Serum brain natriuretic peptide and C-reactive protein levels in adolescent with polycystic ovary syndrome

Objective: Our primary aim was to investigate whether N-terminal pro-brain natriuretic peptide (NT-proBNP) increases in adolescent with polycystic ovary syndrome (PCOS) compared with healthy controls and secondary aim was to determine whether metabolic and hormonal differences exist between groups. Methods: In this cross-sectional study, 25 adolescent patients with PCOS and 25 normal ovulatory control not suffering from PCOS were involved in the study. Fasting serum NT-proBNP, C-reactive protein (CRP), homocystein, insulin levels and biochemical and hormonal parameters were measured. Results: Serum NT-proBNP was not significantly different in PCOS subjects (0.62?±?0.80 vs 1.12?±?1.51?ng/mL, p?=?0.154). The mean serum fasting insulin levels (22.64?±?10.51 vs 13.32?±?3.97 mIU/mL, p?=?0.001) and Homeostasis Model Assessment Insulin–Resistance Index (HOMA-IR) levels (5.16?±?1.81 vs 2.97?±?0.89, p?=?0.001) were significantly high in the study group. The median serum CRP levels were not significantly different between groups (1 [1–12] vs 1 [1–19] g/dL, p?=?0.286). Conclusions: The present study demonstrated that the levels of BNP, CRP and homocystein were not different in PCOS subjects. Serum insulin levels and HOMA-IR were significantly higher in PCOS subjects. Possible serum markers for PCOS-related metabolic abnormalities and cardiovascular events, may not present in the adolescent years.     

Homeostatic indices of insulin resistance among gestational diabetics in anticipating pregnancy complications

Abstract

Objective: This was to determine HOMA-IR score as well as to assess its association in fetal and maternal outcomes among pregnant women with diabetes risks.

Methods: A prospective cohort study of pregnant women with diabetes risks was done. GDM was diagnosed using modified glucose tolerance test. Serum insulin was taken and measured by an electrochemiluminescence immunoassay method. Plasma glucose was measured by enzymatic reference method with hexokinase. HOMA-IR score was calculated for each patient. Maternal and fetal outcomes were analyzed.

Results: From 279 women recruited, 22.6% had GDM with higher HOMA-IR score (4.07?±?2.44 versus 2.08?±?1.12; p?=?0.001) and fasting insulin (16.76?±?8.63?µIU/L versus 10.15?±?5.07?µIU/L; p?=?0.001). Area under ROC curve for HOMA-IR score was 0.79 (95% confidence interval, 0.74–0.84) with optimum cut-off value of 2.92 (sensitivity?=?63.5%; specificity?=?89.8%), higher than recommended by IDF (2.38). This point showed significant association with neonatal hypoglycemia (p?=?0.02) and Cesarean section (p?=?0.04) in GDM mothers.

Conclusions: HOMA-IR score and insulin resistance levels were higher in GDM women in our population. With the cut-off HOMA-IR value of 2.92, neonatal hypoglycemia and Cesarean section were significant complications in GDM mothers. This can be used in anticipation of maternal and fetal morbidities.     

Relationship of maternal serum resistin and visfatin levels with gestational diabetes mellitus

Introduction: Adiponectin, resistin and visfatin are thought to play role in the pathophysiology of gestational diabetes (GDM). In this study, we aimed to investigate the association of maternal second trimester serum resistin and visfatin levels with GDM.

Materials and methods: Screening and diagnosis for GDM was performed between the 24–28th gestational weeks. About 40 women diagnosed with GDM and 40 non-diabetic women constituted the study and control groups, respectively. Groups were compared for second trimester maternal serum resistin, visfatin and HbA1c levels, HOMA-IR and postpartum 75?g OGTT results.

Results: Mean serum resistin (p?=?0.071) and visfatin (p?=?0.194) levels were similar between the groups. However, mean BMI (p?=?0.013), HOMA-IR (p?=?0.019), HbA1c (p?p?=?0.037) were significantly higher in GDM group compared to controls. Type 2 diabetes and impaired glucose tolerance were detected in 2 (5%) and 7 (20%) women in the GDM group, respectively, with 75?g OGTT performed at the postpartum 6th week. Resistin levels of patients with GDM and postpartum glucose intolerance were higher than those with GDM but no postpartum glucose intolerance (p?=?0.012). Visfatin levels in the GDM group showed a positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length (p?Conclusion: Maternal serum resistin and visfatin levels are unchanged in GDM. In patients with GDM, second trimester resistin levels may be predictive for postpartum glucose intolerance and second trimester visfatin levels may be related with fetal biometric measurements. Further larger studies are needed.     

Significance of RBP4 in patients with gestational diabetes mellitus: a case-control study of Han Chinese women

The role of retinol binding protein 4 (RBP4) in insulin resistance was recently identified. Our study investigated the correlation between RBP4 levels with lipid and glucose metabolism in a case-control study of women with gestational diabetes mellitus (GDM). Between May 2008 and May 2010, 70 pregnant women (24–28 weeks gestation) were recruited, including 35 women with GDM and 35 healthy controls. Blood samples were collected prior to and after oral glucose tolerance tests (OGTT) to detect serum RBP4, insulin, glycated hemoglobin, triglyceride (TG) and total cholesterol (TC) levels; the insulin resistance index (HOMA-IR) was calculated. Serum RBP4 levels in the GDM group were significantly higher than the control group (22.9?±?3.09?µg/ml versus 17.9?±?3.91?µg/ml; p?p?r?=?0.49, 0.49, 0.52,0.52, respectively; p?相似文献   

Maternal serum ADAMTS-9 levels in gestational diabetes: a pilot study

Objective: Gestational diabetes mellitus (GDM) is characterized with insulin resistance which is diagnosed during pregnancy. Although pregnancy is a diabetogenic state, not all women develop GDM. Genetic factors together with enviromental factors cause the maladaptation of maternal pancreas to this diabetogenic state and GDM develops. ADAMTS-9 is a recently recognized molecule whose genetic variants have risk of GDM. Decreased levels have already been shown in fetal membranes. Maternal serum levels of this protein have not been studied yet. We hypothesized that the alteration of ADAMTS-9 expression should cause changes in maternal serum levels which further could help to identify the disease and develop new treatment strategies.

Materials and methods: This prospective case–control study is consisted of 27 pregnancies with GDM and 30 healthy singleton pregnancies matched for matenal age, gestational week, and maternal weight. GDM diagnosis was made with 2-h 75?g oral glucose tolerance test. ADAMTS-9 levels were compared between groups.

Results: ADAMTS levels were 3.62?±?0.33?ng/dL (range: 3.04–4.23) in GDM group and 4.65?±?1.70?ng/dL (range: 3.07–8.21) in control group (p?Conclusion: ADAMTS-9 levels were significantly lower in GDM pregnancies. This may help to understand the mechanism of GDM pathogenesis. In future, target treatments with ADAMTS proteins may help to improve the severity of diabetes pathogenesis.     

Macrophage migration-inhibitory factor is elevated in pregnant women with gestational diabetes mellitus

Objective: In reports, abnormal macrophage migration-inhibitory factor (MIF) production has been associated with several diseases. Furthermore, despite scarce data, increasing evidence suggest that MIF plays a central role in glucose homeostasis and in the development of type 1 and type 2 diabetes. However, serum MIF levels in gestational diabetes mellitus (GDM) have not yet been investigated. To address this question, we performed a prospective study between a group of pregnant women with GDM and healthy pregnant controls. Materials and methods: GDM group consisted of 43 pregnant women, whereas the control group consisted of 40 healthy pregnant women. In the morning after an overnight fast, venous blood was sampled for the measurement of serum concentrations of insulin and MIF. Serum was separated by centrifugation and immediately stored at ?80°C until the assay. Results: There was no significant difference between the groups for maternal characteristics. Women with GDM had significantly higher levels of serum insulin (14.37?±?9.92 µU/ml vs. 8.78?±?4.35 µU/ml; p?=?0.001) and serum MIF concentrations (11.31?±?4.92?ng/ml vs. 5.31?±?4.07?ng/ml; p?<?0.001) when compared with healthy pregnant control group. Conclusion: Our data demonstrated that serum levels of MIF are significantly elevated in patients with GDM. Our findings indicate that MIF might have a role in GDM; however, there is a need for further investigation.     

Neopterin and hsCRP are not correlated in gestational diabetes mellitus

Objective: To determine serum neopterin and high sensitive C-reactive protein (hsCRP) levels in patients with and without gestational diabetes mellitus (GDM).

Methods: Neopterin and hsCRP levels were quantified in 28 women with GDM and 20 pregnant women with normal glucose tolerance (NGT). Postpartum neopterin and hsCRP levels were measured in a follow-up study.

Results: Neopterin levels were significantly higher in women with GDM than in women with NGT (15.89?±?8.19?nmol/L versus 10.4?±?3.8?nmol/L, p?p?p?=?0.9, respectively). In contrast, hsCRP levels decreased after delivery in patients with GDM (5.74?±?3.91 versus 3.78?±?2.78, p?r?=?0.3, p?=?0.02) and fasting glucose (r?=?0.4, p?=?0.004), postprandial glucose (r?=?0.3, p?=?0.01), HbA1c (r?=?0.3, p?=?0.02), whereas hsCRP levels were correlated with pre-pregnancy (r?=?0.3, p?=?0.04) and pregnancy body mass index (r?=?0.4, p?=?0.008). No correlation between serum neopterin and hsCRP levels was found (p?=?0.9).

Conclusion: Neopterin levels increased in patients with GDM; hence, it may be related to inflammation. However, the lack of correlation between neopterin and hsCRP suggests the role of different attitudes of these two parameters in the course of pregnancy and GDM.     

Gestational diabetes and pregnancy outcome – do we have right diagnostic criteria?

Abstract

Objective: To determine thresholds of maternal glycemia at which specific adverse pregnancy outcomes occur in high-risk population.

Methods: A total of 1002 pregnant women with risk factors for gestational diabetes mellitus (GDM) underwent an originally modified glucose tolerance test (OGTT) with 75?g of glucose. Information on OGTT results and pregnancy outcomes were collected from database and medical records.

Results: Large for gestational age (LGA) newborn, infant’s stay in the neonatal intensive care unit (NICU) >24?h, neonatal hyperbilirubinemia and cesarean section due to cephalopelvic disproportion were identified as specific GDM adverse outcomes. In the study group of participants with one or more specific GDM adverse outcomes, mean glycemic values during the modified OGTT (4.2?±?1.0?mmol/L at 0?min, 6.8?±?1.7?mmol/L at 30?min, 7.9?±?2.1?mmol/L at 60?min, 7.7?±?2.3?mmol/L at 90?min and 7.5?±?2.3?mmol/L at 120?min) according to Student’s t-test for independent samples were significantly higher than mean glycemic values in the control group of participants without specific adverse outcomes (p?<?0.001, p?=?0.02, p?<?0.001, p?<?0.001, p?<?0.001).

Conclusion: This study provides additional data that support the acceptance of the newly recommended outcome-based GDM diagnostic criteria.     

Clinical significance of neuregulin 4 (NRG4) in gestational diabetes mellitus

Objective: Gestational diabetes mellitus (GDM) is defined as glucose intolerance detected during pregnancy. GDM is increasing worldwide and is associated with adverse maternal and fetal outcomes. Neuregulin 4 (NGR4) is epidermal growth factor like signaling molecule. It plays an important role in cell to cell communication furthermore recent studies indicate that NRG4 may work as a novel adipokine with a possible role in maintaining energy and metabolic homeostasis. The aim of the present study was to assess serum NRG4 levels along with several metabolic parameters in patients diagnosed with gestational diabetic mellitus.

Materials and methods: In this prospective cross-sectional study, the study group was composed of 63 women with GDM and 64 healthy pregnant women matched for age, body mass index (BMI) and gestational age. Blood samples were collected at the 24–28th gestational weeks. Serum NRG4, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides, glucose levels during 75-gr OGTT, fasting insulin, glycosylated hemoglobin A1c (HbA1c), alanine aminotransferase (ALT) and creatinine levels were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) values were calculated.

Results: Serum NRG4 values were significantly elevated in the GDM group compared to the control group (p?β?=?0.910, p?β?=?0.866, p?β?=?0.222, p?Conclusions: Serum NRG4 levels were associated with metabolic parameters of GDM. The present study can be considered to be a guide for future studies to clarify the pathophysiology of NGR4 in GDM patients.     

Serum YKL-40 levels in gestational diabetes mellitus

Objective: Serum YKL-40 levels are elevated in patients with type 1 and 2 diabetes. However, the correlation between YKL-40 and gestational diabetes mellitus (GDM) remains unknown. The present study compared serum YKL-40 levels in pregnant women with GDM and those with normal glucose tolerance and evaluated the relationship between YKL-40 and insulin-resistant syndrome.

Methods: Thirty-five patients with GDM and 43 age-matched healthy pregnant women at 24–28 weeks of gestation were studied. In addition to anthropometric assessments, serum glucose, insulin, YKL-40, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein and glycated hemoglobin were measured in all subjects. All subjects underwent a 2-h 75-g oral glucose tolerance test (OGTT). Body mass index (BMI) and the homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.

Results: Fasting and 2?h serum YKL-40 levels were significantly higher in pregnant women with GDM compared with controls (77.3?±?29.3 versus 50.9?±?16.7 ng/mL, p?<?0.001, fasting concentrations; 63.5?±?20.1 versus 40.6?±?10.7 ng/mL, p?=?0.009, 2?h concentrations). OGTT had no effect on YKL-40 levels in either group (p?>?0.05). There were significant correlations between YKL-40 and glycated hemoglobin (β?=?0.37, p?=?0.006), fasting insulin (β?=?0.49, p?=?0.001) and HOMA-IR (β?=?0.18, p?=?0.015) in the GDM group.

Conclusions: Serum YKL-40 levels are elevated in patients with GDM but are unaffected by OGTT. YKL-40 levels are related to glycated hemoglobin, fasting insulin and HOMA-IR. These results suggest that YKL-40 may be a major contributor to GDM.     

Increased pancreatic-derived factor (PANDER) levels in gestational diabetes mellitus

Abstract

The aim of the study was to investigate the pancreatic-derived factor (PANDER) levels in healthy pregnant women and in pregnant women with gestational diabetes mellitus (GDM). A total of 50 women consecutively diagnosed with GDM and 30 randomly selected age-matched and gestational-age-matched healthy pregnant women were included in this cross-sectional study. Serum PANDER levels and other variables were analyzed. The age, the gestational age at the time, the blood sample was obtained and the hemoglobin A1c (HbA1c) levels of the GDM and control groups were similar. The body mass index (BMI), fasting blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and serum PANDER levels were significantly higher in the GDM group than the control group. The optimal PANDER cutoff value was 227.2?ng/ml, and the ratios above this value were 100 and 86.6% for sensitivity and specificity, respectively (p=.0001). Serum PANDER levels were higher in women with GDM compared to the control group and were positively correlated with insulin, HOMA-IR, and HbA1c levels. These results suggest that PANDER might be considered a new biomarker for GDM.     

Weight gain in gestational diabetes: the effect of treatment modality

Objective: To evaluate treatment effectiveness (diet alone, insulin or glyburide) on maternal weight gain in gestational diabetes (GDM).

Methods: GDM patients were treated with diet alone, insulin or glyburide. Weight gain was stratified into: prior to GDM diagnosis, from diagnosis to delivery and total pregnancy weight gain. Good glycemic control was defined as mean blood glucose ≤105?mg/dl and obesity as Body Mass Index (BMI)?≥?30?kg/m², overweight BMI 25–29?kg/m² and normal <?25?kg/m².

Results: Total weight gain was similar in all the treatment groups. Two-thirds of weight gain occurred prior to diagnosis (diet 85%, insulin 67% and glyburide 78%). Post-diagnosis, patients on diet alone gained less weight than those on insulin or glyburide (p?<?0.001); insulin-treated patients showed greater weight gain than glyburide-treated patients (p?<?0.001). Patients on diet with good glycemic control showed less weight gain after diagnosis than patients on insulin or glyburide (2.8?±?13, 6.6?±?10, 5.2?±?7.9 lbs, respectively, p?<?0.02). Poorly-controlled patients, regardless of treatment, had similar patterns of weight gain throughout pregnancy.

Conclusion: Patterns of maternal weight gain in GDM pregnancies are associated with treatment modality and level of glycemic control.     

Relationship between advanced glycation end products and gestational diabetes mellitus

Objective: To investigate the levels of and dynamic changes of advanced glycation end products (AGEs) in maternal plasma during pregnancy and explore the association between these levels and gestational diabetes mellitus (GDM).

Methods: This study recruited 90 GDM women and 90 healthy pregnant controls. The women received prenatal care and were hospitalized for delivery in Peking University First Hospital in China between October 2015 and April 2016. The patients were recruited and provided blood samples during gestational weeks 24–29. The levels of AGEs, TNF-α, hs-CRP, plasma glucose, and FINS and lipid profiles were measured, and HOMA-IR was calculated. New blood samples were collected and AGE was measured again in the two groups at 33–41 weeks of gestation to identify its dynamic changes.

Results: The levels of AGEs were significantly higher in the GDM group than in the NGT group at both 24–29 weeks (473.65?±?105.32 versus 324.36?±?57.86?ng/L; p?p?p?p?=?.003), TNF-α (p?=?.005), and hs-CRP (p?p?=?.001). In the NGT group, there was no significant change in the concentration of AGEs between the two gestational periods (p?=?.388).

Conclusions: Plasma levels of AGEs are associated with GDM. During pregnancy, the changes observed in the levels of AGEs were different between GDM and normal pregnancies.     

Serum atrial natriuretic peptide levels among clomiphene citrate resistant polycystic ovarian syndrome patients

Aim

To investigate whether atrial natriuretic peptide (ANP) level is altered in polycystic ovarian syndrome (PCOS) patients with clomiphene citrate (CC) resistant and whether it correlates with insulin sensitivity markers.

Role of antioxidants in gestational diabetes mellitus and relation to fetal outcome: a randomized controlled trial

Objective: To examine the effect of antioxidant administration on the oxidative parameters in both blood and placental tissue and its relation to fetal outcome in women with GDM.

Patients and methods: Two-hundred pregnant women with gestational diabetes mellitus (GDM) were randomized into 2 groups, Group1 received 1 gram L-ascorbic acid per day and Group2 received placebo.

Results: The use of antioxidants significantly lower the needed insulin dose for blood sugar control (25.6?±?20.3 versus 40.5?±?23.7, respectively). In placental tissue homogenates, glutathione (GSH) was 49.6?±?5.9 versus 62.34?±?4.99, malondialdahyde (MDA) was 165.7?±?9.2 versus 264.15 ±?12, superoxide dismutase (SOD) was 0.3?±?0.3 versus 0.054?±?0.16 while catalase (CAT) was 14.06?±?2.4 versus 15.52?±?3.97 and glutathione peroxidase (GPx) was 14?±?4.1 versus 26.3?±?4.26 in antioxidant group compared to the control group (p?<?0.001). In maternal blood, GSH was 1.5?±?0.3 versus 0.74?±?0.088, CAT was 380.7?±?11 versus 325.44?±?21.8, GPx was 52.3?±?8.7 versus 75.82?±?6.84 and SOD was 188?±?15.3 versus 98.56?±?11.05 in antioxidant group compared to control group (p <?0.001). In neonatal blood, the level of MDA and SOD showed a statistically significant difference between antioxidants and control groups (4?±?0.7 versus 6.6 7 ±0.66 and1 8 8?±?15.3 versus 98.5?±?11.05, respectively) (p?<?0.001). The neonatal blood sugar after 1 and 2?hours of delivery was more stable in antioxidant group (56.7?±?10.9 versus 39.7?±?11.1 and 58.5?±?10.8 versus 41.7?±?13.1, respectively) (p <0.05). The neonates NICU admission was lower in antioxidant group (5 versus 11) (p <0.05).

Conclusion: The use of antioxidants markedly reverses the oxidative stresses in women with GDM with marked improvement on neonatal outcome.     

Placental volume relative to fetal weight estimated by sonography in diabetic pregnancies

Objective: Our purpose was to analyze the fetal weight and placental volume (PV) ratio in diabetic pregnancies during mid-pregnancy.

Method: One hundred and forty nine diabetic pregnancies [75 gestational diabetes mellitus (GDM) and 74 diabetes mellitus type I (T1DM) with good glycemic control] and 232 healthy patients were analyzed by three-dimensional sonographic volumetry of the placenta, while fetal weight was estimated by two-dimensional technique.

Results: The gestational age-specific estimated fetal weight (EFW) [EFWGDM: 1840.8?±?932.82?g; EFWT1DM: 1475.6?±?914.7?g (mean?±?standard deviation) and placental ratio (PR)] was significantly higher (p?<?0.05) in pregnancies complicated by GDM and T1DM (PRGDM: 5.5?±?1.67?g/cm³, PRT1DM: 4.56?±?3.2?g/cm³) compared to control group (Q) (EFWQ: 532?±?186.49?g; PRQ: 2.2?±?0.8?g/cm³), whereas PV was significantly higher (p?<?0.05) only in GDM (PVGDM: 334.3?±?111.5?cm³) compared to control data (PVQ: 232?±?78.9?cm³). In contrast to GDM, T1DM with good glycemic control did not predispose to any changes in placental sonographic volumetric differences compared to control values.

Conclusions: Fetal weight related to the PV is already elevated in second trimester in pregnancies complicated by gestational diabetes mellitus and type I diabetes mellitus compared to normal pregnancies.     

Insulin resistance and β-cell function influence postprandial blood glucose levels in Japanese patients with gestational diabetes mellitus

Abstract

Aims/introduction: The aim of this study in patients with gestational diabetes mellitus (GDM) was to evaluate the relationship of insulin resistance and secretion to area-under-the-sensor glucose concentration–time curve from before to 120?min postmeal (CGM-AUC_0–120?min) as determined with continuous glucose monitoring (CGM).

Materials and methods: Immunoreactive insulin and HbA1c were determined in 22 Japanese patients with GDM undergoing a 75?g oral glucose tolerance test. Patients underwent CGM within 3 weeks of receiving a diagnosis of GDM.

Results: HbA1c (NGSP) was 5.5?±?0.4%, BMI was 24.8?±?5.3?kg/m², mean sensor glucose by CGM was 94.2?±?10.3?mg/dL, standard deviation was 17.5?±?4.4?mg/dL, and CGM-AUC_0–120?min was 204.2?±?23.8?h?mg/dL. The insulin resistance indices the homeostasis model assessment ratio (HOMA-R), quantitative insulin sensitivity check index (QUICKI), and the Matsuda Index were correlated with CGM-AUC_0–120?min. The disposition index (DI), which was used to evaluate insulin secretion, was negatively correlated with CGM-AUC_0–120?min.

Conclusions: Not only insulin resistance but also beta cell dysfunction contributes to postprandial hyperglycemia in Japanese patients with GDM.     

Serum levels of nesfatin-1 are increased in gestational diabetes mellitus

Objective: To analyze the concentrations of nesfatin-1 in maternal and cord serum, to evaluate the expression of nesfatin-1 in subcutaneous adipose tissue (SAT) from pregnant women with gestational diabetes mellitus (GDM) and those with normal glucose tolerance (NGT).

Methods: We studied a total of 50 GDM and 50 NGT subjects. The clinical features, serum nesfatin-1, homeostasis model assessment of insulin resistance (HOMA-IR), lipid profiles were measured at the third trimester of pregnancy. The expression of nesfatin-1 in the SAT was determined by western blot.

Results: Compared with the NGT group, the GDM group showed greater levels of serum nesfatin-1, adipocyte fatty acid binding protein (AFABP), and leptin; a greater level of cord blood nesfatin-1; and a higher level of expression in SAT (p?p?b?=?0.317, p=?0.022) and body mass index (BMI) before delivery (b?=?0.367, p=0.008) were independently associated with serum nesfatin-1. Nesfatin-1 was the independent risk factor for GDM.

Conclusions: The GDM group had higher levels of maternal serum and cord blood nesfatin-1, and greater nesfatin-1 expression in SAT. Nesfatin-1 is closely related to obesity and IR in pregnancy.     

Second trimester maternal plasma and amniotic fluid adipokines in women who will develop gestational diabetes mellitus

Abstract

Objective: To study the adipokines concentration and glucose homoeostasis in the early-second trimester of women who will develop gestational diabetes mellitus (GDM).

Materials and methods: Maternal plasma and fetal amniotic fluid samples were prospectively collected between 2006 and 2007 at the time of mid-trimester amniocentesis. Eight patients found to be affected by GDM were compared with 10 control patients with a normal pregnancy course. Adipokines leptin and adiponectin, as well as insulin and glucose concentration both in amniotic fluid and maternal plasma were compared between cases and controls. HOMA-IR (homeostatic model assessment for insulin resistance) was also calculated both for amniotic fluid and maternal serum.

Results: The amniotic fluid adiponectin concentration was higher in women who would develop GDM than in controls (29.9?ng/ml, 95% CI 26.7–49.8 ng/ml, versus 14.9 ng/ml, 95% CI 13.5–18.8 ng/ml), p?<?0.05). No difference was shown for leptin both in amniotic fluid and maternal serum. Insulin concentrations in the amniotic fluid were found to be lower in GDM than in controls, while HOMA-IR-index resulted lower in amniotic fluid and higher maternal serum (p?<?0.05).

Conclusions: Our data suggests that an earlier alteration in the fetal glucose metabolism will precede the glucose dysmetabolism in pregnancies later complicated by GDM.     

The effect of different doses of vitamin D supplementation on insulin resistance during pregnancy

Abstract

Low serum vitamin D levels are correlated with insulin resistance during pregnancy. We have assessed the effects of different doses of vitamin D on insulin resistance during pregnancy. A randomized clinical trial was done on 120 women with a gestational age of less than 12 weeks. The women were divided into three groups randomly. Group A received 200?IU vitamin D daily, group B 50?000?IU vitamin D monthly and group C 50?000?IU vitamin D every 2 weeks from 12 weeks of pregnancy until delivery. The serum levels of fasting blood sugar (FBS), insulin, calcium and 25-hydroxyvitamin D were measured before and after intervention. We used the homeostatic model assessment of insulin resistance (HOMA-IR) as a surrogate measure of insulin resistance. The mean?±?standard deviation of serum 25-hydroxyvitamin D increased in group C from 7.3?±?5.9 to 34.1?±?11.5?ng/ml and in group B it increased from 7.3?±?5.3 to 27.23?±?10.7?ng/ml, but the level of vitamin D in group A increased from 8.3?±?7.8 to 17.7?±?9.3?ng/ml (p?<?0.001). The mean differences of insulin and HOMA-IR before and after intervention in groups A and C were significant (p?=?0.01, p?=?0.02). This study has shown that supplementation of pregnant women with 50?000?IU vitamin D every 2 weeks improved insulin resistance significantly.