妊娠期糖尿病孕产妇138例妊娠结局分析

目的探究妊娠期糖尿病(GDM)患者的临床表现及妊娠结局,从而对GDM患者可能出现的情况进行预防。方法选取自2013-01~2014-01入院的138例患GDM孕妇进行各项指标的调查,对于患者妊娠过程中出现的合并症以及分娩后新生儿的情况进行统计和评价,同时对于138例非糖尿病的孕妇进行同样的调查统计,将结果进行对比,分析GDM对妊娠结局及围产儿的影响。结果通过对比发现在妊娠过程中GDM患者的羊水指数、孕期母体体重以及新生儿分娩体重均高于正常孕妇,差异具有统计学意义(P0.05)。通过对两组的分娩方式、羊水指数以及胎龄等指标进行对比发现,GDM患者剖宫产的比例、羊水量出现异常情况都要高于正常组,早产例数与正常组也具有明显的差异性(P0.05)。对比两组的妊娠结局发现,GDM患者合并妊娠期高血压、新生儿并发症及产后出血的发生率要远高出正常组。结论 GDM患者与正常组孕妇相比,其各项指标与妊娠结局有很大的不同,不仅影响孕产妇的身体健康,同时还影响围产儿结局,应该进行提早预防,根据不同的指标进行提前临床干预,减少母体并发症及改善围产儿结局。     

Serum homocysteine levels are increased in women with gestational diabetes mellitus

Serum homocysteine (sHcy) has been found to be elevated in patients with type 2 diabetes mellitus, as well as in other clinical conditions associated with insulin resistance and/or vascular diseases. The aims of this study were to measure the relationship between sHcy with biohumoral markers of insulin resistance in pregnant women affected with gestational diabetes mellitus (GDM). We studied 2 groups of pregnant women categorized, after a 100-g, 3-hour oral glucose tolerance test (OGTT) as nondiabetic (n = 78) or affected with GDM (n = 15), by measuring sHcy, serum folate, albumin, vitamin B(12), uric acid, and lipids. In both groups, peripheral insulin sensitivity was measured by using the OGTT-derived index of Matsuda and DeFronzo (ISI(OGTT)). Serum homocysteine was significantly higher in the group with GDM compared with nondiabetic women (5.88 +/- 2.26 micromol/L v 4.45 +/- 1.52 micromol/L; P =.003); was inversely related to serum folate (r = -.48; P =.0001), and was significantly related to serum albumin (r =.27; P =.009), 2-hour plasma glucose (r =.25; P =.01), as well as to serum uric acid (r =.23; P =.03). No relationship was observed between sHcy and serum vitamin B(12), serum triglycerides, total, or high-density lipoprotein (HDL) cholesterol, mean blood pressure and ISI(OGTT). Vitamin B(12) was correlated with ISI(OGTT) (r =.36; P =.0005) and inversely with mean blood pressure (r = -.24; P =.02). GDM remained significantly associated with higher sHcy concentrations also after adjusting for age, serum folate, albumin, uric acid, ISI(OGTT), and vitamin B(12) (P =.006). In conclusion, we found that sHcy is significantly increased in women with GDM, independently of other confounding variables, is significantly related to 2-hour OGTT plasma glucose, and seems unrelated to insulin resistance in these subjects.     

Chemerin expression in Chinese pregnant women with and without gestational diabetes mellitus

ObjectivesThe aim of this study was to determine the effect of obesity, gestational diabetes mellitus (GDM) on circulating chemerin concentrations and chemerin gene expression of adipotissue in pregnancy women.Material and methodsTotally 42 normal glucose tolerant (NGT) women and 48 women with GDM were included in this study. Their clinical features and biochemical parameters were analyzed. The NGT and GDM women were subgrouped by prepregnancy BMI as normal-weight group, overweight group, and obese group, respectively. Serum chemerin and tumor necrosis factor α (TNF-α) of these individuals were determined by ELISA methods, and subcutaneous adipose tissues’ mRNA expressions of chemerin and CMKLR1 (encoding the receptor of chemerin) were analyzed by real-time PCR.ResultsSerum chemerin in obese-NGT group and normal-weight-GDM group was significantly higher than that of normal-weight-NGT group. Chemerin and CMKLR1 mRNA expression of subcutaneous adipose tissue was lower in the obese-NGT group than normal-weight-NGT group. There was no significant difference of CMKLR1 mRNA expression between normal-weight-NGT and normal-weight-GDM group. Serum chemerin significantly and positively correlated with triglycerides (TG) and homeostasis model assessment of insulin resistance (HOMA-IR) assessed both by uni- and multivariate.ConclusionsGestational obesity, GDM may contribute to the elevating serum chemerin. Serum chemerin in pregnancy was associated with insulin resistance and triglycerides. Chemerin gene may play a role both in obese and GDM patients. CMKLR1 might exert its action only in obese individuals, not in GDM patients before delivery.     

妊娠糖尿病孕妇骨代谢状况的研究

目的探讨妊娠糖尿病（GDM）孕妇与正常孕妇骨代谢特点的异同。方法比较67例妊娠糖尿病患者（GDM组）与13例正常糖耐量孕妇（NGT组）血钙、磷、ALP、250HD、CTx、24h尿钙、跟骨超声（SOS）等骨代谢指标的异同。然后将GDM组患者分为A、B两组,分别给予低、高两种不同剂量钙和维生素D干预至分娩前,比较两组治疗前后上述指标的差异。结果GDM组血钙、磷为（2．3±0．1）mmol／L、（1．3±0．2）mmol／L,NGT组血钙、磷分别为（2．2±0．1）mmol／L,（1．1±0．1）mmol／L（P〈0．05）;GDM组和NGT组24h尿钙均升高;GDMB组24h尿钙治疗前为（11．0±6．9）mmol／L,治疗后为（8．2±4．3）mmol／L,明显下降（P〈0．05）。结论GDM孕妇骨代谢特点和NGT孕妇基本相同,24h尿钙均显著增加。GDM可能导致血钙、磷轻度增加。补充足量的钙剂和维生素D可使尿钙丢失减少。     

GAD65 autoantibodies in women with gestational or insulin dependent diabetes mellitus diagnosed during pregnancy

Summary We have studied the presence of GAD65 autoantibodies in women with insulin-dependent diabetes mellitus (IDDM) (n = 28) or gestational diabetes (GDM) (n = 139) diagnosed during pregnancy and investigated the temporal relationship between these autoantibodies and the subsequent recurrence or development of IDDM. Among the GDM patients, 4.3 % (6 of 139) developed true IDDM during a median follow-up period of 6.3 years (range 4.0–11.0). Of these, 2.2 % (3 of 139) were positive for GAD65 autoantibodies at diagnosis of GDM compared to 0 % (0 of 27) of healthy pregnant women. All 3 GAD65 autoantibody positive GDM patients subsequently developed IDDM after a median of 14 months (range 4–34). GAD65 autoantibodies were present in 50 % (14 of 28) of sera from women with IDDM diagnosed during pregnancy. The non-insulin-requiring remission period was significantly shorter in GAD65 autoantibody positive patients (median 0.5 years [range 0–6.0 years]) than in GAD65 antibody negative patients (median 2.6 years; range 0–9.7 years; p < 0.05). The results suggest that screening for GAD65 autoantibodies in women with GDM or IDDM diagnosed during pregnancy may be useful for predicting the clinical course of the disease. [Diabetologia (1996) 39: 1329–1333] Received: 31 January 1996 and in revised form: 8 May 1996     

Proinsulin in pregnant women with normal glucose tolerance or mild gestational diabetes mellitus.

Pregnancy is characterized by peripheral insulin resistance, which is physiologically compensated by an increase in insulin secretion. Type 2 diabetes and impaired glucose tolerance (IGT) have been associated with an inappropriate increase in insulin precursors, namely proinsulin. The aim of this study was to determine levels of proinsulin (PI), specific insulin (SI) and the proinsulin-to-specific insulin (PI/SI) ratio in consecutive pregnant women (n = 209) with normal glucose tolerance (NGT), as assessed by a 2h oral glucose tolerance test, and with mild gestational diabetes (GDM), in comparison to 32 healthy, non-pregnant women. Furthermore, we related these variables to surrogate markers of insulin resistance and insulin secretion. We found no significant differences in the levels of PI and the PI/ SI ratio between pregnant and non-pregnant women (PI: 5.0 +/- 3.6 vs. 4.8 +/- 3.5 pmol/L, p = NS), and between pregnant women with mild GDM and NGT (PI: 5.4 +/- 2.4 vs. 4.9 +/- 3.9 pmol/L, p = NS). SI was elevated in women with mild GDM (112.2 +/- 47.3 vs. 94.8 +/- 43.0 pmol/L in NGT, p=0.02). PI was related to fasting glucose (r = 0.17, p < 0.02), but not post-load glucose levels, and to fasting insulin [specific insulin: r = 0.67, p = 0.0001; total immunoreactive insulin (IRI): r = 0.69, p = 0.0001], as well as post-load insulin levels (IRI at 120 min: r = 0.18, p < 0.03). The PI/SI ratio showed no association with fasting or post-load glucose or insulin levels. Pregnant women presented with a metabolic pattern suggestive of enhanced insulin resistance, namely increased fasting and post-load insulin levels. In women with mild GDM, fasting and post-load hyperglycemia, as well as an additional increase in insulin resistance was found. Group differences weakened when accounting for differences in body weight. The data of the present study suggest that in normal pregnancy as well as mild GDM metabolic alterations including enhanced insulin resistance and hyperglycemia do not result in an increase in circulating levels of proinsulin, both in absolute terms and relative to levels of specific insulin, as indicated by the proinsulin-to-specific insulin ratio.     

Effect of intensive counselling on physical activity in pregnant women at high risk for gestational diabetes mellitus. A clinical study in primary care

ObjectiveThe level of physical activity (PA) of pregnant women in Finland is unknown. Even more limited is our knowledge of PA of women at high risk for gestational diabetes mellitus (GDM).MethodsThe women (n = 54) were randomly assigned to a lifestyle intervention group (n = 27) including exercise advice by a physiotherapist six times during pregnancy or to a control group (n = 27) without additional exercise advice. Outcomes of the present study were required sample size, timing of counselling and change of PA. PA was retrospectively reported during 12 months before pregnancy and recorded one week monthly during pregnancy.ResultsIndividualized counselling by a physiotherapist resulted in small changes of recreational PA (2.7 MET hours/week, p = 0.056) up to gestational week 25 compared with the similar decreasing tendency of PA in the control group. The women decreased recreational PA after week 30. Sample size of 550 women at high risk for GDM per group would be needed for a PA study.ConclusionsThe optimal time window for increasing PA must be earlier than in the last trimester of pregnancy. Sample size for a study to increase PA by 2.7 MET hours/week on pregnant women at high risk of GDM should be about 550 per group.     

Maternal circulating adipokine profile and insulin resistance in women at high risk of developing gestational diabetes mellitus

BackgroundCytokines produced by adipose and placental tissues (adipokines) have been implicated in the development of gestational diabetes mellitus (GDM). There is, however, limited research regarding the relationship between advancing pregnancy, maternal adipokine profile, insulin resistance and the development of GDM. Furthermore, no studies have investigated these parameters in women with a history of GDM who are at the highest risk of recurrence. This study examined the circulating concentrations of a number of adipokines associated with insulin resistance at two points in pregnancy, and determined whether they were altered in women who developed GDM.MethodsNon-diabetic women with a history of GDM in a previous pregnancy (n = 123) had blood drawn at 14 and 28 weeks of pregnancy for GDM diagnosis, together with assessment of a range of adipokine concentrations by multiplex assay (fatty acid-binding protein 4 [FABP4], leptin, chemerin, adiponectin and resistin).ResultsWith advancing pregnancy, maternal adiponectin concentrations decreased, while leptin and resistin levels increased (p < 0.05). In women who developed GDM at 28 weeks of pregnancy (42%), fasting and postprandial glucose levels were already significantly elevated by 14 weeks (p < 0.05), while adiponectin concentrations were lower (p < 0.05). Adiponectin remained lower at the time of GDM diagnosis (p < 0.05), while the other adipokines were similar between groups at each timepoint.ConclusionMaternal glucose and adipokine profile is altered early in pregnancy in women with a history of GDM who subsequently develop recurrent disease.     

Serum uric acid in early pregnancy and risk of gestational diabetes mellitus: A cohort study of 85,609 pregnant women

AimsHigher serum uric acid (UA) has been associated with increased risk of Type 2 diabetes mellitus. This cohort study examined whether there are any associations between serum UA in early pregnancy and the subsequent risk of gestational diabetes mellitus (GDM).MethodsThis cohort study was conducted in Shanghai, China, and included 85,609 pregnant women. Generalised additive models were used to estimate the associations of serum UA with risk of GDM.ResultsThe prevalence of GDM was 14.0% (11,960/85,609). Non-linear associations between serum UA and GDM risk were observed and these associations varied by gestational ages. Only elevated serum UA levels at 13–18 weeks gestation was associated with substantially increased risk of GDM. Analysis by UA quintiles at 13–18 weeks gestation showed the odds ratios for GDM were 1.11 (95%CI, 1.03–1.20) for the second, 1.27 (95%CI, 1.17–1.37) for the third, 1.37 (95%CI, 1.27–1.48) for the fourth and 1.70 (95%CI, 1.58–1.84) for the fifth quintile of serum UA in comparison with the first quintile. Stratified analysis showed the associations of serum UA with GDM were stronger among pregnant women aged 35 years or older.ConclusionWe found higher serum UA at 13–18 gestational weeks was a risk factor for GDM. Our findings provide new evidence for the role of serum UA in the prevention and early intervention of GDM, and highlighted the need for monitoring serum UA at 13–18 gestational weeks.     

Prediction of postpartum diabetes in women with gestational diabetes mellitus

Aims/hypothesis  

We studied the incidence of postpartum diabetes after gestational diabetes mellitus and investigated biochemical and clinical predictors of postpartum diabetes.     

Effects of pre-pregnancy weight on incidence of large for gestational age newborn in pregnant women with gestational diabetes mellitus

The aim of this study is to compare the incidence of large for gestational age (LGA) infants between gestational diabetes mellitus (GDM) women whose pre-pregnancy weight was in normal and overweight/obese category. Possible associated factors for LGA were evaluated and pregnancy outcomes were compared. A total of 272 singleton pregnant women with GDM were enrolled, 136 overweight/obese women (BMI ≥25 kg/m²) were in study group and another 136 normal weight women (BMI <25 kg/m²) were served as comparison group. Data were retrieved from medical records, including demographic data, GDM diagnosis and risks, labor and delivery data, and pregnancy outcomes. Baseline characteristics and incidence of LGA were compared between groups, and logistic regression analysis was performed in order to determine independent risk factors for LGA, adjusted for potential confounders. Baseline demographic data were comparable between groups, except that study group was significantly more likely to have excessive weight gain and more likely to need insulin treatment than control group. The rate of LGA and macrosomic infants was significantly higher in study group than in control group (p?=?0.038 and 0.024, respectively). Logistic regression analysis showed that only gestational weight gain was significantly associated with LGA. Gestational weight gain less than recommendation significantly decreased the risk of LGA by 60 % (adjusted odds ratio (OR) 0.39, 95 % confidence interval (CI) 0.17–0.96, p?=?0.04). On the other hand, gestational weight gain greater than recommendation significantly doubled the risk of LGA (adjusted OR 2.03, 95 % CI 1.11–3.71, p?=?0.022). Gestational weight gain, but not pre-pregnancy BMI was independently associated with LGA in GDM pregnant women.