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.     

Interconception Care for Women With Prior Gestational Diabetes Mellitus

The diagnosis of gestational diabetes mellitus (GDM) signals greater pregnancy risk but also increased lifelong risk of developing diabetes and cardiovascular disease. In women with GDM, insulin resistance exceeds that observed in normal pregnancy and to varying degrees may persist or worsen after birth. Therefore, during postpartum and interconception periods, women with a history of GDM must be monitored for manifestations of increasing insulin resistance, hyperglycemia, dyslipidemia, hypertension, and increased adiposity. Care of women with prior GDM in the postpartum and interconception periods affords clinicians a unique opportunity for targeted screening and health promotion. The objective of this review was to synthesize evidence related to interconception care for women following a pregnancy complicated by GDM and to suggest principles of care: 1) case finding and multiple patient/clinician reminders for women with prior GDM are necessary so that screening occurs in the postpartum through interconception periods; 2) monitoring of metabolic (glucose) and cardiovascular risk (lipids, blood pressure, adiposity) should occur at regular intervals and more often in women with additional risk factors such as insulin use during pregnancy, early diagnosis of GDM, obesity, prediabetes, and dyslipidemia; 3) breastfeeding and use of long‐term contraception should be encouraged; and 4) lifestyle modifications that are effective in preventing and delaying disease should be encouraged.     

妊娠期糖尿病产后发展为2型糖尿病的相关因素研究进展

妊娠期糖尿病（GDM）是产科常见并发症,会增加妊娠风险。由于生活方式和饮食结构的改变,GDM发病率逐年上升。大部分GDM患者产后短期内血糖会恢复正常,但生活中远期发生2型糖尿病（T2DM）的风险并未降低,GDM妇女已经成为日后发生糖尿病、代谢综合征的潜在危险人群。GDM发展为T2DM的相关危险因素很多,如高龄、肥胖和糖尿病家族史,另外空腹血糖水平、孕期胰岛素治疗、早发型GDM也逐渐被重视。通过认识GDM发展为T2DM的相关危险因素和包括临床特征、生化指标、基因等多种早期预测标志物,预测T2DM发生的风险,以利于提高公众风险意识及GDM妇女产后随访,可以提前进行生活方式干预或药物治疗,预防和延缓T2DM的发生,改善健康结局。     

Leukocyte Esterase Activity as a Predictor of Amniotic Fluid Cultures in Preterm Labor

Leukocyte esterase activity has been utilized as a rapid screen for urinary tract infection. The purpose of this study was to evaluate leukocyte esterase activity as a rapid predictor of amniotic fluid culture results in patients with preterm labor. Amniocentesis was performed on 121 patients ≤34 weeks estimated gestation age with preterm labor and no clinical evidence of infection. Gram stain as well as aerobic, anaerobic, and Mycoplasma cultures were performed on the amniotic fluid. Leukocyte esterase activity was determined immediately following amniocentesis with the use of a commercially available test strip. Amniotic fluid cultures were positive in 19 subjects (16%). Leukocyte esterase was significantly more sensitive than Gram stain in detecting positive amniotic fluid culture results (79% vs. 42%, respectively; P < 0.02). Tocolysis was either unsuccessful or discontinued due to a positive Gram stain significantly more often when leukocyte esterase activity was present. Leukocyte esterase activity is a rapid and simple bedside test that is useful in assessing for subclinical intraamniotic infection in preterm labor.     

Low Amniotic Fluid Index at Term as a Predictor of Adverse Perinatal Outcome

Aim

To determine whether an antepartum low amniotic fluid index (AFI) is a predictor of adverse perinatal outcome in normal pregnancy and to determine a threshold level of AFI that could predict an adverse outcome.

Methods

This was a prospective study conducted among 180 pregnant women at 37–40 weeks of gestation with no known obstetric or medical complications with an AFI ≤ 5th percentile. The results were statistically analyzed and compared.

Results

In the control group, the mean AFI was 10.14 cm and in the study group, it was 4.14 cm. 65 % patients in the study group and 24 % in the control group had a non-reactive non-stress Test. In the control group, 53 % of patients were induced for reasons other than oligohydramnios, while in the study group, 86 % of patients were induced for oligohydramnios. Among the control group, 33 % had a LSCS, while 67 % delivered vaginally; and in the study group, 34 % delivered vaginally and 66 % had a LSCS. In our study, a 5-min APGAR < 7 was seen in 34 % in the study group and 11 % in the control group. 33 % neonates in the control group and 64 % in the study group had birth weights <2.5 kg.

Conclusions

In the presence of oligohydramnios, perinatal morbidity and mortality are high. Determination of AFI is a valuable screening test for predicting fetal distress.     

蛋白酪氨酸磷酸酶1B与GDM胰岛素信号转导

蛋白酪氨酸磷酸酶1B与胰岛素抵抗密切相关,主要通过胰岛素信号转导通路导致信号转导障碍。胰岛素抵抗（IR）是妊娠期糖尿病（GDM）发病的主要原因,胰岛素受体信号传导障碍可能是GDM发生的重要机制。探讨蛋白酪氨酸磷酸酶1B与GDM胰岛素信号转导的关系,进一步研究GDM胰岛素抵抗发生的机制,以早期预防和干预GDM,减少母儿并发症。     

蛋白酪氨酸磷酸酶1B与GDM胰岛素信号转导

蛋白酪氨酸磷酸酶1B与胰岛素抵抗密切相关,主要通过胰岛素信号转导通路导致信号转导障碍。胰岛素抵抗（IR）是妊娠期糖尿病（GDM）发病的主要原因,胰岛素受体信号传导障碍可能是GDM发生的重要机制。探讨蛋白酪氨酸磷酸酶1B与GDM胰岛素信号转导的关系,进一步研究GDM胰岛素抵抗发生的机制,以早期预防和干预GDM,减少母儿并发症。     

妊娠期糖尿病患者羊水量变化与其胎膜和胎盘组织中AQP8、AQP9表达关系的研究

目的:研究患有妊娠期糖尿病(GDM)产妇的胎膜和胎盘中水通道蛋白8(AQP8)、水通道蛋白9(AQP9)的表达变化,探讨其在GDM患者异常羊水量中的调节作用.方法:选择GDM患者羊水过多、羊水量正常及正常足月产妇各20例为研究对象,剖宫产术后取胎膜(羊膜和绒毛膜)和胎盘组织;采用逆转录聚合酶链反应(RT-PCR)技术半定量检测AQP8、AQP9mRNA在各组胎膜和胎盘组织中的表达水平;采用Western免疫印迹技术半定量检测AQP8、AQP9蛋白在各组胎膜和胎盘中的表达水平.结果:①在羊膜和胎盘组织中,GDM羊水量过多组AQP8、AQP9mRNA及其蛋白表达水平均高于GDM羊水量正常组和正常对照组,差异有统计学意义(P<0.05);GDM羊水量正常组AQP8、AQP9mRNA及其蛋白表达水平与正常对照组比较,差异均无统计学意义(P>0.05).②在绒毛膜组织中,GDM羊水量过多组AQP8、AQP9mRNA及其蛋白表达水平与GDM羊水量正常组和正常对照组比较,差异均无统计学意义(P>0.05).结论:羊膜和胎盘组织中AQP8、AQP9的表达可能在妊娠期糖尿病孕妇羊水量调节中发挥重要作用.     

妊娠期糖尿病基因多态性研究进展

由于基冈分型及整组遗传基因鉴定技术的快速发展,已发现许多与2型糖尿病(type2 diabetes mellitus,T2DM)相关的易感基因及其多态性.与之相比,有关妊娠期糖尿病(gestational diabetes mellitus,GDM)的遗传基础研究较少.GDM发病机制与T2DM相似,其发病率近年逐年上升引起广泛关注.普遍认为,GDM是遗传和环境因素共同作用引起的临床综合征.对GDM的遗传基因及其多态性进行初步探讨,发现了一些CDM的易感基因.     

妊娠期糖尿病基因多态性研究进展

由于基因分型及整组遗传基因鉴定技术的快速发展．已发现许多与2型糖尿病（type2 diabetes mellitus,T2DM）相关的易感基因及其多态性。与之相比,有关妊娠期糖尿病（gestational diabetes mellitus,GDM）的遗传基础研究较少。GDM发病机制与T2DM相似,其发病率近年逐年上升引起广泛关注。普遍认为,GDM是遗传和环境因素共同作用引起的临床综合征。对GDM的遗传基因及其多态性进行初步探讨,发现了一些GDM的易感基因。     

Acute Caffeine Ingestion and Glucose Tolerance in Women With or Without Gestational Diabetes Mellitus

ObjectiveRecent work showing that caffeine impairs glucose tolerance may be of particular concern in pregnancy because of a possible negative effect on fetal outcome. The current study sought to assess the effect of acute caffeine ingestion on glucose tolerance in women with or without gestational diabetes mellitus (GDM).MethodsNineteen women whose routine GDM test was negative (control) and eight women with an initial positive GDM screen completed two trials one week apart in a double-blind randomized crossover study. Following an overnight fast, subjects ingested caffeine (3 mg/kg pre-pregnancy body weight) or an identical-appearing placebo (gelatin) capsule and one hour later began a 75 g 2-hour oral glucose tolerance test.ResultsIn the control group, caffeine did not significantly affect blood glucose, insulin, or C-peptide. In the GDM group, glucose area under the curve (AUC) was greater (P < 0.01), C-peptide AUC was greater (P < 0.05), and insulin sensitivity index was lower (18%, P < 0.05) after caffeine than after placebo.ConclusionCaffeine impaired insulin sensitivity in women with GDM. Additional research regarding more specific dietary caffeine recommendations for women with GDM is warranted.     

Barriers to Exclusive Breastfeeding Among Women With Gestational Diabetes Mellitus in the United States

Objective

To identify differences in breastfeeding-related knowledge, attitudes, beliefs, and experiences between women with gestational diabetes mellitus (GDM) and women without GDM.

妊娠期糖尿病患者内脏脂肪素表达的变化及其意义

目的:探讨妊娠期糖尿病(GDM)患者内脏脂肪素(visfatin)表达情况及其在GDM发生、发展中的作用.方法:选择106例于2010年10月至2011年3月在天津医科大学第二医院产科行剖宫产术的妇女,收集研究对象临床资料及组织学标本,采用ELISA方法检测血清visfatin水平;RT-PCR方法检测皮下脂肪、大网膜及胎膜组织中visfatin mRNA表达水平.结果:①GDM组血清visfatin水平与妊娠期糖耐量受损(GIGT)组以及正常糖耐量孕妇(NGT)组相比明显升高(P＜0.05),GIGT组血清visfatin水平高于NGT组,差异有统计学意义(P＜0.05).GDM 组皮下脂肪、大网膜及胎膜组织中visfatin mRNA表达水平均高于GIGT组和NGT组,差异有统计学意义(P＜0.01),而GIGT组和NGT组的组织visfatin mRNA表达水平差异无统计学意义(P＞0.05).②以总体为研究对象,血清visfatin水平与皮下脂肪、大网膜及胎膜组织中visfatin mRNA表达水平呈正相关(r=0.24,P=0.045;r =0.53,P=0.001;r=0.15,P=0.049).③血清visfatin水平与HOMA-IR、FINS、TC、TG、孕期体重增加呈正相关(P＜0.05).结论:GDM患者皮下脂肪、大网膜及胎膜组织的visfatin mRNA表达上调,血清visfatin水平升高,与胰岛素抵抗程度有相关性.visfatin可能参与了GDM的发生、发展过程,其水平的检测为研究GDM提供了一个新的视角.     

Fasting Capillary Glucose as a Screening Test for Ruling Out Gestational Diabetes Mellitus

ObjectiveA common approach to screening for gestational diabetes mellitus (GDM) is the testing of all pregnant women with a one-hour, 50 g glucose challenge test (GCT), followed by a diagnostic oral glucose tolerance test (OGTT) when the GCT is positive (≥ 7. 8 mmol/L). As only a small subset of those with a positive GCT will have GDM, many more women undergo the OGTT than may be necessary. In this context, we hypothesized that measurement of fasting capillary glucose (FCG) could provide a strategy for reducing the number of unnecessary OGTTs. Thus, we sought to identify a threshold level of FCG below which GDM could be ruled out following a positive GCT, without need for the OGTT.MethodsFollowing a positive GCT, 888 women underwent measurement of FCG prior to their OGTT. We evaluated the test characteristics of FCG for identifying the 209 women diagnosed with GDM on the OGTT.ResultsFasting capillary glucose was positively associated with each glucose measurement on the OGTT (all P < 0.001) and inversely related to insulin sensitivity and pancreatic beta-cell function (both P < 0. 001). As FCG increased, the prevalence of GDM progressively rose (P < 0. 001). However, the area under the curve of the receiver-operating characteristic curve for FCG in predicting GDM was modest (0.67). Although using an FCG threshold of 4.8 mmol/L could reduce the number of OGTTs by 28.4%, this approach would miss 18.2% of cases of GDM.ConclusionFasting capillary glucose is associated with glycemia, insulin sensitivity, and pancreatic beta-cell function. However, a single FCG measurement is insufficient for reliably ruling out GDM after an abnormal GCT.     

妊娠期糖尿病免疫遗传学研究进展

妊娠期糖尿病（GDM）是妇女在妊娠期发生或首次发现的不同程度的糖耐量异常,其是多个基因异常表达与环境因素共同作用引起的临床综合征,其发病率呈逐年上升趋势.因此,探索GDM发病机制及其病理生理对GDM患者进行预测和干预显得尤为重要.与妊娠相关的胰岛素抵抗程度超过了胰岛β细胞功能代偿的极限是目前较为公认的GDM发病原因,但其具体的发病机制尚不完全清楚.近年的研究发现,免疫遗传因素在GDM的发生发展中有重要作用.从免疫遗传角度深入探讨GDM患者T细胞、人类白细胞抗原（HLA）复合体等的变化可为进一步研究GDM发病机制提供新思路.