Placental glucose transport in gestational diabetes mellitus

OBJECTIVE: We have previously reported that type 1 diabetes mellitus with hyperglycemia during the first trimester is associated with an up-regulation of placental glucose transport at term. We speculated that glucose concentrations regulate placental glucose transporters only during early pregnancy. To test this hypothesis we studied placental glucose transport in gestational diabetes mellitus, which is associated with hyperglycemia mainly during the second half of pregnancy. STUDY DESIGN: Syncytiotrophoblast microvillous membrane vesicles and basal membrane vesicles were isolated from uneventful pregnancies (control group, n = 32) and pregnancies complicated by gestational diabetes mellitus (n = 18). Glucose uptake and glucose transporter 1 expression were studied by means of radiolabeled tracers and Western blotting, respectively. RESULTS: Gestational diabetes mellitus was not associated with alterations in placental glucose transport. Separate analysis of 6 patients in the gestational diabetes mellitus group with large-for-gestational-age babies did not affect these results. CONCLUSION: These findings are consistent with the hypothesis that the sensitivity of placental glucose transporters to regulation by nutrient availability is limited to early pregnancy.     

Placental Doppler velocimetry in gestational diabetes mellitus

OBJECTIVE: To evaluate if maternal glucose level and growth of the fetus were related to placental vascular impedance in pregnancy complicated by gestational diabetes mellitus. MATERIAL AND METHODS: A retrospective study of 146 gestational diabetic women of which 117 needed insulin therapy. Glycosylated hemoglobin (HbA1c) was evaluated as well as umbilical and uterine artery Doppler velocimetry. The results were related to adverse outcome of pregnancy including newborn birthweight. RESULTS: Abnormal umbilical artery blood flow velocity was seen in 5% of the cases and abnormal uterine artery flow in 16%. Uterine and umbilical artery vascular impedance was significantly lower in macrosomic newborns. There was a poor correlation between HbA1c, vascular impedance and birthweight. There were 11 cases that developed preeclampsia, all having abnormal uterine artery Doppler and two abnormal umbilical artery Doppler. CONCLUSION: Uterine and umbilical artery vascular impedance in pregnancies complicated by gestational diabetes is related to birthweight and placental weight, but not to maternal HbA1c levels. Placental Doppler ultrasound does not seem to be of clinical value for fetal surveillance in these pregnancies unless the pregnancy is complicated by preeclampsia and/or intrauterine fetal growth restriction.     

Placental and fetal pulsatility indices in gestational diabetes mellitus

OBJECTIVE: To assess the usefulness of placental and fetal Doppler velocimetry in the surveillance of gestational diabetes mellitus (GDM). STUDY DESIGN: We studied 89 patients with GDM. All fetuses underwent umbilical, fetal descending thoracic aorta and fetal middle cerebral artery pulsatility index (PI) assessment. Doppler results were not used for management. We correlated PI with route of delivery and with the following perinatal complications: small size for gestational age, cesarean section (CS) for acute fetal distress (AFD), respiratory distress syndrome, hyperbilirubinemia, hypocalcemia, hypoglycemia, macrosomia and stay in a neonatal intensive care unit. RESULTS: Seventy-seven patients (87%) had normal Doppler measurements, while 12 (13%) showed one or more abnormal measurements. The greatest incidence of CS for AFD (42% vs. 16%, P < .001), as well as neonatal hyperbilirubinemia (25% vs. 10%, P < .001) and hypoglycemia (25% vs. 5%, P < .001) was reported among the women with abnormal Doppler measurements. CONCLUSION: Fetal placental hemodynamics are normal in most cases of GDM. In a small percentage of cases we observed abnormal fetal placental PI associated with a higher incidence of perinatal complications. Hence, the finding of abnormal PI must induce the physician to carry out more intensive obstetric care of women with GDM.     

Placental maternal vascular malperfusion and adverse pregnancy outcomes in gestational diabetes mellitus

IntroductionMaternal vascular malperfusion (MVM) lesions represent hypoxic-ischemic damage to the placenta, and they are associated with adverse pregnancy outcomes. Women with gestational diabetes (GDM) are at increased risk for pregnancy complications, so we set out to characterize the prevalence and clinical correlates of MVM lesions in this cohort.MethodsThis was a retrospective cohort study of 1187/1374 (86.4%) women with GDM delivered between 2009 and 2012 who had placental pathology available. Placental lesions of all types were tabulated and grouped into constructs of related entities. MVM lesions specifically included villous infarcts, decidual vasculopathy, increased syncytial knots, perivillous fibrin, and fibrin deposition. We compared maternal characteristics between women with and without MVM lesions, and we also assessed the impact of these lesions on birth weight, preterm birth, and pre-eclampsia using multivariable logistic regression analysis.ResultsMVM lesions were the most common placental lesion type in women with GDM (n = 362, 30.5%). Excess gestational weight gain was independently associated with MVM lesions (aOR 1.42, 95% CI 1.06–1.91, p = 0.02) after adjusting for maternal characteristics. MVM lesions were associated with lower birth weight (−90.3 g, 95% CI -148.0 to −32.7, p = 0.002), as well as a 2-fold increased risk for delivery of a small for gestational age infant (10.8 vs 5.9%, p = 0.01) in overweight and obese women. MVM lesions were also associated with increased risk for preterm birth <34 weeks (adjusted OR 2.36, 95% CI 1.31–4.23, p = 0.004) and hypertensive disorders of pregnancy (HDP; adjusted OR 1.58, 95% CI 1.13–2.22, p = 0.02).DiscussionPlacental maternal vascular malperfusion lesions may be one pathway linking excess gestational weight gain to adverse pregnancy outcomes in women with GDM, and future studies are needed to identify metabolic factors that may explain this association.     

Incidence of gestational hypertension in gestational diabetes mellitus

The purpose of this study has been to establish the incidence of gestational hypertension (GH) in women with gestational diabetes mellitus (GDM) and to examine the frequency of complications in women with co-existent GDM and GH. Furthermore, we wished to evaluate the significance of urine albumin excretion determined by the urine albumin creatinine ratio (ACR). A total of 215 successive pregnancies with risk factors for gestational diabetes, as defined by the Danish National Board of Health screened for gestational diabetes by the WHO criteria, were reviewed. Women who had a normal OGTT during the screening served as controls. Gestational hypertension was defined as a mean arterial pressure (MAP) >105 mmHg (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg). The two groups were comparable with regard to initial body mass index (BMI) and MAP. GH appeared with a higher frequency in women with GDM (28%) than in women with normal OGTT (10%) P=0.003 χ² test. Serious complications (perinatal mortality, malformations, acute caesarean section) also appeared with a higher frequency in women with GH and GDM (10%) than in women with GH but with normal OGTT (2%) P=0.0083 χ² test. We observed a significant increase in ACR in the group with complications (GDM and GH) during gestation regardless of intensive antihypertensive treatment. We also observed that ACR was significantly higher in women with GDM and GH when compared to women with GDM and a normal blood pressure. The BMI was consistently higher in women with GH, regardless of whether they had GDM or not as compared to the normotensive group. GH appears with a higher frequency in women with GDM and the co-existence seems correlated with a higher frequency of complications. The correlation between urine albumin excretion and complications might suggest that regulating GH should strive to normalise ACR in women with GDM. Received: 25 October 2001 / Accepted: 8 December 2001 Correspondence to J. Kvetny     

Inflammatory mediators in gestational diabetes mellitus

The connection between inflammation and insulin resistance has garnered much interest in the past decade. Epidemiologic as well as experimental data have supported the association. The purpose of this article is to review the current evidence linking inflammatory mediators and gestational diabetes mellitus.     

推进循证依据在妊娠期糖尿病诊治实践中的应用

随着健康与疾病的发育起源(Development of Health and Disease,DOHaD)学说研究的不断深入,孕期高血糖对胎儿近远期的影响越来越受到关注.尽管我国对妊娠期糖尿病(gestational diabetes mellitus,GDM)的研究仅有20余年历史,但该领域的相关研究已经取得一定进展,并受到国际同行的关注.     

二甲双胍在妊娠期糖尿病药物治疗中的应用

妊娠期糖尿病(gestational diabetes mellitus,GDM)是孕期常见的并发症,可增加母婴并发症的发生,并可能导致母亲及其子代2型糖尿病和代谢综合征的发生风险增加.通常情况下通过饮食控制和运动治疗,可以将75%～80%GDM孕妇的血糖控制理想,对于血糖控制不理想者,目前胰岛素是首选药物,但胰岛素治疗也存在一些缺点,如需皮下注射、花费高、可能发生低血糖和体重增加过度等问题.     

Waist circumference in predicting gestational diabetes mellitus

Abstract

Peritoneal dialysis (PD) is considered as the most common form of renal replacement therapy for newborns including preterms with acute kidney injury (AKI). Although there are several reports describing successful PD performed for AKI in preterm infants, there is no data describing the use of PD to treat AKI in preterm newborns with congenital diaphragmatic hernia (CDH), which is one of the contraindications for PD.

We present a preterm newborn with CDH, truncus arteriosus and AKI treated with PD and emphasize that PD may be successfully performed with caution even in cases of contraindications when other renal replacement therapies cannot be used.     

自噬在妊娠期糖尿病中的作用

自噬广泛存在于机体细胞中,能够保护细胞,维持正常的细胞功能和组织结构。过度自噬会引起细胞死亡,导致组织出现病理性损伤。胎盘通过自噬维持正常生理功能。在妊娠期糖尿病孕妇的胎盘中,高血糖能够诱导滋养细胞过度自噬,抑制胎盘血管生成,导致组织缺血、缺氧及细胞活性氧水平升高,出现胎盘功能障碍,增加早产、巨大儿等不良妊娠结局的发生风险。     

妊娠合并糖尿病患者胎儿宫内安全监测

妊娠合并糖尿病增加了母儿疾病的发生风险,如妊娠期高血压疾病、羊水过多、巨大胎儿、肩难产、胎儿畸形、胎儿生长受限、胎儿窘迫和胎死宫内、新生儿低血糖、新生儿高胆红素血症以及新生儿远期并发症.对妊娠合并糖尿病患者规范化、专业化及多学科合作的血糖管理,有助于降低母婴并发症发生的风险,合理的宫内监测有助于及早发现胎儿的异常,进而...     

Screening recommendations for gestational diabetes mellitus

As a result of extensive experiences in multiple centers and a review of the current literature, we conclude that a plasma glucose level obtained 1 hour after a 50 gm oral glucose challenge is the "best" gestational diabetes mellitus screening test. This universal screening is performed at least once during pregnancy. The screening threshold should be no higher than 140 mg/dl, or an unacceptable loss in sensitivity occurs. Universal screening for gestational diabetes mellitus is justified by morbidity reduction, cost, and protocol simplicity and ease.     

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。     

肥胖与妊娠期糖尿病

妊娠期糖尿病(gestational diabetes mellitus,GDM)是妊娠期间首次发生或发现的糖代谢异常,是在妊娠期发展的一种对碳水化合物不耐受的状态。近年来肥胖及GDM的发病率逐年增高,成为必须重视的问题。肥胖是GDM发病的独立危险因素,可导致不良妊娠结局。本文从妊娠期肥胖的评价指标及妊娠期肥胖的管理等角度,阐述肥胖与GDM的关系。     

Recurrence of gestational diabetes mellitus.

OBJECTIVE: To assess the influence of several maternal and neonatal variables on the recurrence of gestational diabetes mellitus. METHODS: A retrospective review was conducted on 90 of our patients whose index pregnancy was complicated by gestational diabetes mellitus and whose subsequent pregnancy was also managed at our institution. RESULTS: Forty-seven women (52%) had a recurrence of gestational diabetes mellitus in their subsequent pregnancy. These 47 women had an increased body mass index (BMI) (32.8 +/- 8.2 versus 28.9 +/- 7.2 kg/m2; P < .03) and more large for gestational age (LGA) neonates (38 versus 14%; P < .05) and more of them required insulin during their index pregnancy (38 versus 19%; P < .05) than did those who did not have a recurrence of gestational diabetes mellitus. Women who developed a recurrence of gestational diabetes mellitus also had higher fasting (P < .05), 1-hour, 2-hour, and total glucose tolerance test values (P < or = .01) during their index pregnancy. CONCLUSION: Women with a history of gestational diabetes mellitus who have a BMI greater than 35 kg/m2, whose previous newborn was LGA, and who required insulin during their previous pregnancy are at increased risk for recurrence of gestational diabetes mellitus.