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.     

Risk of adverse pregnancy outcomes stratified for pre-pregnancy body mass index

Objective: To estimate the risk of adverse maternal and perinatal outcomes in women with different pre-pregnancy body mass index (BMI).

Methods: We conducted a cohort study with 14?451 singleton pregnancies in 15 medical centers in Beijing between 20 June 2013 and 30 November 2013 using cluster random sampling. We divided participants into four groups based on pre-pregnancy BMI: Group A (underweight): BMI?<?18.5?kg/m², Group B (normal): 18.5–23.9?kg/m², Group C (overweight): 24–27.9?kg/m², Group D (obesity): ≥28?kg/m². We used multivariate analysis to evaluate the association of the risk of adverse pregnancy outcomes and pre-pregnancy BMI.

Results: The prevalence of maternal overweight and obesity was 14.82% (2142/14?451) and 4.71% (680/14?451) in the study population, respectively. Higher pre-pregnancy BMI is associated with higher prevalence of gestational diabetes (GDM), macrosomia, Cesarean section (C-section), preeclampsia and postpartum hemorrhage. Pre-pregnancy overweight or obesity increases the risk of adverse pregnancy outcomes, regardless of GDM status.

Conclusions: Pre-pregnancy overweight or obesity is associated with increased risk of adverse pregnancy outcomes. Nutrition counseling is recommended before pregnancy in women who have overweight or obesity.     

妊娠期糖尿病与瘦素水平变化的临床研究

目的　探讨瘦素水平与妊娠期糖尿病 (GDM)发病关系以及对其胎儿生长发育的影响。方法　采用放射免疫法测定GDM孕妇 2 0例 ,糖耐量减低 (IGT)孕妇 2 2例 ,正常孕妇 2 5例血清及其新生儿脐血的瘦素水平 ,同时测定这三组孕妇的胰岛素、C肽水平 ,并测量孕前体重指数和孕期体重增加指数 ,分析其与瘦素之间的关系。结果　GDM孕妇血清瘦素、胰岛素和C肽水平明显高于IGT组及正常组 (P <0 .0 0 1)。脐血瘦素水平与胎儿体重呈正相关 (P <0 .0 5 ) 。孕妇血清瘦素水平与胎儿体重无相关。孕妇血清瘦素水平与脐血瘦素水平无相关。GDM孕妇血清瘦素与孕前体重指数明显相关 (P <0 .0 5 ) ,与孕期体重增加指数无相关。结论　 (1)GDM孕妇血清瘦素水平明显高于正常孕妇 ,故瘦素可作为监控GDM的指标之一。(2 )GDM孕妇瘦素水平与脐血瘦素水平虽然不相关 ,提示胎儿瘦素是自身产生 ,但母亲糖尿病也可以影响胎儿产生更多的瘦素。     

Placental Antioxidant Defenses and Autophagy-Related Genes in Maternal Obesity and Gestational Diabetes Mellitus

Maternal obesity and gestational diabetes mellitus (GDM) are increasing worldwide, representing risk factors for both mother and child short/long-term outcomes. Oxidative stress, lipotoxicity and altered autophagy have already been reported in obesity, but few studies have focused on obese pregnant women with GDM. Antioxidant and macro/chaperone-mediated autophagy (CMA)-related gene expressions were evaluated herein in obese and GDM placentas. A total of 47 women with singleton pregnancies delivered by elective cesarean section were enrolled: 16 normal weight (NW), 18 obese with no comorbidities (OB GDM(–)), 13 obese with GDM (OB GDM(+)). Placental gene expression was assessed by real-time PCR. Antioxidant gene expression (CAT, GPX1, GSS) decreased, the pro-autophagic ULK1 gene increased and the chaperone-mediated autophagy regulator PHLPP1 decreased in OB GDM(–) vs. NW. On the other hand, PHLPP1 expression increased in OB GDM(+) vs. OB GDM(–). When analyzing results in relation to fetal sex, we found sexual dimorphism for both antioxidant and CMA-related gene expressions. These preliminary results can pave the way for further analyses aimed at elucidating the placental autophagy role in metabolic pregnancy disorders and its potential targetability for the treatment of diabetes outcomes.     

妊娠期糖尿病合并妊娠期高血压疾病患者的血清学指标特征分析

目的 探讨妊娠期高血压疾病合并妊娠期糖尿病患者的血清学指标及其相关性分析.方法 选择2013年12月至2015年12月来中山市人民医院就诊并定期产前检查的324例孕妇为研究对象,根据糖代谢检查分为A组(对照组,112例)、B组(单纯糖尿病组,180例)、C组(糖尿病合并高血压组,32例).检测空腹血清中糖化血红蛋白(HbA1c)、血糖、C-反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平.结果 三组CRP、IL-6、TNF-α、FPG、HbA1c比较均有显著性差异(F值分别为2.954、3.971、3.013、3.145、3.771,均P<0.05),C组上述指标均最高.Logistic回归分析结果 显示:CRP、IL-6、TNF-α与妊娠期糖尿病合并妊娠期高血压疾病的发生有较强的相关性.ROC分析结果 显示:CRP、IL-6、TNF-α对妊娠期糖尿病合并妊娠期高血压疾病的预测切点分别为6.85mg/L、294.55pg/mL、122.95pg/mL,ROC曲线下面积分别为0.634、0.845、0.645.结论 妊娠期糖尿病患者血糖、HbA1c水平的升高将增加合并妊娠期高血压疾病的风险;CRP、IL-6指标的检测可能对妊娠期糖尿病合并妊娠期高血压疾病有一定预测价值.     

妊娠期高血糖孕妇口服葡萄糖耐量试验的曲线信息以及2时相糖筛方法的探讨

目的分析妊娠期高血糖孕妇口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)曲线的异常信息特点,对妊娠期高血糖的筛查方法进行探讨。方法收集同济医院内科内分泌研究室1 071例孕妇OGTT的资料,按《妊娠合并糖尿病诊治指南(2014)》诊断标准,将其分组为正常组、GDM组和PGDM组,对各组OGTT的不同时相特征进行统计分析。结果 (1)OGTT对孕妇GDM检出率为48.27%,对PGDM检出率为5.79%。(2)GDM中,单点、2点和3点异常者分别占GDM的58.22%、29.01%和12.77%。单点异常者以仅FPG的异常为主,占GDM的42.55%;多点异常者以伴2h PG异常者为主,占GDM的33.66%。(3)FPG或2h PG在分别伴有1h PG异常时,其异常值与3点异常的GDM在相应时相之间差异无统计学意义,P值均>0.05。(4)2h PG对PGDM的检出率为100.00%,FPG+2h PG的时相组合可检出96.89%的孕期高血糖患者。结论 GDM孕妇OGTT异常的主要特征是FPG的异常,FPG或2h PG分别在伴有1h PG异常的时候,其异常值升高的幅度最大;PGDM孕妇OGTT异常的主要特征是糖负荷后的时相血糖异常。根据OGTT不同的时相信息,可为GDM孕妇选择相应的干预对策。诊断GDM仍应以OGTT为准,简易OGTT(FPG+2h PG)模式在适当情况下可用于GDM的筛查。     

血清RBP-4水平与妊娠肥胖、妊娠糖尿病的关系

 目的 探讨血清视黄醇结合蛋白4(RBP-4)与妊娠肥胖、妊娠糖尿病的关系。方法 选用2015-01至2016-12住院的32例BMI＞28 kg/m²的妊娠糖尿病(GDM)孕妇(肥胖型GDM组),30例BMI 18.5～23.9 kg/m² (单纯型GDM组),29例BMI＞28 kg/m² (妊娠肥胖组),27例BMI18.5～23.9 kg/m²的健康孕妇(健康对照组),采用酶联免疫吸附法(ELISA)检测4组孕妇血清RBP-4水平、脂联素(APN)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)肥胖型GDM组孕妇血清RBP-4明显高于其他3组孕妇(P<0.05),妊娠肥胖组孕妇血清RBP-4高于单纯型GDM组及健康对照组(P<0.05);(2)血清RBP-4与孕前BMI、FINS、TG、HOMA-IR呈正相关,与APN呈负相关(r分别为0.562,0.409,0.484,0.618,-0.412,P均<0.05)。结论 RBP-4水平在妊娠肥胖组及肥胖型GDM组均高于健康对照组,其中肥胖型GDM组孕妇血清升高明显,可见血清RBP-4水平与妊娠肥胖、妊娠糖尿病均有密切联系,特别是对肥胖型GDM患者易生产巨大儿起到非常关键的作用。     

Obstetric outcomes of twin pregnancies at advanced maternal age: A retrospective study

Objective

To evaluate obstetric outcomes in twin pregnancies of advanced maternal age (≥35 years).