行葡萄糖耐量试验后的血压变化

高血压和糖尿病往往并存 ,并与高胰岛素血症和胰岛素抵抗有关[1,2 ] 。有报道显示 ,妊娠期糖尿病患者 ,妊娠高血压综合征 (妊高征 )、先兆子痫的发生率高于正常孕妇 ,提示妊高征和先兆子痫的发生与葡萄糖耐量受损的程度有关[3 ] 。目前 ,尚不清楚血压正常的妊娠期糖尿病孕妇的血压改变 ,是否与行葡萄糖耐量试验 (ｏｒａｌｇｌｕｃｏｓｅｔｏｌｅｒａｎｃｅｔｅｓｔ,ＯＧＴＴ)的结果有关。本研究旨在探讨血压正常的妊娠期糖尿病孕妇 ,其ＯＧＴＴ值与平均动脉压之间的关系。一、资料和方法1.对象选择 :选择 1999年 1月至 1999年 12月 ,在香港…     

妊娠期糖尿病孕妇肌醇水平变化及其与糖脂代谢的相关性

目的:探讨妊娠期糖尿病（gestational diabetes mellitus, GDM）孕妇血、尿肌醇水平变化及其与糖脂代谢的相关性。方法:本研究为横断面研究。以2018年11月至2019年8月于福建省妇幼保健院门诊常规产前检查的GDM孕妇80例作为GDM组,同期本院门诊常规产检的非GDM孕妇50例作为非GDM组...     

内脏脂肪素mRNA表达变化与妊娠期糖尿病的相关性

目的 探讨晚期妊娠孕妇大网膜组织内脏脂肪素(VF)Mrna表达的变化与妊娠期糖尿病(GDM)的相关性.方法 采用半定量RT-PCR技术检测100例晚期妊娠妇女大网膜组织VFmRNA的表达水平,其中包括GDM孕妇45例(GDM组)、糖耐量正常(NGT)孕妇55例(NGT组).检测各组孕妇空腹血糖、空腹血清胰岛素、总胆固醇(TC)及甘油三酯(TG)水平,采用稳态模型(HOMA)计算胰岛素抵抗(IR)指数(HOMA-IR)并计算孕前体重指数(BMI).结果 GDM组与NGT组大网膜组织中VF Mrna表达水平分别为0.8±0.4、0.5±0.3,空腹血糖水平分别为(4.12±0.14)、(3.65±0.13)mmol/L,空腹血清胰岛素水平分别为(72±5)、(61±5)pmol/L,TG水平分别为(5.6±0.3)、(3.8±0.3)mmol/L,TC水平分别为(5.6±0.9)、(3.9±0.3)mmol/L,孕前BMl分别为(22.6±0.8)、(20.9±0.4)ks/m2,HOMA-IR分别为12.5±5.9、9.5±0.8,两组以上各值分别比较,GDM组各值均高于NGT组,差异均有统计学意义(P<0.05).VF Mrna表达水平与孕前BMI呈正相关关系(r=0.32,P<0.01),但与HOMA-IR、TC、TG无相关性.结论 VF Mrna表达上调可能与GDM、肥胖的发生密切相关.     

中性粒细胞明胶酶相关脂质运载蛋白与子痫前期及妊娠期糖尿病孕妇糖代谢和脂代谢指标的相关性

目的 通过测定正常妊娠孕妇、子痫前期糖代谢正常患者、妊娠期糖尿病( gestational diabetes mellitus,GDM)患者及子痫前期合并GDM患者血清中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)水平,探讨NGAL与子痫前期、GDM孕妇糖代谢和脂代谢的相关性. 方法 选取2009年12月至2010年11月在广州医学院附属广东省妇女儿童医院定期产前检查并分娩的单胎正常妊娠孕妇、子痫前期糖代谢正常患者及GDM患者各77例,子痫前期合并GDM患者32例.测定所有研究对象血清NGAL、空腹血精、空腹胰岛素、脂代谢参数、尿酸、肌酐、乳酸脱氢酶及24 h尿蛋白等指标,测量血压,计算体重指数(body mass index,BMI),用稳态模型评估法计算胰岛素抵抗指数(homeostasis model assessment for insulin resistance,HOMA-IR)评价胰岛索敏感性.正态分布资料用单因素方差分析及Student's t检验进行比较,非正态分布资料用Kruskal-Wallis H检验和Mann-Whitney U检验进行比较.采用Spearman相关分析和多元逐步回归法进一步分析. 结果 子痫前期合并GDM组孕妇血清NGAL水平高于子痫前期糖代谢正常组[(70.82±20.02) ng/ml与(56.17±18.22)ng/ml,t=3.65,P＜0.01]、GDM组[(43.99±14.82) ng/ml,t=5.97,P＜0.01]及正常妊娠组[(17.80±5.78) ng/ml,t=14.76,P＜0.01);子痫前期糖代谢正常组血清NGAL水平高于GDM组(t=5.90,P＜0.01);子痫前期合并GDM组和子痫前期糖代谢正常组中,子痫前期重度组血清NGAL水平均高于子痫前期轻度组[(76.44±28.06)ng/ml与(60.15±25.86) ng/ml,t=2.82,P＜0.05; (61.61±37.14) ng/ml与(46.30±13.97) ng/ml,t=4.74,P＜0.01].校正孕周、孕妇年龄后血清NGAL水平与孕前BMI(r=0.335,P＜0.01)、入组BMI(r=0.427,P＜0.01)、入组收缩压(r=0.648,P＜0.01),入组舒张压(r=0.664,P＜0.01)、空腹血糖(r=0.320,P＜0.01)、空腹胰岛素(r=0.381,P＜0.01)、HOMA-IR(r=0.399,P＜0.01)、甘油三酯(r=0.405,P＜0.01)、总胆固醇(r=0.145,P＜0.05)、游离脂肪酸(r=0.335,P＜0.01)、尿酸(r=0.292,P＜0.01)、肌酐(r=0.226,P＜0.01)及24 h尿蛋白(r=0.436,P＜0.001)呈正相关,与高密度脂蛋白胆固醇(r=-0.189,P=0.008)呈负相关.多元逐步回归分析显示,入组收缩压(β=0.251,P＜0.01),入组舒张压(β=0.351,P＜0.01)、HOMA-IR(β=0.265,P＜0.01)、24 h尿蛋白(β=0.140,P＜0.05)是血清NGAL的独立相关因素. 结论 子痫前期及GDM患者血清NGAL水平显著升高,与糖脂代谢及血管内皮功能失调相关,提示NGAL可能在子痫前期及GDM的病理生理过程中发挥作用.     

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     

妊娠期糖尿病孕妇合并妊高征相关因素的探讨

血糖水平增高和血管病变使妊娠期糖尿病孕妇发生妊娠高血压综合征的可能性增加 ,迅速、稳定地控制血糖 ,降低妊高征的发生 ,是临床上需要研究的问题。我们回顾分析了妊娠期糖尿病孕妇发生妊高征的相关因素和妊娠结局 ,报道如下。1　资料与方法1.1　资料来源　回顾分析 1999年 12月～ 2 0 0 1年 2月收治的 88例孕妇。孕前均无糖尿病史及严重内科合并症 ,通过正规糖耐量试验 (ＯＧＴＴ)确诊为妊娠期糖尿病 (ＧＤＭ)。根据有无妊高征的发生 ,将孕妇分成妊高征组和非妊高征组。1.2　方法1.2 .1　ＯＧＴＴ和餐后 2ｈ血糖测定及诊断标准　 (1)孕妇…     

妊娠合并糖尿病妊娠期糖代谢变化

葡萄糖不仅是胎儿能量物质 ,而且是胎儿脂肪、糖原合成的原料 ,每公斤体重胎儿每分钟消耗 6ｍｇ葡萄糖 ,足月胎儿每日需摄取 2 6～ 30 ｇ葡萄糖。为满足胎儿在胚胎期、器官分化发育期和成熟期发育的能量需要 ,母体内糖代谢及其它各系统代谢皆发生相适应的变化。为了提高对糖代谢异常的认识 ,有助于充分了解妊娠与糖尿病的相互影响 ,以便及时诊断和有效处理。因此 ,掌握妊娠期糖代谢的变化是十分必要的。1　妊娠期母体激素的改变妊娠期母体激素代谢显著增加[1,2 ] 。孕期垂体的体积比非孕期增加 1倍 ,垂体前叶嗜酸细胞增生 ,自孕 7周开始分泌…     

The Long-Term Follow-up of Women with Gestational Diabetes

Four hundred and forty-seven women who had gestational diabetes have been retested at intervals from 1 to 12 years following diagnosis; 49 (11%) were found to be diabetic and 35 (7.8%) had impaired glucose tolerance using the WHO criteria. An abnormal glucose tolerance test in the puerperium and obesity at the time of retesting had significant associations with abnormal glucose tolerance at follow-up. However, the best predictive factor of the likelihood of the development of significant hyperglycaemia was the recurrence of gestational diabetes in a subsequent pregnancy, since 28% of these women were diabetic and a further 4% had impaired glucose tolerance at the time of follow-up. These findings indicate that the criteria used for the diagnosis of gestational diabetes at the Mercy Maternity Hospital, Melbourne (1-hour greater than or equal to 9 mmol/l together with a 2-hour greater than or equal to 7 mmol/l) are appropriate for an Australian population.     

Determinants of Birth-weight in Women with Established and Gestational Diabetes

Summary: Increased birth-weight (macrosomia) can complicate the diabetic pregnancy, but many factors other than hyperglycaemia can influence birth-weight, in particular maternal obesity. In a mixed population (European, Maori and Pacific Islander) with a high prevalence of glucose intolerance and obesity we have examined the relative impact of various maternal factors on birth-weight in women with both established and gestational diabetes. Mean birth-weight was significantly greater in women with established or gestational diabetes than in controls (p < 0.0001), but was similar in women with gestational and established diabetes, despite glycaemic control being significantly poorer (p < 0.0001) in the latter. Birth-weight closely paralleled prepregnancy body mass index rather than glycaemic control, but in Maori women it was lower than expected, probably because of their high prevalence of smoking. Daily cigarette consumption was negatively correlated with birth-weight (p<0.01) despite the smokers having significantly poorer glycaemic control (p<0.001). The most significant variables influencing birth-weight in the diabetic pregnancy were gestational age at delivery, prepregnancy body mass index, maternal height, estimated weight gain during pregnancy, the presence of hypertension and cigarette smoking (the latter 2 having negative effects on birth-weight). Glycaemic control in the last half of pregnancy was not significant in this analysis. We conclude that within the limits of glycaemic control which we obtained, birth-weight was largely determined by maternal factors other than hyperglycaemia. Birth-weight thus has severe limitations as an outcome measure of the diabetic pregnancy.     

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.     

A Community-Based Parish Nurse Intervention Program for Mexican American Women with Gestational Diabetes

Objective: To examine the effects of a Parish Nurse Intervention Program (PNIP) on maternal health behaviors, glycemic control, and neonatal outcomes among Mexican American women with gestational diabetes.
Design: A randomized controlled trial comparing care as usual (CAU) with a supplementary 1-hour education session for diabetes education reinforcement by a Parish Nurse.
Setting: An outpatient treatment clinic for gestational diabetes within a 250-bed tertiary care, non-profit hospital with a Parish Nurse partnership.
Participants: One hundred Mexican American women were included in the study with randomization into Parish Nurse Intervention Program ( n =49) and care as usual ( n =51) groups.
Main Outcome Measures: The Health Promoting Lifestyle Profile II (HPLP II) and two measures of glycemic control pre- and post-intervention, as well as newborn size, and days of maternal and neonatal hospitalization.
Results: Outcomes indicate significantly improved Health Promoting Lifestyle Profile II scores in the Parish Nurse Intervention Program group post-intervention compared with the Care As Usual group. No significant differences between groups regarding glycemic control, macrosomia, or days of maternal or neonatal hospitalization were found.
Conclusions: A Parish Nurse Intervention Program for pregnant women of Mexican descent with gestational diabetes is effective in leading to improved self-reported health promoting behaviors.     

Gestational Diabetes and Follow-up Among Immigrant Vietnam-born Women

Summary: Gestational diabetes is associated with an increased risk of fetal macrosomia and perinatal death. Immigrant mothers from Vietnam who delivered in the Mercy Hospital for Women between January 1,1979 and December 31,1990 were investigated to assess their risk of gestational diabetes, the factors that were associated with gestational diabetes, and the prevalence of diabetes mellitus on follow-up. These mothers were compared with Australian-born mothers attending the same hospital and who delivered in the same period. Using a logistic regression model, gestational diabetes was found to be more common in Vietnam-born mothers who were older, who were primigravidas, or were underweight and the risk of gestational diabetes increased over the time period of the study. The adjusted relative risk of gestational diabetes for Vietnam-born women was 1.43 (95% confidence limits 1.10, 1.86) compared with Australian-born women. The incidence of gestational diabetes was 7.8% (144 of 1,839) in Vietnam-born mothers and 4.3% (1,173 of 27,086) in Australian-born mothers. Vietnam-born mothers also had a greater risk of diabetes mellitus on follow-up; 25% (17 of 68) of those with follow-up testing had developed diabetes mellitus within 9 years of diagnosis of gestational diabetes, in comparison with an incidence of 9% (52 of 581) of Australian-born mothers with follow-up testing. Vietnam-born mothers should have glucose tolerance testing performed during pregnancy to detect gestational diabetes and those diagnosed should have long-term follow-up to detect the development of diabetes mellitus.     

Exercise Fails to Improve Postprandial Glycemic Excursion in Women with Gestational Diabetes

The effect of an acute period of moderate intensity exercise on maternal glycemic excursion following a mixed nutrient meal was studied. Five normal (NL) and six gestational diabetic (GDM) subjects were enrolled. A randomized crossover design was used to compare fasting glucose and insulin levels, peak glucose and insulin levels and incremental area of the glycemic and insulin curves following a mixed nutrient meal with or without an exercise stress that took place 14 h earlier. Exercise consisted of upright stationary cycling for 30 min at a heart rate consistent with 60% O_{2 max}. The clinical characteristics of normal and gestational diabetic subjects were comparable. Mean values (±SM) with, versus without, exercise for fasting glucose (NL: 78.9 ± 2.6 vs. 80.0 ± 2.6 mg/dl; GDM: 86.4 ± 2.0 vs. 82.1 ± 3.5 mg/ dl), peak glucose (NL: 132.3 ± 10.4 vs. 139.1 ± 15.6 mg/dl; GDM: 165.8 ± 5.5 vs. 160.3 ± 7.8 mg/dl), the area under the glycemic curve (NL: 5758 ± 1038 vs. 6393 ± 1281 mg/dl ± min; GDM: 8,178 ± 890 vs. 8,331 ± 563 mg/dl ± min) did not differ. Similarly, plasma insulin levels did not differ between protocols for either group of subjects. Exercise has been proposed as a treatment to reduce glycemia in gestational diabetes. Results from this study indicate a single bout of exercise did not blunt the glycemic response observed following a mixed nutrient meal.     

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%) .     

妊娠期糖尿病患者视黄醇结合蛋白4的变化及其与血糖和血脂的代谢关系

目的:探讨妊娠期糖尿病(GDM)患者孕中期时视黄醇结合蛋白4(RBP4)的变化及其与血脂代谢和行葡萄糖耐量试验(OGTT)时血糖代谢的关系.方法:选择2008年5月至2010年5月在浙江大学医学院附属妇产科医院行产前检查、孕周在24～28周诊断为GDM的孕妇35例为研究对象(GDM组),同期选择正常孕妇35例为对照组.检测并比较两组孕妇血清RBP4、空腹血糖、服糖1、2、3小时后血糖、空腹胰岛素、糖化血红蛋白(HbA1c)、甘油三酯(TG)、胆固醇(TC)值和胰岛素抵抗指数(HOMA-IR),并采用Person分析血清RBP4与以上指标的相关性.结果:①两组空腹和服糖后3小时血糖值及HbA1c值比较,差异无统计学意义(P＞0.05);而GDM组服糖后1小时和2小时的血糖值明显高于对照组(P＜0.01).②GDM组RBP4、TC、TG、空腹胰岛素值和HOMA-IR值均明显高于对照组(P＜0.05).③两组血清RBP4与空腹血糖、空腹胰岛素和HbA1c值均无相关性(P＞0.05),而GDM组血清RBP4与服糖后1小时、2小时的血糖水平、TG、TC和HOMA-IR均呈正相关(r=0.523、0.521、0.490、0.620、0.486,P＜0.05).结论:GDM孕妇孕中期血清RBP4水平上升,并与胰岛素抵抗、血糖以及血脂代谢异常有关.