铬硒钒与妊娠期糖尿病相关性研究

目的通过对血清铬、硒、钒3种微量元素含量的测定,探讨3种元素与妊娠期糖尿病发生的关系。方法选择2004年1月至2005年1月在中国福利会国际和平妇幼保健院住院的妊娠期糖尿病孕妇50例,正常孕妇47例,以电感耦合高频等离子体发射光谱法（ICP-AES）测定两组孕妇血清铬、硒、钒含量,分析其与空腹血糖、胆固醇、三酰甘油及新生儿体重的关系。结果妊娠期糖尿病孕妇血清铬、硒含量较正常孕妇明显降低（P〈0.05）;血清钒有降低趋势;血清铬与胆固醇、三酰甘油及新生儿体重呈明显负相关（P〈0.05）,但与空腹血糖不相关。硒、钒与空腹血糖、胆固醇、三酰甘油及新生儿体重均不相关。结论妊娠期糖尿病孕妇可能存在铬、硒缺乏。     

妊娠期糖尿病与非糖尿病孕妇发铬含量比较

目前尚未对妊娠期糖尿病(GDM)、非胰岛素依赖性糖尿病(NIDDM)或胰岛素依赖性糖尿病(IDDM)孕妇发铬含量进行评价。为测定糖尿病孕妇发铬含量(HCC),并与正常孕妇比较,以了解 HCC 与年龄、产次、孕龄的关系,收集健康孕妇发样68份,进行研究。首次发样采集是在平均孕龄19±6周时,第二次采集是在30±6周时。采取 GDM 患者发样42     

妊娠期糖尿病孕妇血清肿瘤坏死因子α水平变化与胰岛素抵抗关系的研究

目的　探讨妊娠期糖尿病孕妇血清肿瘤坏死因子α(TNF α)水平变化与胰岛素抵抗的关系。方法　采用酶联免疫吸附试验测定 4 2例妊娠期糖尿病孕妇 (GDM组 )、4 0例正常妊娠晚期孕妇 (正常妊娠组 )空腹血清TNF α水平 ;同时测定两组孕妇空腹血糖、C肽、胰岛素、糖化血红蛋白(HbA1c)水平。并且根据公式计算两组孕妇的胰岛素敏感指数 (ISI) ,以评价胰岛素抵抗程度。结果(1)GDM组孕妇空腹血清TNF α水平为 (5 2± 1 6 )ng/L ,正常妊娠组孕妇为 (4 5± 0 5 )ng/L ,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇ISI为 - 4 3± 0 4 ,正常妊娠组为 - 3 8± 0 3,两组比较 ,差异有极显著性 (P <0 0 1)。 (2 )GDM组孕妇空腹血糖、胰岛素、C肽水平分别为 (5 5± 0 7)mmol/L、(13 4± 3 8)mU/L、(1 6± 0 4 )nmol/L ,正常妊娠组孕妇空腹血糖、胰岛素、C肽水平分别为(4 9± 0 4 )mmol/L、(9 3± 2 5 )mU/L、(1 2± 0 3)nmol,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇HbA1c为 (5 6± 0 5 ) % ,正常妊娠组孕妇为 (5 3± 0 5 ) % ,两组比较 ,差异有显著性(P <0 0 5 )。 (3)GDM组孕妇空腹血清TNF α水平与ISI呈显著负相关 (r=- 0 70 3,P <0 0 1) ,分别与空腹血糖、C肽、HbA1c呈显著正相关 (r     

瘦素胰岛素与妊娠期高血压疾病发病的关系

目的　探讨瘦素、胰岛素在妊娠期高血压疾病 (妊高征 )发病中的意义及相互关系。方法　 2 0 0 1年 1月至 2 0 0 2年 12月 ,采用放射免疫法对 30例妊娠期高血压疾病患者 ,30例正常孕妇的血清瘦素、胰岛素进行测定 ,并测定孕妇血压及尿蛋白含量 ,同时测定其新生儿脐血清瘦素、胰岛素水平。结果　妊娠期高血压疾病患者血清瘦素与胰岛素水平均明显高于对照组 (P <0 0 1)。妊娠期高血压疾病患者血清瘦素与胰岛素呈正相关(r =0 4 6 )。妊娠期高血压疾病患者血清瘦素水平与尿蛋白含量呈正相关 (P <0 0 5 ) ,与血压无明显相关性 (P>0 0 5 )。结论　孕妇血清瘦素水平可作为反映妊娠期高血压疾病患者胎盘缺氧严重程度即病情严重程度的潜在临床指标。妊娠期高血压疾病患者血清胰岛素与瘦素水平呈正相关 ,两者共同参与妊娠期高血压疾病的发病。     

对孕妇行重复性血糖筛查必要性的研究

目的　探讨对孕妇行重复性血糖筛查的必要性及相关因素。方法　 2 0 0 1年 12月 1日至 2 0 0 2年 12月 31日 ,选取自孕早期开始在我院行产前检查并分娩的单胎、初产孕妇 714例 ,在孕中期行口服 5 0 g葡萄糖负荷试验 (GCT) ,对其中的 6 39例在孕晚期行第 2次 5 0 gGCT ;5 7例第 2次直接进行 75g葡萄糖耐量试验 (OGTT)。妊娠期糖尿病的诊断以国内董志光等的标准为准 ,并与美国糖尿病资料组 (NDDG)标准进行比较。同时对发生妊娠期糖尿病相关因素进行分析。结果　 (1)以5 0 gGCT 1h血糖≥ 7 8mmol/L为异常 :第 1次 5 0 gGCT异常 190例 ,异常率为 2 6 6 % ,正常 5 2 4例 (73 4 % ) ;第 2次 5 0 gGCT异常 2 2 5例 ,异常率为 35 2 %。 5 0gGCT异常组孕妇年龄大于正常组(P <0 0 5 ) ,而两组孕妇在家族史及体重指数 (BMI)间比较 ,差异无显著性 (P >0 0 5 )。第 2次 5 0 gGCT异常组的新生儿出生体重及巨大儿例数均比正常组明显增加 (P <0 0 5 )。 (2 )按董志光的标准 ,第 1次 5 0 gGCT筛查出妊娠期糖尿病 2 8例 ,葡萄糖耐量低减 4 0例 ;第 2次 5 0gGCT又新筛查出妊娠期糖尿病 15例 ,葡萄糖耐量低减 2 7例。按NDDG的标准 ,第 1次 5 0 gGCT筛查出妊娠期糖尿病 14例 ,葡萄糖耐量低减 2 4例 ;第 2次 5 0 g     

孕妇血清瘦素水平测定对妊娠期糖耐量异常的预测价值

目的　探讨孕妇血清瘦素水平测定对妊娠期糖耐量异常有无预测价值。方法　采用葡萄糖负荷试验法对 583例孕妇行妊娠期糖尿病筛查,根据筛查结果分为糖耐量正常组及糖耐量异常组(包括妊娠期糖耐量低减和妊娠期糖尿病)孕妇。同时检测两组孕妇不同孕周的血清瘦素水平。结果　(1)糖耐量正常组 507例孕妇血清瘦素水平由孕 24周的 (7.0±1.8)μg/L逐渐缓慢上升,至孕 34~35周时上升最为明显,形成峰值为(9.4±2.1)μg/L,之后略有下降。(2)糖耐量异常组 76例(妊娠期糖耐量低减 61例、妊娠期糖尿病 15例 )孕妇血清瘦素水平波动在 ( 11.3±3.1 )μg/L至(14.5±4.3)μg/L之间,不同孕周间的血清瘦素水平比较,差异无统计学意义 (P>0.05)。(3)糖耐量异常组孕妇平均血清瘦素水平为(12.5±3.5)μg/L,显著高于糖耐量正常组的 (8.5±2.6 )μg/L,且在任何孕周,糖耐量异常组孕妇血清瘦素水平均比糖耐量正常组显著升高,两组比较,差异有统计学意义(P<0.05)。(4) 15例妊娠期糖尿病孕妇中,有 10例血清瘦素水平超过 14.0μg/L。当瘦素水平≥17.0μg/L时, 64.7%的孕妇有不同程度的糖耐量异常。瘦素水平与妊娠期糖耐量低减和妊娠期糖尿病的患病率呈正相关。结论　血清瘦素水平与妊娠期糖耐量异常有相关性, 血清瘦素水平升高对妊娠期     

50例妊娠合并糖尿病孕妇的妊娠期管理分析

目的 :探讨妊娠合并糖尿病孕妇的妊娠期管理方法。方法 :将 5 0例妊娠合并糖尿病孕妇与 4 8例正常孕妇比较。结果 :5 0例妊娠期糖尿病孕妇中有 38例 ( 76 % )经饮食疗法后血糖控制效果良好 ,另 12例需饮食疗法加胰岛素治疗方能将血糖控制在正常范围内。经临床治疗后 ,5 0例妊娠合并糖尿病的孕妇 ,除早产发病率高于非糖尿病组孕妇外(P <0 0 5 ) ,妊高征、感染、产后出血、羊水过多、羊水过少、胎儿窘迫、巨大儿、胎儿生长受限 (FGR)、新生儿窒息、新生儿高胆红素血症等发病率与非糖尿病组孕妇无区别。结论 :加强妊娠合并糖尿病孕妇的妊娠期管理 ,用饮食疗法或胰岛素治疗控制血糖 ,适时终止妊娠 ,可有效降低母婴并发症的发生     

妊娠高血压综合征及妊娠期糖尿病孕妇血小板功能状态的研究

目的　探讨妊娠高血压综合征 (妊高征 )及妊娠期糖尿病孕妇血小板功能状态和血小板活化情况。方法　选择妊娠晚期中度妊高征孕妇 2 1例 (妊高征组 ) ,妊娠期糖尿病孕妇 2 3例 (妊娠期糖尿病组 ) ,正常妊娠晚期妇女 2 0例 (对照组 )作为研究对象。采用血细胞分析仪和流式细胞术观察3组孕妇血小板计数、血小板平均容积和血小板α 颗粒膜蛋白 (CD6 2P)的表达。结果　 (1)妊高征组孕妇血小板计数为 (181± 5 6 )× 10 9/L ,妊娠期糖尿病组孕妇为 (2 0 6± 6 0 )× 10 9/L ,对照组孕妇为 (2 2 9± 5 6 )× 10 9/L。妊高征组孕妇血小板计数显著低于对照组 ,两组比较 ,差异有统计学意义 (P <0 0 1) ;妊娠期糖尿病组与对照组比较 ,差异无统计学意义 (P >0 0 5 )。 (2 )妊高征组孕妇的血小板平均容积为 (11 2± 2 0 )fl,妊娠期糖尿病组孕妇为 (9 5± 1 6 )fl,对照组孕妇为 (8 7± 1 6 )fl,妊高征组血小板平均容积高于对照组 ,两组比较 ,差异有统计学意义 (P <0 0 0 1)。而妊娠期糖尿病组血小板平均容积与对照组比较 ,差异无统计学意义 (P >0 0 5 )。 (3)妊高征组孕妇阳性血小板百分比CD6 2P(% )为 (42± 13) %、阳性血小板荧光强度 [CD6 2P(I) ]为 10 9± 39,妊娠期糖尿病组孕妇血小板CD6 2P为 (42± 14 ) %     

妊娠并发糖代谢异常孕妇血清载脂蛋白变化

目的 :探讨妊娠糖代谢异常者血清载脂蛋白变化及有效血糖控制对血清载脂蛋白的影响 ,观察糖代谢异常并发妊高征 (PIH)时载脂蛋白的变化。方法 :测定 2 1例妊娠期糖耐量减低 (gestationalimpairedglucosetolerance ,GIGT)、2 6例妊娠期糖尿病 (gestationaldiabetesmellitus ,GDM)及 2 4例正常孕妇血清APOA1,APOB ,LP(a) ,并计算APOB APOA1(B A1) ,观察这些指标与糖代谢异常及并发妊高征之间的关系。结果 :(1)GDM及GIGT孕妇的APOB、LP(a)较正常孕妇有增高趋势 ,但无统计学差异 (P >0 0 5 )。在糖代谢异常孕妇中 ,血糖控制满意者APOB及B A1显著低于控制不满意者 (P <0 0 1) ,饮食 +胰岛素控制者APOB、B A1、LP(a)均明显低于单纯饮食控制者 (P <0 0 5 )。随孕周增长糖代谢异常孕妇APOA1有下降趋势 ,APOB有上升趋势 ,产后APOA1较血糖控制前明显降低 (P <0 0 1) ,B A1较控制前明显升高 (P <0 0 1) ;(2 )并发妊高征者与血压正常者各项载脂蛋白差异无显著性。结论 :妊娠糖耐量异常可伴血清载脂蛋白变化 ,有效控制血糖 ,有调节血脂作用     

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     

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 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.     

Serum levels of 1,5-anhydro-D-glucitol during the normal and diabetic pregnancy and puerperium

In 25 normally non-pregnant women, 543 normally pregnant women and 75 pregnant women with diabetes mellitus or gestational diabetes mellitus, the relationship between the serum concentration of 1,5-anhydro-D-glucitol (1-deoxy-glucose) and carbohydrate metabolism was studied. The concentration of 1,5-anhydro-D-glucitol was estimated by means of gas-liquid chromatography. In normally non-pregnant women the concentration was found to be 18.6 +/- 5.2 mg/l (mean +/- SD). During the normal pregnancy, from 9 weeks of gestation, a steadily decreasing concentration was observed as the pregnancy progressed and the lowest value (10.2 +/- 4.6 mg/l) was found in the third trimester. After 5 days of puerperium the concentrations were found to be 10.8 +/- 3.7 mg/l. On the 30th day postpartum, the level was within the range for non-pregnant subjects. The values in pregnant women with diabetes mellitus and gestational diabetes mellitus were mostly below 10 mg/l throughout the entire pregnant period. The 1,5-anhydro-D-glucitol concentration was not affected by meals or oral glucose loading. A concentration below 10 mg/l was found in 36% of the normally pregnant women, where oral glucose tolerance tests and measurement of glycohemoglobin were shown to be within the normal range. The present study suggests that a change of 1,5-anhydro-D-glucitol level during pregnancy may reflect a mild alteration of carbohydrate metabolism that goes undetected by all the other diabetic indicators.     

Serum alpha-1-antitrypsin concentration during normal and diabetic pregnancy

OBJECTIVES: The aim of this study was a comparison of serum alpha-1-antitrypsin (AAT) concentration in the course of normal and diabetic pregnancy. METHODS: Serum AAT concentration was determined on NOR-Partigen plates (Behring Diagnostics GmbH, Marburg). The studied material included healthy women without pregnancy (n=14), healthy pregnant women in the first trimester (n=12), second trimester (n=15), third trimester (n=15), and 16 pregnant women with type-1 diabetes mellitus studied prospectively in successive stages of pregnancy. RESULTS: In the first trimester of normal pregnancy, a significant increase of serum AAT concentration was observed in comparison with healthy women without pregnancy (P<0.01). In all stages of pregnancy with type-1 diabetes mellitus, a higher increase of AAT concentration was found as compared with healthy pregnant women (P<0.0001), especially in third trimester. There was no correlation shown between concentration of AAT and fructosamine in the serum of healthy and diabetic pregnant women (P>0.05). CONCLUSIONS: During normal and diabetic pregnancy, an increase of serum AAT concentration occurred with the regression lines exhibiting a different slopes. The highest AAT concentration was observed in third trimester of diabetic pregnancy. Increase in concentration of AAT in the serum of pregnant women with diabetes does not depend on the value of glycaemic control.     

Circulating levels of MCP-1 are increased in women with gestational diabetes

OBJECTIVE: We investigated whether gestational diabetes mellitus is associated with monocyte-chemoattractant-protein-1 (MCP-1) and soluble CD40 ligand (sCD40L), the functional relevant proteins in the inflammatory process. METHODS: In all 32 women with gestational diabetes mellitus, 18 women without gestational diabetes mellitus and 40 nonpregnant women were included. MCP-1 and sCD40L were measured at the time of the oral glucose tolerance test (second trimester), in the third trimester and postpartum. RESULTS: MCP-1 was higher in pregnant women (women with gestational diabetes mellitus and without) than in nonpregnant women (p < 0.001) in the third trimester, and also in the second trimester and postpartum. MCP-1 was elevated in patients with gestational diabetes mellitus in the third trimester compared to healthy pregnant women (p = 0.007). In gestational diabetes mellitus, MCP-1 increased from the second to the third trimester (p = 0.003). We found no association of sCD40L and gestational diabetes mellitus. CONCLUSION: The elevation of MCP-1 in the third trimester in gestational diabetes mellitus suggests an association between inflammation and GDM. Copyright (c) 2008 John Wiley & Sons, Ltd.     

Perinatal complications in women with gestational diabetes mellitus

BACKGROUND: The aim of the study was to examine the outcome of the pregnancy and neonatal period in 1) women with gestational diabetes mellitus and non-diabetic pregnant women, and 2) in women with early and late diagnosis of gestational diabetes mellitus. METHODS: Included were 327 women with gestational diabetes mellitus and 295 non-diabetic women, who were screened with a 75 g oral glucose tolerance test because of risk factors for gestational diabetes. Women with gestational diabetes mellitus were treated with low-caloric diet and insulin when appropriate, while women in the control group received routine antenatal care. RESULTS: Gestational age at delivery was significantly lower in the group with gestational diabetes mellitus, both when considering all deliveries (39.1+/-1.7 weeks versus 39.8+/-2.0 weeks, p<0.05) and only those with spontaneous onset of labor (38.8+/-2.0 weeks versus 40.0+/-1.6 weeks, p<0.05). The frequency of macrosomia was increased, although not statistically significant (8% vs. 2%, p=0.07), and the rate of admission to the neonatal ward was significantly increased (18% vs. 9%, p<0.05) in the group with gestational diabetes. Women with early diagnosis of gestational diabetes mellitus had a significantly increased need for insulin treatment during pregnancy (36% vs. 9% p<0.05) and a significantly higher occurrence of diabetes mellitus at follow-up from two months until three years postpartum. CONCLUSIONS: This study of women with gestational diabetes mellitus and non-diabetic pregnant women showed that gestational diabetes mellitus was associated with a significantly lower gestational age at delivery and an increased rate of admission to the neonatal ward. Women diagnosed with GDM before 20 weeks of gestation had an increased need for insulin treatment during pregnancy and a high risk of subsequent overt DM, compared with women diagnosed with GDM later in pregnancy.     

妊娠期糖尿病孕妇外周血、脐血及胎盘中的chemerin表达

目的:探讨正常孕妇和妊娠期糖尿病(GDM)患者外周血、脐血以及胎盘中趋化素(chemerin)的表达差异及其临床意义。方法:选取2010年10月至2011年10月上海交通大学医学院附属第一人民医院20例正常孕妇及20例GDM孕妇。应用ELISA法检测外周血及脐血中chemerin水平,Western blot法测定其在胎盘中的表达,并分析其与临床相关特征的关系。结果:chemerin在正常孕妇和GDM孕妇外周血中的表达无显著差异,而在脐血和胎盘中的表达差异显著(P<0.05),与空腹血糖、餐后2h血糖、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、C反应蛋白(CRP)、胰岛素用量呈正相关(P<0.05)。结论:chemerin是影响GDM的一个独立因素,在GDM孕妇的脐血和胎盘中表达较高,并随着胰岛素用量的增加而表达增多,其可能通过糖代谢途径及炎症反应在GDM的发生发展中起着重要作用。     

Moderate caloric restriction in obese women with gestational diabetes

The effect of moderate caloric restriction on weight gain during pregnancy and fetal outcome in 22 obese women with gestational diabetes mellitus was assessed. A new tool was used to assess dietary compliance in an outpatient setting. The authors observed that obese gestational diabetics gained less weight during pregnancy than ten normal pregnant women or 31 lean women with gestational diabetes. Paradoxically, the placentas of obese gestational diabetics were larger (P not significant), and infants of these mothers were significantly heavier than those of normal women or lean women with gestational diabetes (P less than .03). The authors suggest that the currently recommended daily caloric allowances for normal women may be excessive for obese gestational diabetics who are not prone to ketosis but have a complex metabolic problem characterized by hyperinsulinemia and insulin resistance.     

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.     

Maternal serum adiponectin concentration in gestational diabetes

Aim. Adiponectin is an insulin sensitizing protein. Because gestational diabetes mellitus is associated with insulin resistance, we compared serum adiponectin levels in women with gestational diabetes mellitus and healthy pregnant women.

Study design. Twenty-nine women with gestational diabetes and 26 women with impaired glucose tolerance were compared with 27 normal pregnant women in control group. Controls were matched for gestational age, age and body mass index (BMI) before pregnancy with two other groups. At 28 weeks of gestation serum concentration of adiponectin, insulin and insulin resistance (calculated by the homeostasis model assessment) were measured in three groups.

Main findings. The serum adiponectin level in gestational diabetes (6379.31 ± 1934.90 ng/ml), was significantly lower than the impaired glucose tolerance test (7384.61 ± 1626.70 ng/ml) and control groups (7962.96 ± 2667.20 ng/ml),(p = 0.02). Serum level of insulin and HOMA index in gestational diabetes were higher than the normal group (p > 0.05). In patients with gestational diabetes, there was a significant correlation between serum adiponectin level and BMI before pregnancy (r = ?0.531, p = 0.013). Also, the correlation between maternal serum adiponectin levels and neonatal birth weight was not significant (r = ?0.07, p value = 0.73).

Conclusion. Our data show that serum adiponectin level was significantly lower in gestational diabetes in comparison with healthy pregnant women.