Determinants of Maternal Triglycerides in Women With Gestational Diabetes Mellitus in the Metformin in Gestational Diabetes (MiG) Study

OBJECTIVE

Factors associated with increasing maternal triglyceride concentrations in late pregnancy include gestational age, obesity, preeclampsia, and altered glucose metabolism. In a subgroup of women in the Metformin in Gestational Diabetes (MiG) trial, maternal plasma triglycerides increased more between enrollment (30 weeks) and 36 weeks in those treated with metformin compared with insulin. The aim of this study was to explain this finding by examining factors potentially related to triglycerides in these women.

RESEARCH DESIGN AND METHODS

Of the 733 women randomized to metformin or insulin in the MiG trial, 432 (219 metformin and 213 insulin) had fasting plasma triglycerides measured at enrollment and at 36 weeks. Factors associated with maternal triglycerides were assessed using general linear modeling.

RESULTS

Mean plasma triglyceride concentrations were 2.43 (95% CI 2.35–2.51) mmol/L at enrollment. Triglycerides were higher at 36 weeks in women randomized to metformin (2.94 [2.80–3.08] mmol/L; +23.13% [18.72–27.53%]) than insulin (2.65 [2.54–2.77] mmol/L, P = 0.002; +14.36% [10.91–17.82%], P = 0.002). At 36 weeks, triglycerides were associated with HbA_1c (P = 0.03), ethnicity (P = 0.001), and treatment allocation (P = 0.005). In insulin-treated women, 36-week triglycerides were associated with 36-week HbA_1c (P = 0.02), and in metformin-treated women, they were related to ethnicity.

CONCLUSIONS

At 36 weeks, maternal triglycerides were related to glucose control in women treated with insulin and ethnicity in women treated with metformin. Whether there are ethnicity-related dietary changes or differences in metformin response that alter the relationship between glucose control and triglycerides requires further study.Maternal metabolism in late pregnancy is catabolic, with increasing insulin resistance, decreased adipose tissue lipoprotein lipase (LPL) activity, and increased lipolysis (1). These processes combine to ensure the availability of maternal fuels such as glucose, fatty acids, and ketone bodies for fetal use (1). It is recognized that gestational age, maternal obesity (2), and preeclampsia (3) are associated with increases in lipids during pregnancy. Gestational diabetes mellitus (GDM) is also associated with abnormalities in maternal lipid metabolism (4–6), which may contribute to the elevated fat mass seen at birth in infants of women with GDM (7–10).Maternal glucose control and the pharmacological therapies used for treatment of GDM have the potential to influence these changes in maternal lipids (11). Insulin suppresses adipose tissue lipolysis and might be expected to reduce circulating triglycerides (12). Metformin reduces insulin resistance, but it has also been suggested to influence lipid metabolism (13), independent of glycemic control. In type 2 diabetes, metformin treatment is associated with a reduction in plasma triglyceride, total cholesterol, LDL cholesterol (13), and VLDL cholesterol concentrations (14). Metformin treatment in type 2 diabetes is also associated with increases in LPL mass level and LDL cholesterol particle size (15) and with a reduction in the release of free fatty acids from adipose tissue (16).We have recently examined maternal lipids in the Metformin in Gestational Diabetes (MiG) trial and found that maternal fasting plasma triglycerides and measures of glucose control at 36 weeks were the strongest predictors of customized birth weight >90th percentile (17). Interestingly, triglycerides increased more from randomization to 36 weeks'' gestation in women allocated to metformin than in those allocated to treatment with insulin, but there was no difference in customized birth weights or other neonatal anthropometry measures between the groups; there were also no differences in cord blood triglycerides (17). The aim of this study was to examine the known and putative determinants of maternal triglyceride concentrations and determine whether the difference seen in maternal plasma triglycerides at 36 weeks was due to treatment or other factors that may have differed between treatment groups.     

Mild Gestational Diabetes Mellitus and Long-Term Child Health

OBJECTIVETo evaluate whether treatment of mild gestational diabetes mellitus (GDM) confers sustained offspring health benefits, including a lower frequency of obesity.RESULTSFive hundred of 905 eligible offspring (55%) were enrolled. Maternal baseline characteristics were similar between the follow-up treated and untreated groups. The frequencies of BMI ≥95th (20.8% and 22.9%) and 85th (32.6% and 38.6%) percentiles were not significantly different in treated versus untreated offspring (P = 0.69 and P = 0.26). No associations were observed for BMI z score, log waist circumference, log triglycerides, HDL cholesterol, blood pressure, or log HOMA-estimated insulin resistance (HOMA-IR). The effect of treatment was different by sex for fasting glucose and log HOMA-IR (P for interaction = 0.002 and 0.02, respectively) but not by age-group (5–6 and 7–10 years) for any outcomes. Female offspring of treated women had significantly lower fasting glucose levels.CONCLUSIONSAlthough treatment for mild GDM has been associated with neonatal benefits, no reduction in childhood obesity or metabolic dysfunction in the offspring of treated women was found. However, only female offspring of women treated for mild GDM had lower fasting glucose.     

High Calorie Intake Is Associated With Worsening Insulin Resistance and β-Cell Function in Hispanic Women After Gestational Diabetes Mellitus

OBJECTIVETo assess associations between dietary intake and rates of change in insulin resistance and β-cell function in Hispanic women with prior gestational diabetes mellitus (GDM).RESULTSThe median length of follow-up from the first postpartum evaluation was 8.0 years (interquartile range 4.5–10.8 years). At baseline, women were 32 ± 5.7 years old and had a median calorie intake of 2,091 kcal/day. Over the course of follow-up, dietary intake did not change significantly. Higher baseline calorie intake was associated with a faster decline in insulin sensitivity, measured by the insulin sensitivity index (S_I) (P = 0.029), and β-cell compensation, measured by the disposition index (DI) (P = 0.027), over time. These associations remained after adjustment for baseline characteristics; changes in BMI, calorie intake, levels of physical activity; and additional pregnancies during the follow-up period. The median rates were −0.06 vs. −0.02 units/year for S_I and −810 vs. −692 units/year for DI for women with baseline calorie intake above versus below the cohort median.CONCLUSIONSHigh calorie intake is associated with a faster decline in insulin sensitivity and β-cell compensation in Hispanic women who are at high risk for type 2 diabetes, independent of adiposity.     

Self-Rated Health and Health Care Use Among Women With Histories of Gestational Diabetes Mellitus

OBJECTIVE

To examine self-rated health and health care utilization among women with a history of gestational diabetes mellitus (hGDM).

RESEARCH DESIGN AND METHODS

This study was a cross-sectional analysis of the 2006 National Health Interview Survey of parous women with (n = 370) and without (n = 6,695) hGDM.

RESULTS

Women with hGDM reported fair or poor health status and ≥10 office visits in the past year more frequently than women without hGDM. The higher prevalence of obesity in hGDM women accounted for their poorer self-rated health after adjustment for other demographic factors. Whereas the association between hGDM and more frequent office visits was reduced after adjustment for demographic factors including health insurance, hGDM was still associated with a lower odds of contact with a mental health professional.

CONCLUSIONS

Because of obesity, women with hGDM have poorer self-rated health than women without hGDM. Contact with mental health providers was reduced compared with women without hGDM.Self-rated health can act as a global summary measure of health and has been found to correlate with mortality (1) and health care use (2) independent of chronic disease. Studies that examine self-rated health among women with a history of gestational diabetes mellitus (hGDM) conflict (3–6), and health care use among hGDM women has not been reported. Women with hGDM may have poorer self-rated health than women without hGDM because of their poorer socioeconomic status (7), greater prevalence of obesity (7), and/or greater prevalence of postpartum depression (5). Therefore, we sought to determine whether women with hGDM had poorer self-rated health than parous women without hGDM, whether any differences persisted after adjustment for demographic factors and consideration of BMI and mental health distress, and whether hGDM women had different patterns of health care use than women without hGDM.     

Disproportionate Body Composition and Neonatal Outcome in Offspring of Mothers With and Without Gestational Diabetes Mellitus

OBJECTIVE

High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

Population-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998–2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm³) was ≤90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0–3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes.

RESULTS

The risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09–1.30]) and hypoglycemia (1.23 [1.11–1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section.

CONCLUSIONS

The risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA.High birth weight (BW), in both diabetic and nondiabetic pregnancies, is associated with increased risk of maternal and perinatal complications as well as long-term adverse health consequences for the offspring (1–10). Gestational diabetes and maternal obesity are well-established risk factors for high BW (11–14). In pregnancies with gestational diabetes mellitus (GDM), reported rates of high-BW infants range between 15 and 62.5% (15–18), corresponding to a several-fold increased risk compared with the general obstetric population (19). Complications associated with high BW include excessive maternal bleeding, prolonged labor, instrumental delivery, Cesarean section, perineal tears, stillbirth, neonatal birth trauma, low Apgar scores, acute respiratory disorders, hypoglycemia, and neonatal death (1–7). Irrespective of BW, GDM offspring face an excess risk of future morbidities (20–23). However, the risk may be even further increased in infants born with fetal macrosomia (24,25).The definition for high BW is not consistent. Current definitions are based on either absolute BW (>4,000 or 4,500 g) and referred to as fetal macrosomia or BW in relation to gestational age and sex (large for gestational age [LGA], BW >90th or 97.5th percentile). It is unclear which of these definitions best predicts the risk of adverse outcome. None of the current definitions take into account body proportionality, i.e., the relation between the infant''s BW and birth length (BL). The ponderal index (PI; i.e., BW in grams/BL in cm³) is a marker for body proportionality, and at a population level, the PI is a useful estimate of body proportionality when BW and BL are routinely collected. Fetal macrosomia or LGA in infants born to mothers with GDM and/or obesity is characterized by a disproportionate body composition with high BW in relation to BL (26) and increased fat mass (27–29).The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in LGA infants (BW >90th percentile) stratified by maternal GDM status. We hypothesized that infants with a disproportionate body composition, most likely as a consequence of fetal hyperinsulinemia, would have an increased risk of perinatal complications compared with those with a proportionate body composition.     

Epigenome-Wide Association Study Reveals Methylation Loci Associated With Offspring Gestational Diabetes Mellitus Exposure and Maternal Methylome

OBJECTIVEGestational diabetes mellitus (GDM) is associated with an increased risk of obesity and insulin resistance in offspring later in life, which might be explained by epigenetic changes in response to maternal hyperglycemic exposure.RESEARCH DESIGN AND METHODSWe explored the association between GDM exposure and maternal blood and newborn cord blood methylation in 536 mother-offspring pairs from the prospective FinnGeDi cohort using Illumina MethylationEPIC 850K BeadChip arrays. We assessed two hypotheses. First, we tested for shared maternal and offspring epigenetic effects resulting from GDM exposure. Second, we tested whether GDM exposure and maternal methylation had an epigenetic effect on the offspring.RESULTSWe did not find any epigenetic marks (differentially methylated CpG probes) with shared and consistent effects between mothers and offspring. After including maternal methylation in the model, we identified a single significant (false discovery rate 1.38 × 10⁻²) CpG at the cg22790973 probe (TFCP2) associated with GDM. We identified seven additional FDR-significant interactions of maternal methylation and GDM status, with the strongest association at the same cg22790973 probe (TFCP2), as well as cg03456133, cg24440941 (H3C6), cg20002843 (LOC127841), cg19107264, and cg11493553 located within the UBE3C gene and cg17065901 in FAM13A, both susceptibility genes for type 2 diabetes and BMI, and cg23355087 within the DLGAP2 gene, known to be involved in insulin resistance during pregnancy.CONCLUSIONSOur study reveals the potential complexity of the epigenetic transmission between mothers with GDM and their offspring, likely determined by not only GDM exposure but also other factors indicated by maternal epigenetic status, such as maternal metabolic history.     

Body Composition Is Normal in Term Infants Born to Mothers With Well-Controlled Gestational Diabetes Mellitus

OBJECTIVE

This study aims to describe body composition in term infants of mothers with gestational diabetes mellitus (GDM) compared with infants of mothers with normal glucose tolerance (NGT).

RESEARCH DESIGN AND METHODS

This cross-sectional study included 599 term babies born at Royal Prince Alfred Hospital, Sydney, Australia. Neonatal body fat percentage (BF%) was measured within 48 h of birth using air-displacement plethysmography. Glycemic control data were based on third-trimester HbA_1c levels and self-monitoring blood glucose levels. Associations between GDM status and BF% were investigated using linear regression adjusted for relevant maternal and neonatal variables.

RESULTS

Of 599 babies, 67 (11%) were born to mothers with GDM. Mean ± SD neonatal BF% was 7.9 ± 4.5% in infants with GDM and 9.3 ± 4.3% in infants with NGT, and this difference was not statistically significant after adjustment. Good glycemic control was achieved in 90% of mothers with GDM.

CONCLUSIONS

In this study, neonatal BF% did not differ by maternal GDM status, and this may be attributed to good maternal glycemic control.Fetal growth and development is affected through the altered intrauterine environment of gestational diabetes mellitus (GDM) (1,2). An accurate method to characterize overgrowth is by estimation of body composition, which includes fat mass (FM) and fat-free mass (FFM) (3,4). Previous studies have shown that increases in FM are present in infants of GDM pregnancies, regardless of their weight for gestational age (1,5). The gold-standard method of measuring body composition changes is air-displacement plethysmography (ADP) (4,6,7). The aim of this study was to describe body composition and anthropometric measurements at birth in term infants of women with GDM compared with infants of mothers with normal glucose tolerance (NGT) levels.     

Fatty Acid Composition of Serum Lipid Fractions in Relation to Gender and Quality of Dietary Fat

The fatty acid compositions of serum lipid fractions are believed to reflect the quality of dietary fat, but only a few cross-sectional studies have examined these relationships in a representative free-living population. We related the composition of dietary fat obtained by 7-day food records from 84 free-living middle-aged married couples, on their habitual diets, to gas chromatographic analyses of the percentage compositions of fatty acids in three lipid fractions of fasting sera. Dietary polyunsaturated fat had Pearson's correlation coefficients of 0.63, 0.73 and 0.44 with n-6 polyunsaturated fatty acids in serum cholesteryl esters, triglycerides and phospholipids, respectively. Intake of fish showed correlations of 0.60, 0.36 and 0.52 with the percentage of eicosapentaenoate in the respective fractions. Dietary saturated fat had correlations of 0.57 and 0.54 with saturated fatty acids in serum cholesteryl esters and triglycerides, respectively. Dietary monounsaturated fat did not correlate positively with mono-unsaturated fatty acids in any serum lipid fraction. There were some small but significant gender differences in the serum fatty acid compositions. Conclusions: of the three serum lipid fractions, triglycerides appear to be the best reflectors of dietary polyunsaturated and saturated fat, but the intake of monounsaturated fat is poorly reflected in all serum lipid fractions. Intake of fish is mirrored in all serum lipid fractions, best in cholesteryl esters and phospholipids.     

Prepregnancy Dietary Protein Intake,Major Dietary Protein Sources,and the Risk of Gestational Diabetes Mellitus: A prospective cohort study

OBJECTIVE

Dietary protein is an important modulator of glucose metabolism. However, studies regarding the association between dietary protein intake and gestational diabetes mellitus (GDM) risk are sparse. This study was to examine the association.

RESEARCH DESIGN AND METHODS

Our study included 21,457 singleton pregnancies reported among 15,294 participants of the Nurses'' Health Study II cohort between 1991 and 2001. Included pregnancies were free of chronic diseases before pregnancy or previous GDM. Generalized estimating equations were used to estimate the relative risks (RRs) and 95% CIs.

RESULTS

After adjustment for age, parity, nondietary and dietary factors, and BMI, multivariable RRs (95% CIs) comparing the highest with lowest quintiles were 1.49 (1.03–2.17) for animal protein intake and 0.69 (0.50–0.97) for vegetable protein intake. The substitution of 5% energy from vegetable protein for animal protein was associated with a 51% lower risk of GDM (RR [95% CI], 0.49 [0.29–0.84]). For major dietary protein sources, multivariable RRs (95% CIs) comparing the highest with the lowest quintiles were 2.05 (1.55–2.73) for total red meat and 0.73 (0.56–0.95) for nuts, respectively. The substitution of red meat with poultry, fish, nuts, or legumes showed a significantly lower risk of GDM.

CONCLUSIONS

Higher intake of animal protein, in particular red meat, was significantly associated with a greater risk of GDM. By contrast, higher intake of vegetable protein, specifically nuts, was associated with a significantly lower risk. Substitution of vegetable protein for animal protein, as well as substitution of some healthy protein sources for red meat, was associated with a lower risk of GDM.Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition during pregnancy, is a growing health concern (1). Approximately 7% (ranging from 1 to 14%) of all pregnancies in the U.S. are complicated by GDM, resulting in more than 200,000 cases annually (2). GDM is associated with an increased risk of adverse pregnancy and perinatal outcomes (3) and long-term adverse health consequences for both mothers and their children, including a predisposition to obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM) (1,2,4); thus, the identification of modifiable risk factors that may contribute to the prevention of GDM is important.Recently, several dietary and lifestyle factors have been associated with GDM risk, although precise underlying mechanisms have yet to be established (5). Macronutrients including carbohydrates (6) and fats (7) have previously been evaluated for their association with GDM risk. The association with protein, however, remains unclear. Dietary proteins and amino acids are important modulators of glucose metabolism, and a diet high in protein may impact glucose homeostasis by promoting insulin resistance and increasing gluconeogenesis (8). Moreover, emerging data suggest that protein actions may vary by the amino acid types and food sources. For instance, a prospective cohort study in Europeans showed that long-term high intake of animal protein but not vegetable protein was associated with an increased risk of T2DM (9). Additionally, a study of metabolomics recently demonstrated that plasma concentrations of several kinds of amino acids, including branched-chain amino acids (BCAAs) and aromatic amino acids, were strongly and significantly associated with incident T2DM risk (10).Several major food sources of animal protein, such as red meat, were positively associated with the risk of both T2DM (11) and GDM (12). Conversely, higher intakes of nuts (13) and legumes (14) were associated with a lower risk of T2DM, but their associations with GDM have not yet been evaluated. In addition, the associations between other major sources of animal protein (e.g., poultry, fish, and dairy products) and GDM risk have not been reported.In this prospective cohort study, we aimed to examine the associations of prepregnancy dietary protein intake (total, animal, and vegetable protein) as well as major dietary protein sources with the risk of GDM. We also estimated the effect of substituting prepregnancy protein for carbohydrates, substituting vegetable protein for animal protein, and substituting other major dietary protein sources for red meat on the risk of GDM.     

Genetic Risk of Progression to Type 2 Diabetes and Response to Intensive Lifestyle or Metformin in Prediabetic Women With and Without a History of Gestational Diabetes Mellitus

OBJECTIVE

The Diabetes Prevention Program (DPP) trial investigated rates of progression to diabetes among adults with prediabetes randomized to treatment with placebo, metformin, or intensive lifestyle intervention. Among women in the DPP, diabetes risk reduction with metformin was greater in women with prior gestational diabetes mellitus (GDM) compared with women without GDM but with one or more previous live births.

RESEARCH DESIGN AND METHODS

We asked if genetic variability could account for these differences by comparing β-cell function and genetic risk scores (GRS), calculated from 34 diabetes-associated loci, between women with and without histories of GDM.

RESULTS

β-Cell function was reduced in women with GDM. The GRS was positively associated with a history of GDM; however, the GRS did not predict progression to diabetes or modulate response to intervention.

CONCLUSIONS

These data suggest that a diabetes-associated GRS is associated with development of GDM and may characterize women at risk for development of diabetes due to β-cell dysfunction.     

超声心动图Tei指数在妊娠期糖尿病孕妇胎儿心脏功能评价中的应用

目的探讨超声心动图Tei指数在妊娠期糖尿病(GDM)孕妇胎儿心脏功能评价中的应用价值。方法选取在本院住院分娩的120例GDM孕妇和120例健康妊娠孕妇作为研究对象,分别为观察组和对照组。对两组胎儿进行超声心动图检查,对比两组胎儿的心功能检测结果。结果观察组与对照组胎儿的LVDd、LVDs、RVDd、RVDs水平比较,差异均无统计学意义(P>0.05);与对照组相比,观察组胎儿的IVSs、IVSd、LVWTd、LVWTs、RVWTd、RVWTs水平明显更高(P<0.05)。观察组胎儿的LVEF、LVFS、RVFS水平均显著高于对照组,E/AMV、E/ATV水平均显著低于对照组(P<0.05)。观察组胎儿的左室Tei指数、右室Tei指数均显著高于对照组(P<0.05)。结论GDM孕妇胎儿普遍存在心脏结构及功能受损,超声心动图Tei指数能够较为准确地评估胎儿心室功能受损情况,从而为临床早期诊断胎儿心功能受损提供可靠依据。     

不同糖化血红蛋白控制水平对妊娠糖尿病妊娠结局的影响分析

目的 探讨不同糖化血红蛋白控制水平对妊娠糖尿病妊娠结局的影响.方法 选取深圳市人民医院2008～2009年住院分娩妊娠糖尿病患者136例,以糖化血红蛋白≥6.0%为A组,<6.0%为B组,比较两组的空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、胰岛素(FINS)、稳态模式法的胰岛素抵抗指数(HOMA-IR)以及妊娠结局的差异.结果 A组的FBG,TC,TG,LDL-C,FINS,HOMA-IR均高于B组,差异有统计学意义.除胎膜早破和巨大儿两者差异不明显外,A组的妊高征、羊水过多、剖宫产、新生儿窒息、高胆红素血症均显著高于B组.HbA1c与FPG显著正相关,相关系数为0.912 (P<0.05).结论 GDM患者的HbA1c水平与妊娠结局相关.     

Association of Maternal Folate and Vitamin B12 in Early Pregnancy With Gestational Diabetes Mellitus: A Prospective Cohort Study

OBJECTIVETo investigate the association of folate and vitamin B₁₂ in early pregnancy with gestational diabetes mellitus (GDM) risk.RESEARCH DESIGN AND METHODSThe data of this study were from a subcohort within the Shanghai Preconception Cohort Study. We included pregnancies with red blood cell (RBC) folate and vitamin B₁₂ measurements at recruitment (between 9 and 13 gestational weeks) and those with three samples available for glucose measurements under an oral glucose tolerance test. GDM was diagnosed between 24 and 28 weeks’ gestation. Odds ratio (OR) and 95% CI of having GDM was used to quantify the association.RESULTSA total of 1,058 pregnant women were included, and GDM occurred in 180 (17.01%). RBC folate and vitamin B₁₂ were significantly higher in pregnancies with GDM than those without GDM (P values were 0.045 and 0.002, respectively) and positively correlated with 1-h and 2-h serum glucose. Daily folic acid supplementation in early pregnancy increases the risk of GDM; OR (95% CI) was 1.73 (1.19–2.53) (P = 0.004). Compared with RBC folate <400 ng/mL, pregnancies with RBC folate ≥600 ng/mL were associated with ∼1.60-fold higher odds of GDM; the adjusted OR (95% CI) was 1.58 (1.03–2.41) (P = 0.033). A significant trend of risk effect on GDM risk across categories of RBC folate was observed (P_trend = 0.021). Vitamin B₁₂ was significantly associated with GDM risk (OR 1.14 per 100 pg/mL; P = 0.002). No significant association of serum folate and percentile ratio of RBC folate/vitamin B₁₂ with GDM was observed.CONCLUSIONSHigher maternal RBC folate and vitamin B₁₂ levels in early pregnancy are significantly associated with GDM risk, while the balance of folate/vitamin B₁₂ is not significantly associated with GDM.     

孕期营养指导对妊娠期糖尿病患者母婴结局的影响

目的探索孕期营养指导对于妊娠期糖尿病患者母婴结局的影响。方法选取我院2015年10月~2016年12月收治的400例妊娠期糖尿病患者。两组患者接受常规治疗,根据孕期管理方法的不同分入到观察组和对照组中,对照组患者给予常规孕期管理,观察组患者给予孕期营养指导,对比分析两组产妇并发症发生率、新生儿并发症发生率。结果观察组孕妇的并发症发生率(胎膜早破、羊水过多、产褥期感染)以及新生儿并发症发生率(巨大儿、新生儿窒息、新生儿低血糖、新生儿呼吸窘迫综合症)均比对照组更低,差异有统计学意义(P<0.05)。结论孕期营养指导用于妊娠期糖尿病患者有助于改善母婴结局,具有临床推广应用价值。