Plasma and erythrocyte magnesium changes following a glucose challenge during pregnancy.

This study examined the effects of pregnancy and glucose loading on plasma and erythrocyte (RBC) magnesium (Mg) concentrations. In a completely randomized design with repeated measures, 15 nonpregnant, 15 early pregnant (13-17 weeks) and 15 late pregnant (28-34 weeks) women ingested 100 g glucose. Blood was collected at 0, 30, 60, 120 and 180 minutes to evaluate changes in Mg levels. Fasting plasma Mg concentrations decreased slightly but not significantly as gestational age of the groups increased. Fasting RBC Mg concentrations were significantly higher (p less than 0.05) in late pregnant women compared with early pregnant and nonpregnant women. Plasma Mg responses to a glucose challenge in nonpregnant women exhibited a curvilinear pattern whereas responses in pregnant women appeared unaffected by the glucose challenge. RBC Mg concentrations for nonpregnant and early pregnant women failed to respond to the glucose challenge whereas it decreased in a linear pattern during late pregnancy. The diabetogenic effect of late pregnancy appears to affect RBC Mg. This redistribution of Mg during late pregnancy could suggest a possible role for RBC as a Mg pool.     

Effect of a glucose challenge on plasma copper levels during pregnancy

This study examined the effect of pregnancy and glucose loading on plasma copper (Cu) levels. In a completely random design with repeated measures, 18 nonpregnant women, 16 early pregnant women (13-17 weeks), and 16 late pregnant women (28-34 weeks) ingested 100 g glucose with blood collected at 0, 30, 60, 120, and 180 minutes to evaluate changes in Cu levels in blood. Plasma Cu and plasma ceruloplasmin (CP) activity increased significantly (p less than 0.05) as pregnancy progressed, even though there were no significant differences in dietary Cu intakes. Plasma Cu and CP activity responses to the glucose challenge were similar for the three groups. Combined data from the three groups showed a significant (p less than 0.05) increase in plasma Cu by 30 minutes, which dropped significantly (p less than 0.05) by 180 minutes, and a significant decrease (p less than 0.05) in plasma CP activity from baseline to 180 minutes. Although plasma Cu and CP activity were altered with pregnancy, their responses to a glucose challenge did not appear to be associated with the diabetogenic state of pregnancy.     

Blood and urinary zinc changes after a glucose challenge in early and late pregnancies

This study was undertaken to investigate the effect of pregnancy and glucose loading on zinc metabolism. In a completely random design with repeated measures, 18 non-pregnant women, 16 early-pregnant women (13-17 wk), and 16 late-pregnant women (28-34 wk) had blood collected at 0, 30, 60, 120, and 180 min after ingesting 100 g glucose to evaluate changes in variables of Zn nutriture. Fasting plasma Zn concentrations decreased significantly as pregnancy progressed. Late-pregnant women had significantly higher erythrocyte Zn levels and greater 24-h urinary Zn and glucose excretions. Erythrocyte Zn responses to glucose loading were unaffected by gestational age. Plasma Zn after a glucose load in nonpregnant women exhibited a curvilinear response whereas pregnant women showed no change. This lack of response by pregnant women may be related to their lower plasma Zn concentrations. Plasma Zn in pregnant women may not be as readily available to assist in glucose utilization.     

Dietary Intake in Early Pregnancy and Glycemia in Late Pregnancy among Women with Obesity

Women with obesity have increased risk for hyperglycemia during pregnancy, with negative health consequences for mother and child. We aimed to investigate adherence to nutritional recommendations in early pregnancy and to examine associations between early pregnancy dietary intake and late pregnancy glycemia among women with obesity. We included 120 women with pre-pregnancy body mass index (BMI) ≥30 kg/m² who participated in one of two randomized controlled trials. The participants completed a food frequency questionnaire in early pregnancy (gestational weeks 12–22). Fasting and 120 min glucose tolerance after ingestion of 75 g glucose were assessed in late pregnancy (gestational weeks 32–37). About 90% of the participants reported early pregnancy diary intake within the recommendations. Average intakes of vitamin D, iron, and folate were below recommended levels. High intakes of dairy products and protein in early pregnancy were associated with lower fasting glucose in late pregnancy, whereas high intake of bread was associated with lower 120 min glucose. There were no clear associations between single dietary variables and gestational diabetes mellitus (GDM) diagnosis in late pregnancy. In conclusion, some early pregnancy dietary variables were associated with late pregnancy glycemia. Potential causality of these findings should be investigated in future studies.     

Sweet taste and intake of sweet foods in normal pregnancy and pregnancy complicated by gestational diabetes mellitus.

BACKGROUND: Dietary compliance in gestational diabetes mellitus (GDM) is poor. Changes in sweet taste perception might alter food preferences in GDM, making dietary compliance difficult to achieve. These indexes have never been studied in GDM. OBJECTIVES: This study documented changes in sweet taste perception and dietary intakes in pregnant women with and without GDM and determined whether these differences persisted postpartum. DESIGN: Subjects were 30 pregnant women without GDM, 25 pregnant women with recently diagnosed GDM, and 12 nonpregnant control subjects. Pregnant women were tested at 28-32 wk gestation and retested 12 wk postpartum. Subjects evaluated the taste of strawberry-flavored milks with different sucrose (0-10%) and fat (0-10%) contents and glucose solutions (10-160 mmol/L). RESULTS: Women with GDM showed no differences in liking for the milk samples across test sessions and their liking ratings were not significantly different from those of nonpregnant control subjects. Women without GDM liked the 10% sucrose-sweetened milk samples less during pregnancy than at 12 wk postpartum (P 相似文献   

Plasma carnitine and renal-carnitine clearance during pregnancy

This study assessed the time course of decrease in plasma carnitine during pregnancy and compared the renal clearance of carnitine during late pregnancy with nonpregnant women. As early as the 8th wk of pregnancy, the mean (+/- SD) value of total plasma-carnitine concentration in 19 women was significantly decreased from 39.0 +/- 6.3 to 32.8 +/- 4.6 mumol/l and the values continued to fall to 17.3 mumol/l by the 36th wk. The pattern was due to a fall in free-carnitine level; acylcarnitine remained unchanged. In 12 other women examined during late pregnancy, the renal clearance of acylcarnitine was significantly higher than in nonpregnant women, 53.9 +/- 29.4 versus 13.3 +/- 3.0 ml/min, in contrast to free carnitine, 3.5 +/- 2.8 versus 2.8 +/- 1.9 ml/min. Urinary excretion of carnitine (expressed per mol creatinine) did not differ between the two groups. Pregnant women showed sustained excretion of carnitine in the presence of low plasma-carnitine concentrations.     

Obligatory nitrogen losses in pregnant rats with special reference to estimation of net protein utilization.

For estimation of net protein utilization of dietary proteins during pregnancy, obligatory nitrogen losses were measured in protein-deficient rats in which pregnancy was maintained by administration of ovarian steroids. On shift from normal to protein-free diet, urinary nitrogen, expressed as mg/day or mg/100 g BW per day, decreased initially rapidly and then gradually during the first two weeks in both pregnant and nonpregnant rats. However, urinary endogenous nitrogen increased during the final week of pregnancy, whereas it continued to decrease in nonpregnant controls. The endogenous urinary nitrogen excretions during early-mid and late pregnancies were significantly higher in pregnant rats (666 mg/15 days and 234 mg/6 days, respectively) than in nonpregnant animals (585 mg/15 days and 153 mg/6 days, respectively), indicating pregnancy-induced protein hypercatabolism. The metabolic fecal nitrogen excretions in pregnant and nonpregnant rats were comparable. In pregnant rats, a protein-free diet resulted in decrease of basal energy expenditure, from 24 kcal/day on day 1 to about 15 kcal/day on days 16, 19 and 22 of pregnancy. Thus, the ratio of endogenous urinary nitrogen to basal energy expenditure increased in late pregnancy, indicating that "the law of a constant relationship of minimal nitrogen and energy output" is not applicable to the pregnant animals. We discuss which values for obligatory nitrogen loss should be used for estimating the net utilization efficiency of dietary proteins in pregnancy.     

Humoral and cell mediated immune responses to a pertussis containing vaccine in pregnant and nonpregnant women

Vaccination of pregnant women is recommended for some infectious diseases in order to protect both women and offspring through high titres of maternal IgG antibodies. Less is known on the triggering of cellular immune responses by vaccines administered during pregnancy. In an ongoing study on maternal pertussis vaccination (2012–2014) 18 pregnant women were vaccinated with a tetanus-diphtheria-acellular pertussis (Tdap) containing vaccine (Boostrix®) during the third pregnancy trimester. Sixteen age-matched nonpregnant women received the same vaccine in the same time period. A blood sample was taken at the moment of, but before vaccination and one month and one year after vaccination. Anti-Pertussis Toxin (PT), filamentous hemagglutinin (FHA), pertactin (Prn), tetanus toxin (TT) and diphtheria toxin (DT) antibodies were measured by ELISA. Cellular immune responses were analyzed using a diluted whole blood assay, measuring proliferation, and cytokine release in response to vaccine antigens PT, FHA, TT, and to pokeweed mitogen (PWM) as polyclonal stimulus.Antibody levels to all five vaccine components increased significantly and to the same extent after vaccination in pregnant and nonpregnant women. One year after vaccination, antibody titres had decreased particularly to PT, but they were still significantly higher to all antigens than before vaccination. In contrast, proliferative and IFN-γ responses were increased to TT, PT, and FHA in nonpregnant women one month after vaccination, whereas in pregnant women only TT specific T cell responses were increased and to a lesser extent than in the control group. One year after vaccination, cellular responses equaled the baseline levels detected prior to vaccination in both groups. In conclusion, a Tdap vaccination can increase vaccine specific IgG antibodies to the same extent in pregnant and in nonpregnant women, whereas the stimulation of vaccine specific Th1 type cellular immune responses with this acellular vaccine is transient and impaired during pregnancy.     

Reactogenicity and immunogenicity of tetanus toxoid,reduced diphtheria toxoid,and acellular pertussis vaccine (Tdap) in pregnant and nonpregnant women

ObjectiveTetanus toxoid, reduced diphtheria toxoid, and acellular pertusiss (Tdap) vaccine is recommended during each pregnancy, regardless of prior receipt. Data on reactogenicity and immunogenicity, particularly after repeated Tdap, are limited. We compared local injection-site and systemic reactions and serologic response following Tdap in (1) pregnant and nonpregnant women and (2) pregnant women by self-reported prior Tdap receipt.Study designPregnant women (gestational age 20–34 weeks) and nonpregnant women receiving Tdap were enrolled in this observational study. Injection-site and systemic reactions were assessed for one week post-vaccination. Pertussis toxin, filamentous hemagglutinin, pertactin, fimbriae, tetanus and diphtheria specific IgG antibody titers were determined by standardized enzyme-linked immunosorbent assay at baseline and 28 days post-vaccination. Reactogenicity and serologic responses were compared by pregnancy status, and within pregnant women by self-reported prior Tdap receipt.Results374 pregnant and 225 nonpregnant women were vaccinated. Severe local or systemic reactions or “any” fever were uncommon (≤3% for both groups). Moderate/severe injection-site pain was significantly higher in pregnant (17.9%) versus nonpregnant (11.1%) women, but did not prompt a healthcare visit. Proportions of other moderate/severe or any severe reactions were not significantly higher in pregnant compared to nonpregnant women. Moderate/severe (including pain) and severe reactions were not significantly higher in pregnant women receiving repeat versus first-time Tdap. Antibody titers increased from baseline to post-vaccination for all vaccine antigens in pregnant and nonpregnant women; post-vaccination titers against pertussis toxin and filamentous hemagglutinin were significantly higher in nonpregnant versus pregnant women (p < 0.01).ConclusionTdap was well-tolerated in pregnant and nonpregnant women. Pregnant women were more likely to report moderate/severe pain at the Tdap injection-site compared with nonpregnant women, but did not necessitate medical visits. Prior Tdap receipt did not increase occurrence of moderate/severe local or systemic reactions in pregnant women. Serologic responses to all vaccine antigens were robust.Clinical Trial Registration@ClinicalTrials.gov. NCT02209623.https://clinicaltrials.gov/ct2/show/NCT02209623.     

Pregnancy but not moderate undernutrition attenuates insulin suppression of fat mobilization in sheep

Nonpregnant and late-pregnant ditocous ewes were fed either to maintain zero energy balance in maternal tissues (fed) or at 50% of this level (underfed) for several weeks. Plasma concentrations of nonesterified fatty acids (NEFA) and glycerol were measured under basal conditions and during infusion of various doses of insulin while maintaining euglycemia (hyperinsulinemic, euglycemic clamp technique). Pregnancy and undernutrition separately increased basal plasma NEFA concentration in an additive manner; plasma glycerol was increased by pregnancy but unaffected by undernutrition. The molar ratio of NEFA to glycerol was significantly greater in underfed ewes. Analysis of dose-response relations between plasma insulin and metabolites during insulin infusions showed that maximally insulin-suppressed concentrations of NEFA and glycerol were significantly greater in pregnant than in nonpregnant ewes but were unaffected by undernutrition. Neither pregnancy nor undernutrition affected the maximally insulin-suppressed NEFA to glycerol ratio, or the plasma insulin concentration for 50% maximal responses to insulin of plasma NEFA, plasma glycerol, or the plasma NEFA to glycerol ratio. Thus, even in ewes at or close to zero energy balance, pregnancy seems to reduce adipose responsiveness but not sensitivity to the antilipolytic effect of insulin. This is another manifestation of the normal development of insulin resistance in maternal tissues during late pregnancy.     

妊高征患者血浆中分子物质含量变化及其临床意义

目的:探讨中分子物质(MMS)在妊娠高血压综合征(妊高征)患者血浆中的变化及其临床意义。方法:采用改进的紫外吸收法测定82例妊高征患者、98例正常妊娠妇女及66例正常非妊娠妇女血浆MMS含量。结果:妊高征患者血浆MMS水平显著高于正常妊娠妇女及正常非妊娠妇女(P<0.01);在轻、中、重度妊高征之间,血浆MMS有显著差别(P<0.01或P<0.05),MMS水平越高,妊高征病情越重;妊高征患者分娩后48 h其血浆MMS水平有所回落(P<0.05)。正常妊娠妇女及正常非妊娠妇女血浆MMS水平没有显著性差异(P>0.05)。结论:MMS与妊高征发病学有关,MMS可作为判断妊高征病情程度的指标之一。     

Relationship between pre-pregnancy BMI and plasma zinc concentrations in early pregnancy

We previously reported that pregnant women whose plasma Zn concentrations were below the 50th percentile tended to have high pre-pregnancy BMI (kg/m(2)) values. We therefore hypothesized that in pregnant women, plasma Zn concentrations are negatively correlated with BMI. We evaluated the association between BMI values and plasma Zn concentrations in 1474 women whose blood samples were obtained before 15 weeks of gestation. Their mean age was 22.7 years and mean gestational age at blood sampling was 10 weeks. The mean plasma Zn concentration and BMI were 11.6 micromol/l and 26.6 kg/m(2) respectively. Because plasma Zn concentrations decrease as gestational age increases, plasma Zn concentrations were standardized by Z-scores. Z-score distributions were compared among the quartiles of BMI. The highest BMI group had the lowest plasma Zn concentrations, whereas the lowest BMI group had the highest; the differences were significant between the BMI groups (P<0.0001). The interpretation of plasma Zn concentrations to assess Zn nutriture in pregnancy may be complicated not only by the well-established factor of gestational age at blood sampling, but also by a previously unrecognized factor, maternal BMI.     

不同NYHA分级妊娠期高血压疾病患者正常血浆BNP变化及其与心功能关系的研究

目的研究不同美国纽约心脏病学会(NYHA)分级妊娠期高血压疾病患者血浆脑钠肽(BNP)变化及其与心功能的关系,为患者的临床诊断提供指导。方法选取2017年1月-2019年6月在该院妇产科诊断为妊娠期高血压疾病且在该院有完整产前定期体检记录的62例孕妇作为观察组。同时选取在该院建档生产的正常妊娠孕妇50例作为对照组。按照NYHA制定的心功能分级将观察组患者分为心功能正常的A组(22例)、Ⅱ级的患者为B组(20例)、Ⅲ级的患者为C组(11例)、Ⅳ级的患者为D组(9例)。分别在妊娠早、晚期与产后6周对研究对象的血浆BNP水平以及心功能进行测定比较,对不同NYHA分级妊娠期高血压疾病患者血浆BNP变化及其与心功能的关系进行分析。结果观察组不同NYHA分级孕妇的血浆BNP水平明显高于对照组孕妇,差异有统计学意义(P<0.05)。观察组不同NYHA分级的A、B、C、D组间血浆BNP水平两两相比,差异有统计学意义(P<0.05);NYHA分级等级越高,孕妇的血浆BNP水平越高。观察组孕妇妊娠早期、妊娠晚期以及产后6周的血浆BNP水平均明显高于对照组孕妇,差异有统计学意义(P<0.05)。观察组孕妇的二尖瓣血流舒张早期充盈峰(E)、E峰速度时间积分(EVTI)以及E/A比值均明显低于对照组孕妇,差异有统计学意义(P<0.05)。观察组孕妇的舒张晚期充盈峰(A)、A峰速度时间积分(AVTI)均明显高于对照组孕妇,差异有统计学意义(P<0.05)。结论血浆BNP浓度不仅与产妇妊娠期高血压疾病的严重程度有关,还与心力衰竭的发生有着较为密切的关系,NYHA分级等级越高,孕妇的血浆BNP水平越高。     

健康妊娠妇女血糖指标参考区间的建立

目的:探讨非妊娠女性血糖指标参考区间用于评估健康妊娠妇女临床价值,并建立健康妊娠妇女血糖指标正常参考区间。方法:选取本院2016年1月-2018年12月产前检查产妇750例,按照孕期分为早孕组、中孕组和晚孕组各250例,另选本院体检的非妊娠妇女250例为对照组。检测各组空腹血糖水平。结果:K-S检验显示4组血糖测定值均呈正态分布(P>0.05)。空腹血糖水平早孕组、中孕组和晚孕组高于对照组(P<0.05),而中孕组和晚孕组无差异(P>0.05)但高于早孕组(P<0.05)。4组内不同年龄段血糖水平未见差异(P<0.05)。通过±1.96s计算参考值区间,对照组4.02~5.40mmol/L,早孕组3.91~5.83mmol/L,中孕组4.32~5.97mmol/L,晚孕组4.33~6.05mmol/L。结论:用非妊娠妇女的血糖指标参考区间值评估妊娠妇女的血糖值存在不合理性,临床应建立针对妊娠妇女的血糖指标正常参考区间,可为妊娠期糖尿病的早发现、早预防、早干预提供科学依据。     

Screening for diabetes in obese pregnant women

Oral glucose tolerance testing (oGTT) was performed according to WHO criteria among obese pregnant women (body mass index greater than 28) who were recruited with the help of computerized pregnancy counselling data base. oGTT was carried out for the first time between gestational ages of 16-20 weeks, and it was repeated monthly as far as possible. Gestational diabetes was diagnosed in 4 cases out of 50 obese patients. Two gestational diabetic patients needed insulin treatment. According to computerized data obese patients have significantly higher risk of having macrosomic infants and/or intrauterine death. Fasting blood glucose values of obese pregnant women were significantly higher in all the gestational ages. It is emphasized that obesity means a risk factor for gestational diabetes, but the onset of carbohydrate intolerance may be prevented or diagnosed as early as possible with the help of repeated oGTT during pregnancy and dietary counselling. In this way fetal complications, especially macrosomia will not develop.     

妊娠合并糖代谢异常孕妇性激素结合球蛋白(SHBG)水平与母儿合并症的关系

目的:研究妊娠早期正常孕妇、妊娠期糖尿病(GDM)及妊娠期糖耐量异常(GIGT)孕妇性激素结合球蛋白(SHBG)水平与母儿合并症的关系。方法:对正常妊娠组420例和妊娠期糖代谢异常组304例进行50g葡萄糖负荷实验(GCT)检测,其中GCT结果异常者再进行75g葡萄糖耐量实验(OGTT);同时对所有研究对象均进行SHBG的测定并根据其水平高低分组进行母儿合并症的统计。结果:早孕期妊娠合并糖代谢异常孕妇两组血清SHBG值均较正常孕妇者低(P<0.001),而妊娠期糖代谢异常患者的母儿并发症随SHBG水平的降低而增多。结论:SHBG在妊娠期糖代谢异常的早期筛查诊断及母儿预后评估中具有重要意义。     

Zinc status and pregnancy outcome of pregnant Lebanese women

Serum, hair and urinary zinc levels were measured in 51 pregnant Lebanese women during the last 6 weeks of pregnancy and in 50 nonpregnant controls. Mean serum zinc was significantly lower and mean urinary zinc was significantly higher in pregnant women than in nonpregnant women. Pregnant women gave birth at term to infants who averaged 3449 g (range 2700 and 4300 g); no birth defects were noted. The six women who smoked 0.5 or more packages of cigarettes per day gave birth to infants who were significantly smaller than the other infants (2940 g). Infant birth weight was not correlated with hair, urinary, or plasma zinc, parity or maternal blood pressure. The zinc nutriture of the Lebanese pregnant women seemed to be adequate to support fetal growth.     

妊娠妇女巨细胞病毒及单纯疱疹病毒感染与免疫状态研究

为了解妊娠期间巨细胞病毒（ＣＭＶ）及单纯疱疹１８３名妊娠妇女、２２名反复自发流产妇女和３２名非妊娠妇女进行病毒分离、抗体测定、病毒抗原特异性淋巴细胞增殖反应（ＬＰＲ）测定。早期和晚期妊娠妇女ＨＳＶ阳检率分别为２．７％（５／１８３）和１．０％（１／１０１），ＣＭＶ阳检率为１．１％（２／１８３）和２．０％（２／１０１）。妊娠妇女、反复自发流产妇女和非妊娠妇女ＣＭＶ抗体阳检率为５１．６％、５０％和３４．     

妊娠糖尿病规范化治疗对妊娠结局的影响

目的：探讨妊娠期糖尿病（GDM）规范化治疗对妊娠结局的影响。方法：选择富阳市妇幼保健院128例GDM孕妇应用饮食、运动、药物等规范化治疗为治疗组,同期住院分娩的正常孕妇130例为对照组,对妊娠结局进行比较。结果：规范化治疗后GDM孕妇的空腹血糖（FPG）、餐后2小时血糖（2hPG）显著下降;母婴患病率与对照组差异无统计学意义（P〉0.05）;空腹血糖在4.0~4.8mmol/L、餐后2h血糖在4.8~7.0mmol/L、糖化血红蛋白在5%~6.2%范围内GDM母婴患病率最低。结论：早发现、早规范化治疗,可促进GDM母儿的良好结局。     

糖化血红蛋白早期预测妊娠期糖尿病的临床效果和应用价值

目的:探讨糖化血红蛋白早期预测妊娠期糖尿病的临床效果和应用价值。方法:将386例孕妇根据建卡进行系统性产检的按孕周分为早孕组196例(孕周<24周)和中孕组190例(孕周24～28周),将同期已确诊为妊娠期糖尿病的56例晚孕患者(孕周>34周)纳入对照组。采用空腹血糖(FPG)测定法、糖化血红蛋白(HbA1c)法和50 g葡萄糖负荷试验(GCT)进行筛查,采用75 g糖耐量实验进行确诊并对确诊的妊娠期糖尿病患者纳入早期干预组并进行合理的指导和治疗,对照组患者进行常规的入院治疗,比较3种筛查方法的可靠性以及对照组和治疗组的妊娠结局。结果:HbA1c在妊娠期糖尿病的筛查中灵敏度、特异度和阳性预测值分别为85.3%、97.6%和95.65%,优于FPG和GCT的筛查,其差异有统计学意义(P<0.05)。经早期筛查诊断并进行治疗的孕妇其妊娠期合并症发病率明显低于对照组,进行早期干预治疗的孕妇早产率和新生儿并发症发病率也明显低于对照组,差异均有统计学意义(P<0.05)。结论:HbA1c对妊娠期糖尿病诊断的特异度和灵敏度高,方便可靠,利用其对妊娠期糖尿病进行早期诊断和治疗可有效减少母婴并发症,值得在临床推广应用。