妊娠期糖尿病孕妇产后糖代谢异常的研究

目的　了解妊娠期糖尿病（ＧＤＭ） 患者产后糖代谢异常情况、筛出预测产后糖代谢异常的高危因素及ＧＤＭ 患者远期糖尿病发生情况。　方法　收集１９８２ 年１１ 月～１９９８ 年４ 月在我院分娩并产后随访的９７ 例ＧＤＭ 孕妇,其中远期随访１～８ 年者３３ 例。　结果　ＧＤＭ 产后近期随访诊断为显性糖尿病者２３ 例,糖耐量减低１１ 例,列为产后糖代谢异常组。与产后糖代谢正常组（４１ 例） 进行比较发现：糖尿病家族史、孕期血糖异常出现时间、糖筛查血糖高、空腹血糖升高以及糖尿病孕期治疗情况两组间存在明显差异。远期追踪３３ 例中显性糖尿病１０ 例,糖耐量减低３ 例。　结论　ＧＤＭ产后仍有部分患者糖代谢不能恢复正常,尤其有糖尿病家族史,在妊娠２４ 周以前确诊ＧＤＭ,糖筛查血糖较高,空腹血糖升高,孕期需胰岛素治疗者更应重视产后血糖检查,以便及时发现产后糖代谢异常。产后近期糖代谢正常者,仍需进行远期随访     

妊娠期糖尿病空腹血糖筛查的意义及其对妊娠结局的影响

妊娠期糖尿病(gestational diabetes mellitus,GDM)的发生率逐年上升,不良妊娠结局与血糖水平相关,即使妊娠妇女的血糖水平在正常范围,随着血糖水平的升高,大于胎龄儿、剖宫产率、新生儿低血糖、新生儿高胰岛素血症及生后糖尿病的发生等母儿不良预后的发生率增加,尽早诊断及治疗GDM有助于改善不良妊娠结局。利用空腹血糖(fasting plasma glucose,FPG)筛查GDM越来越受关注。其具有操作简单,价格低廉,可重复率高并且容易被妊娠妇女接受等优点。近年来许多研究证实,妊娠早期FPG与葡萄糖负荷试验(glucose challenge test,GCT)及口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)的血糖水平呈正相关,且显著降低了需要行OGTT检查的人数。故FPG筛查对GDM有较高的价值。     

妊娠期糖尿病与妊娠高血压综合征相关因素的探讨

目的 :探讨妊娠糖尿病 (GDM)与妊娠高血压综合征 (妊高征 ,PIH)的相关因素。方法 :将 16 1例 GDM分为三组 ,GDM合并 PIH的 39例中 ,2 3例合并轻度 PIH分为 组 ;16例 GDM合并中、重度妊高征者为 组 ;12 2例单纯GDM为 组。结果 :1 组孕期体重增加值大于其余两组 (P=0 .0 2 8,P=0 .0 33)。 组有高血压家族史者明显高于 组(P=0 .0 0 7)。 2 组肾功能改变、眼底改变、血粘度、外周血管阻力异常发生率高于 组 (P=0 .0 0 4 ,0 .0 0 6 ,0 .0 0 5 ,0 .0 0 3)。孕 2 4～ 2 8周的平均动脉压 (MAP) 组比 、 组均高 (P=0 .0 0 9,P=0 .0 0 5 )。 3孕期血糖控制满意率 组远低于其他两组 (P=0 .0 0 1,P=0 .0 0 2 )。结论 :高血压家族史及孕期体重异常增加、孕中期 MAP升高、血粘度增加和外周血管阻力增高及孕期血糖控制不满意均为 GDM合并 PIH的高危因素     

妊娠期糖尿病基因多态性研究进展

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

Gestational Diabetes Mellitus: Insulinic Management

Diabetic pregnancies have attendant risks. Adverse fetal, neonatal, and maternal outcomes in a diabetic pregnancy can be avoided by optimum glycemic control. Most pregnancies with GDM can be managed with non-insulinic management, which includes medical nutrition therapy. However, many necessitate concomitant insulinic management. The new insulin analogs present undoubted advantages in reducing the risk of hypoglycemia, mainly during the night, and in promoting a more physiologic glycemic profile in pregnant women with diabetes. Rapid-acting insulin analogs seem to be safe and efficient in reducing postprandial glucose levels more proficiently than regular human insulin, with less hypoglycemia. The long-acting insulin analogs do not have a pronounced peak effect as NPH insulin, and cause less hypoglycemia, mainly during the night. The review focuses on glycemic goals in pregnancy, insulinic management of GDM, and posology of insulin and its analogs. Clear understanding of the insulinic management of GDM is essential for women’s health care providers to provide comprehensive care to women whose pregnancies are complicated with diabetes and rechristen the ‘‘diabetic capital of the world’’ to the ‘‘diabetic care capital of the world.’’     

Fetal Breathing Activity in WelLControlled Dietary-Treated Gestational Diabetes Mellitus

The purpose of our study was to assess fetal breathing activity in well-controlled gestational diabetic women. The study group included 20 dietary-treated well-controlled gestational diabetic women in their third trimester. During a 20-min observation period, the number and length of breathing episodes and the number of breathing movements in each episode were recorded, and the percentage of time spent in breathing activity and the frequency of fetal breathing movements were calculated. The control group included 20 women with uncomplicated pregnancies, matched for gestational age. The fetuses of the study group spent more time in breathing activity (65% vs. 26%, P < 0.0001), due to a higher number of breathing episodes with a duration of >30s (8.25 vs. 2.4, P < 0.0001). This occurred despite similar blood glucose levels in the two groups, sampled just before the recordings. No differences were found in either the number of short breathing episodes or the rate of breathing movements per minute. Fetal breathing activity, even in well-controlled gestational diabetic women, is significantly higher than in normal pregnancies and resembles the breathing activity pattern described in type I diabetes. It is suggested that blood glucose level is not the only factor involved in the regulation of breathing activity in gestational diabetes mellitus.     

妊娠期血脂改变与妊娠期糖尿病的关系

妊娠期随着雌孕激素的变化,内分泌代谢也会发生相应的生理性改变,但当改变超过生理性上限时会引发一系列妊娠期并发症,如妊娠期糖尿病（gestational diabetes mellitus,GDM）、妊娠期高血压疾病、胎膜早破、早产和巨大儿等。GDM是其中较为常见的并发症,作为一种内分泌疾病,GDM常伴有糖代谢和脂代谢异常。而血脂代谢的异常也会增加GDM的患病风险。在妊娠早期发现血脂异常并加以控制,对GDM的预防、确诊和治疗意义重大,因此对GDM脂代谢的研究是十分有意义的。究竟是血脂代谢的改变增加了GDM的患病风险,还是GDM的发病导致了血脂代谢的紊乱,并没有明确的研究成果。综述妊娠期正常血脂代谢及妊娠期血脂代谢与GDM关系的研究进展。     

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

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

妊娠期糖尿病的影响因素及围生结局的研究分析

目的:通过对天津地区妊娠期糖尿病(GDM)的影响因素及围生结局进行回顾性分析,加深对GDM的认识,为其防治提供一定的研究依据。方法:选取2014年1—6月参加天津市GDM检测的孕妇47 118例,其中确诊GDM3 650例纳入GDM组,其余43 468例纳入非GDM组,对两组孕妇的相关资料进行比较分析。结果:GDM组年龄≥35岁、大专及以上学历、孕前超重和肥胖比例均高于对照组,差异有统计学意义(P<0.01);多因素Logistic回归分析显示,年龄大、城市户籍、文化程度高、孕前BMI高及多胎妊娠是GDM的危险因素。GDM组剖宫产、早产、妊娠期高血压疾病、巨大儿及低出生体质量儿的发生均高于非GDM组,差异有统计学意义(P<0.01)。结论:GDM发病与多种因素有关,应重视相关的危险因素,并加强GDM妊娠期管理,降低母婴并发症的发生。     

妊娠早期脂肪因子水平预测妊娠期糖尿病研究进展

妊娠期糖尿病（gestational diabetes mellitus,GDM）是一种妊娠过程中常见的并发症,其发病率正在逐年上升,对母儿近期及远期健康均有不良影响。虽然GDM的发病机制不明,但通过在妊娠早期筛查血清中高危因子以预测GDM的发生,对促进GDM的早期干预和减轻危害具有重要意义。目前研究发现,多种脂肪细胞因子在妊娠早期与GDM的发生风险增加有关,包括降低的脂联素、网膜素1、鸢尾素、趋化因子水平和升高的瘦素、抵抗素、内脂素、脂肪酸结合蛋白4、视黄醇结合蛋白4、促代谢因子水平。这些脂肪因子水平变化对未来GDM预测模型的建立提供理论支持。     

妊娠期糖尿病发病机制及对母婴的影响

年龄、肥胖、种族、不良孕育史和糖尿病家族史是影响妊娠期糖尿病(gestational diabetes mellitus,GDM)的主要因素.胰岛索抵抗是其主要发病机制.GDM对母儿影响的严重程度与病情及血糖控制情况密切相关,主要表现为妊娠期高血压、羊水过多、巨大儿、早产、难产及软产道损伤、剖宫产等发生率明显增高,还可...     

动态监测妊娠期糖尿病患者餐后血糖的变化规律

目的:利用动态血糖监测系统探讨妊娠期糖尿病(GDM)患者餐后血糖变化规律。方法:对我院门诊产检孕妇进行GDM筛查,采用两步法进行诊断,选取15例GDM患者利用动态血糖监测系统(CGMS)进行连续72小时血糖监测。取餐后03、0、60、90、120、150、180分钟数据进行分析。结果:15例GDM孕妇早餐后血糖升幅较午餐及晚餐明显,进餐前血糖为最低时段(5.15±0.01)mmol/L。餐后3小时内平均血糖值5.96±1.63 mmol/L,餐后血糖峰、谷值分别为9.58±1.38 mmol/L、3.36±0.47 mmol/L;血糖波动最大幅度10.3 mmol/L。餐后2小时血糖≥7.2mmol/L者占47%(7例),餐后2小时血糖≥11.1 mmol/L者占6%(1例),餐后2小时、3小时血糖≤3.9 mmol/L者占27%(4例)。结论:CGMS系统有助于动态观察GDM患者餐后血糖水平,可为临床GDM患者饮食、运动、药物治疗的选择提供依据。     

二次OGTT诊断妊娠期糖尿病围生结局分析

【摘 要】 目的：探讨二次口服葡萄糖耐量试验（oral glucose tolerance test,OGTT）诊断妊娠期糖尿病（gestational diabetes mellitus,GDM）的围生结局。方法：初次OGTT诊断GDM者188例,作为GDM1组。二次OGTT诊断GDM者38例,作为GDM2组;同期血糖正常产妇200例,作为对照组。比较3组产妇围生结局,如产后出血、早产、胎膜早破、巨大儿等。结果：GDM2组的产后出血、胎膜早破、大于胎龄儿发生率高于对照组,差异有统计学意义（P＜0.05）;GDM2组的巨大儿发生率高于GDM1组,差异有统计学意义（P＜0.05）。结论：二次OGTT可以提高GDM的诊断率,从而尽早诊断、积极干预GDM,改善妊娠结局。     

代谢组学方法在妊娠期糖尿病研究中的应用

妊娠期糖尿病（GDM）易造成子痫前期、羊水过多、巨大儿等多种并发症。目前在妊娠中晚期检测血糖筛查GDM,确诊患者接受治疗的时间短,母婴健康存在严重隐患。代谢组学（metabolomics）是一种定量考察生命系统受内外界刺激或基因修饰后的代谢应答规律的学科。将代谢组学的方法应用于GDM研究,有望实现GDM的早期诊断,理解GDM的致病机制,对GDM的防治和母婴预后都有重要的意义。综述代谢组学方法在GDM及相关疾病研究中的应用。     

First-Trimester Abdominal Adipose Tissue Thickness to Predict Gestational Diabetes

Objective

To estimate the discriminative capacity of first-trimester subcutaneous (SATT), visceral (VATT), and total (TATT) adipose tissue thickness in predicting gestational diabetes mellitus (GDM), including that requiring insulin.

糖化血红蛋白联合空腹血糖检测在妊娠期糖尿病诊断中的应用价值

目的：建立天津市中心妇产科医院（我院）孕妇孕中期糖化血红蛋白（HbA1c）的正常参考区间,并探讨HbA1c联合空腹血糖（FPG）检测在妊娠期糖尿病（GDM）诊断中的应用价值。方法：依据2010年国际妊娠合并糖尿病研究组织（IADPSG）推荐的GDM诊断标准,从2016年5-12月期间在我院行75 g口服葡萄糖耐量试验（OGTT）产前检查的孕24～28周的孕妇中筛查出196例GDM孕妇作为GDM组,以同期健康孕妇320例作为对照组（健康孕妇组）,同时收集其相关的临床资料。采用高效液相色谱法检测HbA1c水平,采用受试者工作特征（ROC）曲线分析HbA1c联合FPG用于筛查GDM的价值。结果：①GDM组的年龄、孕前体质量和孕前体质量指数（BMI）均高于健康孕妇组（P＜0.01）,2组孕妇的孕周和身高比较差异无统计学意义（P＞0.05）;②GDM组HbA1c水平和OGTT各时点血糖水平均高于健康孕妇组,差异有统计学意义（P＜0.01）;③320例健康孕妇HbA1c水平符合正态分布,其孕中期HbA1c水平的正常参考区间（取其第2.5～97.5百分位数）为4.4%～5.8%;④当HbA1c为5.35%时,其预测GDM的敏感度（44.9%）和特异度（77.5%）最高,此时HbA1c诊断GDM的ROC曲线下面积（AUC）为0.665（95%CI：0.617～0.713）;HbA1c（≥5.35%）联合FPG（≥5.1 mmol/L）诊断GDM的AUC为0.933（95%CI：0.909～0.957）。结论：建立了我院孕妇孕中期HbAlc的正常参考区间。HbAlc联合FPG检测简单、方便,有望成为GDM诊断的有力补充。