Heterogeneity of insulin resistance level in gestational diabetes mellitus. Therapeutic implications

OBJECTIVE: The evaluation of insulin resistance (IR) level in population of women with gestational diabetes(GDM) and its relation to treatment of GDM. MATERIALS AND METHODS: 657 GDM women, aged 17-45, treated between the years 2003 and 2005, in Bydgoszcz were studied. Age, pregravid body mass index(BMI), weight gain during pregnancy at the GDM diagnosis, week of GDM diagnosis, week of the beginning of insulin therapy and daily doses of insulin were assessed in the whole population. Daily doses of insulin were evaluated as minimal doses needed at the initial phase of GDM therapy and as maximal doses during gestation. IR was evaluated at the GDM diagnosis, with the use of homeostasis model assessment (HOMA-IR), based on fasting glucose and insulin concentration. RESULTS: 47% women were classified as low HOMA-IR(<2) subpopulation, 50% as intermediate HOMA-IR(2-10) subpopulation, 3% as high HOMA-IR(10-46)subpopulation. Subpopulation with intermediate HOMA-IR had higher BMI, higher weight gain and blood glucose at 0 OGTT compared to subpopulation with low HOMA-IR but lower insulin concentration compared to high HOMA-IR subpopulation. Women in high HOMA-IR subpopulation and in intermediate HOMA-IR subpopulation were twice as often treated with insulin, compared to low HOMA-IR group, accordingly, 58%, 42%, 24%. Daily insulin doses, assessed both minimal and maximal doses, were increasing parallel to HOMA-IR in whole population, accordingly, minimal doses of insulin, 16.0 = -12.7 vs 18.4 vs 20.8 vs 30.8 +/- 30.3 and maximal doses of insulin, accordingly, 39.0 +/- 322.4 vs 50.9 +/- 42.4 vs 70.3 +/- 30.3. CONCLUSION: The studied population of women consisted mainly of subpopulation with low or intermediate HOMA-IR value, in rare cases, of high HOMA-IR value. Our results suggest that adipose tissue is particularly associated with insulin resistance level in subpopulation with intermediate HOMA-IR. Both, frequency of insulin therapy and daily insulin doses are associated with insulin resistance level at the GDM diagnosis.     

Circulating concentrations of adiponectin and tumor necrosis factor-alpha in gestational diabetes mellitus.

Adiponectin and tumor necrosis factor-alpha (TNF-alpha) have been implicated in insulin resistance and diabetes mellitus (DM). In the present study we investigated levels of adiponectin and TNF-alpha and their relationships with each other and metabolic factors in women with gestational DM (GDM). Thirty-four pregnant women with GDM and 31 pregnant women with normal glucose tolerance (NGT) were included in the study. Plasma adiponectin levels were lower in GDM than in NGT (36.9 +/- 6.7 vs. 61.3 +/- 13.0 ng/ml, p = 0.028). Serum TNF-alpha levels were increased in GDM compared with NGT (20.5 +/- 2.4 vs. 14.0 +/- 1.5 pg/ml, p = 0.042). After adjustment for pre-pregnancy and current body mass index (BMI), adiponectin levels correlated negatively with insulin resistance by homeostasis model assessment-insulin resistance (HOMA-IR) and 0-h and 1-h glucose both at glucose challenge test and oral glucose tolerance test in GDM. Adiponectin levels were correlated only with very low-density lipoprotein cholesterol and triglyceride levels in NGT. TNF-alpha levels were correlated with glycated hemoglobin in GDM. There was a significant positive correlation between TNF-alpha levels and pre-pregnancy and current BMI in GDM as well as NGT. HOMA-IR for adiponectin and pre-pregnancy BMI for TNF-alpha remained as significant determinants in multiple regression analyses. In conclusion, these data suggest that reduced adiponectin and increased TNF-alpha may be involved in the pathogenesis of GDM.     

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.     

Folate, vitamin B12, and homocysteine levels in South Asian women with growth-retarded fetuses

OBJECTIVE. To investigate whether intrauterine growth retardation (IUGR) and preterm delivery in a poor population of South Asia was associated with altered maternal and fetal levels of folate, vitamin B12, and homocysteine. SUBJECTS AND METHODS. Hundred and twenty-eight pregnant women from a low socio-economic strata in the city of Lahore, Pakistan were followed with ultrasound of fetal growth from the 12th week of pregnancy. Blood samples were drawn from the woman and the cord at delivery. Serum was analyzed by a chemiluminescent immunoassay for folate and vitamin B12 and by fluorescence polarization immunoassay for total homocysteine (tHcy). RESULTS. Fourty-six infants showed IUGR. In term, but not preterm, deliveries with IUGR, maternal and cord blood folate levels were half of those in deliveries of normal birth weight infants (P=0.004 and P=0.005). The risk of IUGR was reduced among women with folate levels in the highest quartile (OR 0.31, 95% CI 0.10--0.84). There was no association between vitamin B12 and IUGR. Total homocysteine levels were higher in women delivering IUGR infants (P=0.02). There was an inverse correlation between cord blood folate and tHcy levels (r=-0.26, P=0.006). We also found increased risks for hypertensive illness (OR 3.5, 95% CI 1.4--8.6) and premature delivery (OR 2.5, 95% CI 1.1--6.2) in women in the highest quartile of tHcy. CONCLUSIONS. The occurrence of IUGR increased with low maternal and cord concentrations of folate and high maternal levels of tHcy. Further studies on the effects of vitamin B supplementation through pregnancy are warranted.     

Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia

OBJECTIVE: To study the plasma levels of homocysteine in preeclampsia and relate them to insulin sensitivity. METHODS: In association with a 3-hour intravenous glucose-tolerance test (glucose 0.3 g/kg at 0 and 0.03 IU insulin 20 minutes later), we measured plasma levels of homocysteine, vitamin B12, and folic acid in 22 women with preeclampsia and 16 controls between 29 and 39 weeks' gestation. In 14 women with preeclampsia and 11 controls, plasma samples also were collected 3 months after delivery. RESULTS: Levels of homocysteine in women with preeclampsia (6.7 +/- 0.4 micromol/L, mean +/- standard error) were higher (P < .001) than those in controls (3.8 +/- 0.2 micromol/L) and related significantly to the level of proteinuria (r = .49, P = .02). Vitamin B12 concentrations were lower in women with preeclampsia (166.0 +/- 10.4 compared with 212.4 +/- 16.4 pmol/L, P = .02), whereas levels of folic acid showed no difference between the groups. After delivery, levels of homocysteine increased to 9.1 +/- 0.6 and 8.2 +/- 0.6 micromol/L in women with preeclampsia and controls, vitamin B12 increased to 298.8 +/- 28.6 compared with 334.9 +/- 24.0 pmol/l, and folic acid decreased to 10.6 +/- 2.0 compared with 7.9 +/- 0.8 nmol/L, with no difference emerging between the groups. In women with preeclampsia but not in controls, plasma homocysteine was negatively related to insulin sensitivity (r = -.51, P = .02). The mean 2.9-fold increase in glucose or 52.5-fold increase in insulin during the insulin-sensitivity test failed to affect homocysteine levels. CONCLUSION: Women with preeclampsia have high plasma homocysteine levels that are inversely related to insulin sensitivity.     

妊娠期糖尿病患者血清网膜素水平与糖、脂代谢指标的相关性研究

目的:探讨妊娠期糖尿病(GDM)患者血清网膜素(Omentin)水平的变化及其与糖、脂代谢指标的相关性。方法:采用酶联免疫吸附法检测35例孕前肥胖的GDM孕妇(A组)、32例孕前非肥胖的GDM孕妇(B组)、36例正常健康孕妇(C组)的血清Omentin水平;同时测定所有受试者的糖、脂生化指标,并计算胰岛素抵抗指数(HOMA-IR)。结果:(1)GDM孕妇三酰甘油(TG)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)水平均高于正常对照组,高密度脂蛋白(HDL-C)水平低于正常对照组(P均<0.05);(2)3组孕妇血清Omentin水平A组相似文献   

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     

肿瘤坏死因子α启动子基因多态性与妊娠期糖尿病的相关性研究

目的探讨肿瘤坏死因子α(TNF-α)启动子基因多态性及其血浆水平与妊娠期糖尿病(GDM)发病的关系。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)检测35例GDM孕妇(GDM组)及35例正常孕妇(对照组)TNF-α启动子-308基因型。采用放射免疫法测定两组孕妇血浆中TNF-α水平及计算胰岛素抵抗指数。结果(1)GDM组A等位基因频率(61·4%)显著高于对照组(30·0%),GA+AA型基因频率(71·4%)也显著高于对照组(37·1%),两组比较,差异有统计学意义(P<0·01)。(2)GDM组孕妇血浆TNF-α水平为(52±13)fmol/L,对照组为(14±4)fmol/L,两组比较,差异有统计学意义(P<0·05)。(3)GDM组胰岛素抵抗指数为13·6±6·5,对照组为1·9±0·2,两组比较,差异有统计学意义(P<0·05)。结论TNF-α-308G/A基因多态性与GDM发病有关,其机制可能是通过升高GDM孕妇血浆TNF-α水平,产生胰岛素抵抗而导致GDM的发生。     

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.     

胰岛素受体底物1表达及其酪氨酸磷酸化与妊娠期糖尿病患者胰岛素抵抗的关系

目的探讨骨骼肌组织中胰岛素受体底物1（IRS-1）表达及其酪氨酸磷酸化与妊娠期糖尿病发生胰岛素抵抗的关系。方法采用蛋白印迹法（western blot）及免疫沉淀法检测22例妊娠期糖尿病患者（妊娠期糖尿病组）、22例正常妊娠妇女（正常妊娠组）及13例正常非孕妇女（正常非孕组）骨骼肌组织中IRS-1蛋白表达水平及其酪氨酸磷酸化程度;采用放射免疫法及葡萄糖氧化酶法检测各组妇女空腹胰岛素（FINS）及空腹血糖（FPG）水平,并采用稳态模型法计算胰岛素抵抗指数（HOMA—IR）。结果（1）妊娠期糖尿病组FPG、FINS、HOMA—IR分别为（5．6±0．8）mmol／L、（15．4±5．1）mU／L、1．2±0．5,正常妊娠组分别为（4．4±0．5）mmol／L、（10．6±3．1）mU／L、0．8±0．3,两组间各指标分别比较,差异均有统计学意义（P〈0．01）;正常非孕组FINS、HOMA—IR分别为（7．6±2．3）mU／L、0．5±0．3,分别与正常妊娠组比较,差异均有统计学意义（P〈0．01）。（2）妊娠期糖尿病组IRS．1蛋白表达水平为0．64±0．11,明显低于正常妊娠组的0．81±0．13,两组分别比较,差异均有统计学意义（P〈0．01）;正常非孕组IRS-1蛋白表达水平为0．83±0．12,与正常妊娠组比较,差异无统计学意义（P〉0．05）。（3）妊娠期糖尿病组基础及胰岛素刺激后的IRS-1酪氨酸磷酸化程度分别为0．35±0．12及0．48±0．14,均低于正常妊娠组的0．38±0．13及0．66±0．12,两组分别比较,差异均有统计学意义（P〈0．01）;正常妊娠组胰岛素刺激后的IRS．1酪氨酸磷酸化程度明显低于正常非孕组的0．85±0．09（P〈0．01）。（4）妊娠期糖尿病组IRS-1蛋白表达水平和胰岛素刺激后的酪氨酸磷酸化程度与HOMA-IR呈明显负相关（r=-0．613,-0．632;P〈0．01）;正常妊娠组胰岛素刺激后酪氨酸磷酸化程度与HOMA—IR呈明显负相关（r=-0．526,P〈0．05）。结论骨骼肌组织中IRS-1蛋白表达及其酪氨酸磷酸化程度异常,是妊娠期糖尿病患者发生胰岛素抵抗的分子机制之一。     

Serum adiponectin during pregnancy and postpartum in women with gestational diabetes and normal controls

Aims. To investigate changes in serum adiponectin during pregnancy and postpartum and assess its relationship with insulin resistance as measured by homeostasis model assessment (HOMA-IR).

Methods. Twenty-two normal pregnant women were compared with 22 women diagnosed with gestational diabetes mellitus (GDM). Serum adiponectin levels were measured at the time of the glucose challenge test as well as in the immediate postpartum period and the correlation of adiponectin to HOMA-IR was performed.

Results. Adiponectin was significantly lower in women with GDM than in controls during pregnancy (5381 vs. 8449 ng/dl, p = 0.004), as well as postpartum (3278 vs. 6958 ng/ml, p = 0.002). A significant reduction in adiponectin (3278 vs. 5381 ng/ml, p = 0.002) was observed postpartum in GDM women but not in controls. Using a lower cut-off value of 5253 ng/ml, maternal adiponectin could exclude GDM with a sensitivity of 86.4% and a specificity of 59.1% (area under the curve = 0.752, standard error = 0.77, 95% confidence interval 0.601–0.903, p = 0.004). Adiponectin levels during pregnancy were negatively correlated with HOMA-IR (r = ?0.375, p = 0.012).

Conclusion. GDM is associated with decreased serum adiponectin levels both in pregnancy as well as postpartum. Adiponectin is negatively correlated to HOMA-IR. A reduction in maternal adiponectin after delivery indicates a significant placental contribution to adiponectin production.     

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   

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     

妊娠期糖尿病合并慢性高血压孕妇胰岛素抵抗水平及其对妊娠结局的影响

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)合并慢性高血压(chronic hypertension,CHT)孕妇的胰岛素抵抗(insulin resistance,IR)水平及其对妊娠结局的影响。方法本研究为回顾性病例对照研究。纳入2014年1月1日至2016年12月31日在北京大学第一医院规律产前检查并参加GDM一日门诊的单胎妊娠GDM孕妇2457例。回顾临床资料,采用稳态模型评估IR水平(homeostasis model assessment insulin resistance,HOMA-IR)。根据GDM孕妇是否合并CHT分为GDM合并CHT组(n=47)和GDM未合并CHT组(n=2410),并进一步根据孕前体重指数(body mass index,BMI)分为孕前BMI正常组(n=1590)及孕前超重和肥胖组(n=863)进行分层分析。采用两独立样本t检验、χ2检验分析组间孕妇年龄、HOMA-IR、孕前BMI、孕期增重、血糖等临床特征的差异。采用logistic回归模型分析HOMR-IR水平对妊娠结局的影响。结果合并CHT的GDM孕妇HOMA-IR(3.5±1.8与2.6±1.5,t=-3.290)、空腹血浆葡萄糖[(5.4±0.5)与(5.2±0.5)mmol/L,t=-3.005]、孕前BMI[(26.7±4.7)与(23.3±3.4)kg/m2,t=-4.842]以及发生子痫前期的比例[14.9%(7/47)与2.5%(61/2410),χ2=21.790]高于未合并CHT的GDM孕妇,但孕期增重少于未合并CHT者[(9.6±5.8)与(12.2±4.7)kg,t=3.790](P值均<0.01)。根据孕前BMI分层后,超重和肥胖孕妇中,GDM合并CHT组子痫前期的比例高于GDM未合并CHT组[15.2%(5/33)与4.2%(35/830),χ2=6.290,P=0.012],但HOMA-IR差异无统计学意义(P>0.05);而对于孕前BMI正常的孕妇,GDM合并CHT组HOMA-IR(3.0±1.5与2.3±1.2,t=-2.217)、空腹血浆葡萄糖[(5.4±0.5)与(5.1±0.5)mmol/L,t=-2.299]和子痫前期的比例[2/14与1.6%(26/1576),χ2=6.545]均高于未合并CHT组(P值均<0.05)。对于GDM合并CHT孕妇,HOMA-IR水平不会增加剖宫产、早产、大于胎龄儿、小于胎龄儿和巨大儿的发生风险(P值均>0.05)。控制年龄、空腹血浆葡萄糖、孕前BMI、孕期增重后,对于未合并CHT的GDM孕妇,HOMA-IR水平的增加会使早产的发生风险增加(OR=1.223,95%CI:1.093~1.369,P<0.001)。结论GDM合并CHT孕妇胰岛素抵抗程度更重,子痫前期的发病率更高,但其他不良妊娠结局的发生风险未见增加。     

妊娠期糖尿病孕妇血清及皮下脂肪组织中视黄醇结合蛋白4的表达及其与胰岛素抵抗的关系

目的 探讨妊娠期糖尿病孕妇血清及皮下脂肪组织中视黄醇结合蛋白4(RBP-4)的表达变化及其与胰岛素抵抗的关系.方法 选择2008年5月至2009年4月在青岛大学医学院附属医院产科行选择性剖宫产术的妊娠期糖尿病孕妇32例为妊娠期糖尿病组,同期行选择性剖宫产术的糖耐量正常孕妇30例为对照组.采用酶联免疫吸附试验检测两组孕妇血清中RBP-4水平,放射免疫法榆测两组孕妇空腹胰岛素(FINS)水平,匍萄糖氧化酶法检测两组孕妇空腹血糖(FPG)水平,并计算稳态模型的胰岛索抵抗指数(HOMA-IR).采用半定量RT-PCR技术及蛋白印迹法检测两组孕妇皮下脂肪组织中RBP-4 mRNA和蛋白表达水平,并对妊娠期糖尿病组孕妇皮下脂肪组织中RBP-4mRNA和蛋白表达水平与血清中RBP-4水平及HOMA-IR行相关性分析.结果 (1)妊娠期糖尿病组孕妇血清中RBP-4、FINS、FPG水平及HOMA-IR分别为(27.0±1.2)mg/l、(12.1±1.4)mU/L、(5.3±019)mmol/L及2.5±0.2,对照组分别为(19.4 ±1.8)mg/L、(8.3±0.8)mU/L、(4.1±0.6)mmol/L及1.5±0.1,妊娠期糖尿病组孕妇以上4项指标均显著高于对照组(P均<0.05).(2)妊娠期糖尿病组孕妇皮下脂肪组织中RBP-4 mRNA和蛋白表达水平分别为0.76 ±0.12和0.74 ±0.09,显著高于对照组的0.53±0.06和0.54±0.06,两组分别比较,差异有统计学意义(P均<0.05).(3)妊娠期糖尿病组孕妇皮下脂肪组织中RBP-4 mRNA和蛋白表达水平与HOMA-IR均呈明显正相关关系(r=0.575、0.851,P均<0.05);血清巾RBP-4水平与HOMA-IR呈明显正相关关系(r=0.635,P<0.05);皮下脂肪组织中RBP-4 mRNA和蛋白表达水平与血清中RBP-4水平无明显相关性(P>0.05).结论 妊娠期糖尿病孕妇出现的皮下脂肪组织中RBP-4 mRNA高表达及血清中RBP-4高水平的变化,可能是妊娠期糖尿病孕妇发生胰岛素抵抗的机制之一.     

妊娠期糖尿病患者磺脲类药物受体1基因多态性的研究

目的　探讨与妊娠期糖尿病(GDM)遗传易感性相关的磺脲类药物受体 1(SUR1)基因型以及SUR1不同基因型与体重指数 (BMI)、胰岛素分泌水平之间的关系。方法　采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析方法,检测GDM患者 35例(GDM组)、2型糖尿病的女性住院患者 35例(T2DM组)、正常健康孕妇 35例 (正常对照组 )的SUR1基因型,包括 24内含子 (c和t等位基因,cc、ct和tt基因型)与 31外显子(A和G等位基因,AA、AG和GG基因型);用放射免疫法和葡萄糖氧化酶法测定GDM组患者空腹血糖、空腹胰岛素(INS0 )水平和口服 75g葡萄糖后 2h胰岛素(INS120 )水平。结果　(1)GDM组、T2DM组c等位基因频率 (分别为 70.0%、71.4% )均明显高于正常对照组的(52.9% ), 2组分别与正常对照组比较,差异均有统计学意义 (P<0.05)。(2)GDM组、T2DM组A等位基因频率(分别为 41.4%、44.3% )均明显高于正常对照组的 (24.3% ), 2组分别与正常对照组比较,差异均有统计学意义 (P<0.05 )。 ( 3 )GDM组 24内含子cc基因型患者BMI[ (29.2±5.6)kg/m2 ]、INS0 [ (14.9±8.7)mU/L]、INS120 [ (40.2±12.1)mU/L]均显著高于ct基因型患者[BMI(25.2±4.6)kg/m2、INS0 (10.1±6.2)mU/L、INS120 (32.7±10.5)mU/L]及tt基因型患者[BMI(24.2±1.7)kg/m2、     

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     

Vitamin C and the risk of gestational diabetes mellitus: a case-control study

OBJECTIVE: To examine whether low maternal dietary intake of vitamin C and low maternal plasma ascorbic acid (AA) concentrations are associated with an increased risk of gestational diabetes mellitus (GDM). METHODS: Cases were 67 women with GDM meeting National Diabetes Data Group criteria. Controls were 260 women without such a diagnosis. Maternal dietary vitamin C consumption during the periconceptional period and during pregnancy was assessed using a 121-item, semiquantitative food frequency questionnaire. Maternal plasma AA concentrations were determined using automated enzymatic procedures on specimens collected during the intrapartum period. RESULTS: Mean maternal daily consumption of vitamin C and plasma AA concentrations were 10% and 31% lower, respectively, among GDM cases as compared with controls (130.7 +/- 10.2 vs. 145 +/- 4.9 mg/d, P = .190; 36 +/- 2.0 vs. 53 +/- 1.0 micromol/L, P <.001). After controlling for maternal age, race, prepregnancy adiposity, family history of type 2 diabetes, energy intake and income, women reporting low daily vitamin C intake (< 70 mg/d), as compared with the other women, experienced a 3.7-fold increased risk of GDM (odds ratio [OR] = 3.7, 95% confidence interval [CI] 1.7-8.2). There was a linear relation in risk of GDM with decreasing concentrations of plasma AA (P for linear trend <.001). After adjusting for confounders, women in the lowest quartile (< 42.6 micromol/L), as compared with women in the highest quartile (> 63.3 micromol/L), experienced > 12-fold increased risk of GDM (OR = 12.8, 95% CI 3.5-46.2). CONCLUSION: Low maternal dietary vitamin C intake and low plasma AA concentrations are associated with an increased risk of GDM. Large, prospective, cohort studies are needed to further evaluate the potential beneficial role of vitamin C and other antioxidants in the prevention of impaired glucose tolerance in pregnancy.     

Increased serum retinol-binding protein 4 concentrations in women with gestational diabetes mellitus

The authors hypothesized that serum retinol-binding protein 4 (RBP4) concentrations will be higher in gestational diabetes mellitus (GDM) subjects. This study tested both women with GDM and healthy pregnant women and correlated their serum RBP4 concentrations with body mass index (BMI) and a variety of other parameters. Also, since there is no information on the relationship between RBP4 concentrations in maternal and fetal serum, this study measured these at delivery and examined whether there were correlations between the cord serum RBP4 levels and maternal serum RBP4 concentrations, neonatal birth weights, and gestational age at delivery. A total of 40 women were evaluated: 20 women with GDM and 20 healthy pregnant women to serve as control subjects. Serum RBP4 concentrations were analyzed with the use of an enzyme-linked immunosorbent assay kit. Serum RBP4 concentrations at glucose challenge test (GCT) were significantly higher in the GDM group (42.4 +/- 13.8 ng/mL) than in the healthy control group (32.0 +/- 8.7 ng/mL; P = .007). BMI at GCT (P = .003) and GDM/no GDM (P = .014) were significantly correlated to serum RBP4 concentrations at GCT by multiple linear regression analysis. In GDM subjects, serum RBP4 concentrations immediately after delivery were significantly lower than those at GCT (30.1 +/- 11.0 ng/mL, 42.4 +/- 13.8 ng/mL; P < .001), but there was no such difference in normal subjects (30.9 +/- 10.0 ng/mL, 32.0 +/- 8.7 ng/mL; P = .581). Cord serum RBP4 concentrations were significantly lower than maternal serum RBP4 concentrations at delivery (10.9 +/- 3.8 ng/mL, 30.5 +/- 10.4 ng/mL; P < .001). Only fetal birth weight (P = .049) was independently related to cord serum RBP4 concentrations at delivery by multiple linear regression analysis. This study found increased serum RBP4 concentrations at GCT in GDM subjects, and GDM was significantly correlated to serum RBP4 levels after adjustment for the effect of BMI. Lower RBP4 concentrations were found at delivery in GDM subjects. Maternal serum RBP4 concentrations were significantly higher than cord serum RBP4 concentrations, and fetal birth weights were independently correlated to cord serum RBP4 concentrations. These findings may indicate that RBP4 plays a role in the pathogenesis of GDM. However, further experiments are required to clarify this role and find a possible regimen for GDM treatment.     

Effect of smoking on serum concentrations of total homocysteine, folate, vitamin B12, and nitric oxide in pregnancy: a preliminary study

OBJECTIVE: Nitric oxide (NO) is a potent vasodilator released by endothelial cells that plays an important role in modulating maternal and fetal vascular tone in normal pregnancy. Lower plasma levels of vitamins may result in hyperhomocysteinemia, a known risk factor in pregnancy. The aim of this study was to investigate whether there are alterations in the serum levels of total homocysteine (tHcy), folate, vitamin B12, and total nitrite, as an index of NO, in smoking as compared with age-matched nonsmoking pregnant women. METHODS: Thirty-three women (19 smoking and 14 nonsmoking) between 16 and 22 weeks of their gestation were included in this study. The serum tHcy levels were analyzed by using an enzyme-linked immunosorbent assay kit. Vitamin B12 and folate values were measured by means of DPC kits. Total nitrite was measured by Griess reaction as an index of endogenous NO production. RESULTS: The serum tHcy concentrations were significantly increased in smoking as compared with nonsmoking pregnant women (p<0.001). The folate and vitamin B12 concentrations were lower in smoking than in nonsmoking pregnant women, but only the differences in folate concentrations were statistically significant (p<0.001). The tHcy concentrations showed a significant negative correlation with folate in the smoking pregnant women. The serum total nitrite concentrations were lower in smoking than in nonsmoking pregnant women (p<0.05). In addition, the serum nitrite levels in smoking pregnant women had significant negative correlations with tHcy and positive correlations with folate and vitamin B12 levels. CONCLUSIONS: In the light of our findings, we propose that smoking might enhance the vasoconstrictor capacity in pregnant women by increased tHcy concentrations and by a simultaneous decrease in the production of NO which is a vasodilator compound.