Analysis of Serum Ferritin Levels in Pregnant Women with Gestational Diabetes Mellitus versus Healthy Pregnant Women: A Cross-sectional Study

To elucidate the influence of fetal genotype in both non-diabetic gravidas and pregnant women on gestational diabetes mellitus (GDM) through analysis of the genotype discrepancy between maternal and fetal Pro12Ala single nucleotide polymorphism (SNP) of peroxisome proliferator-activated receptor gamma 2 (PPARG2) genes. Pregnant women, who delivered in the Obstetrics and Gynecology Hospital of Fudan University from October 2005 to February 2007, and their newborn babies were selected, and were divided into GDM and control group. The GDM group consisted of 55 gravidas with GDM and 40 newborns born to the GDM mothers, and the control group consisted of 173 healthy gravidas and their 50 neonates. Polymerase chain reaction-denaturing high-performance liquid chromatography was applied to detect the distribution of PPARG2 Pro12Ala alleles in all subjects. The concentrations of plasma fasting blood sugar (FBS) and several bio-markers of lipids, including total cholesterol, triglyceride, apoprotein A, high-density lipoprotein and low-density lipoprotein, were also tested for the mothers. (1) No significant difference was found in the frequencies of Pro/Pro genotype between the GDM mothers and control mothers (94.6% vs 90.8%, P > 0.05), nor between the GDM offspring and control offspring (95.0% vs 94.0%, P > 0.05) or between the GDM mothers and GDM offspring (P > 0.05). The same was shown in the frequencies of Pro/Ala genotype both between the GDM mothers and control mothers (5.5% vs 9.2%, P > 0.05) and between the GDM offspring and control offspring (2.5% vs 3.0%, P > 0.05). (2) Within both GDM and control group, the maternal FBS and various lipids concentrations of Pro/Pro genotype gravidas showed no significant difference compared to those of Pro/Ala genotype mothers (P > 0.05). (3) Based on the four possible PPARG2 genotype pairs between the mothers and fetuses, Pro/Pro mother and her Pro/Pro fetus, Pro/Ala mother and her Pro/Ala fetus, Pro/Ala mother and her Pro/Pro fetus, and Pro/Pro mother and her Pro/Ala fetus, less Pro/Pro pairs and more Pro/Ala pairs were found in the GDM group than in the control (72.5% vs 92.0%, P = 0.014; 27.5% vs 6.0%, P < 0.05). Neither the maternal nor the offspring's Pro/Ala genotypes is associated with the genesis of GDM. However, the discrepancy of PPARG2 Pro12Ala polymorphism between mother and her fetus implies a possible cause of GDM.

Not much is currently known about disturbances in insulin signaling and glucose transport in leukocytes of women with gestational diabetes mellitus (GDM) during and after pregnancy. In this study, the expression of insulin signaling (INSR, IRS1, IRS2 and PIK3R1)- and glucose transporter (SLC2A1, SLC2A3 and SLC2A4)-related genes in the leukocytes of 92 pregnant women was assayed using quantitative RT-PCR. The cohort consisted of 44 women without GDM (NGT group) and 48 with GDM (GDM group) at 24-28 weeks of gestation. GDM women were then tested again one year after childbirth (pGDM group: 14 women (29.2%) with abnormal glucose tolerance (AGT) and 34 women (70.8%) with normoglycemia). The GDM and NGT groups were closely matched for gestational age and parameters of obesity, such as pre-pregnancy body mass index (BMI), pregnancy weight, and gestational weight gain (GWG) (p > 0.05). Compared to the NGT group, the GDM and pGDM groups were hyperglycemic, but the GDM group featured a more highly insulin-resistant condition than the pGDM group, as reflected by higher fasting insulin (FI) levels and the values of the homeostasis model assessment for insulin resistance (HOMA-IR) (p < 0.05). In leukocytes from the GDM and pGDM groups, PIK3R1, SLC2A1, and SLC2A3 were upregulated and IRS1 was downregulated, with a larger magnitude in fold change (FC) values for PIK3R1 and IRS1 in the GDM group and for SLC2A1 and SLC2A3 in the pGDM group. The expression of SLC2A4 was unchanged in the GDM group but upregulated in the pGDM group, where it was inversely correlated with HOMA-IR (rho = -0.48; p = 0.007). Although the INSR and IRS2 levels did not significantly differ between the groups, the IRS2 transcript positively correlated with pregnancy weight, fasting plasma glucose, FI, and HOMA-IR in the GDM group. Our findings indicate that pronounced quantitative changes exist between the GDM and pGDM groups with respect to the expression of certain genes engaged in insulin signaling and glucose transport in leukocytes, with insulin resistance of a variable degree. These data also highlight the relationship of leukocyte SLC2A4 expression with insulin resistance in the postpartum period.

Introduction: Gestational Diabetes Mellitus (GDM) is the development of carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Iron is essential for the beta cell functioning of the pancreas and glucose homeostasis in adequate quantities. However, excess iron levels can lead to the generation of an increased amount of free radicals, which can cause toxicity to the pancreatic beta cells, leading to insulin resistance by impairing glucose metabolism. Aim: To compare maternal and foetal blood analysis in term pregnancies with and without GDM. Materials and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, JSS Medical College and Hospital Research Centre, Mysuru, Karnataka, India, on 120 term pregnant women, with 60 cases of GDM and 60 non GDM controls. Maternal blood and cord blood samples were used to measure Haemoglobin (Hb), Packed Cell Volume (PCV), serum iron, and serum ferritin in the mother and newborn at the time of delivery. Foetal blood analysis was performed in terms of foetal haemoglobin, iron, and ferritin. Birth weight was also measured. Statistical analysis was performed using the Chi-square test and Independent t-test, with a p-value &lt;0.05 considered significant. Results: The serum ferritin level of the mother was higher in GDM cases (mean value 89.47 ng/mL) than in non GDM controls (mean value 47.62 ng/mL), and this difference was statistically significant. Serum ferritin levels in newborns were significantly lower in the GDM group (85.43) compared to the non GDM group (102.71). Mean values of haemoglobin, PCV, and iron levels were not significantly higher in newborns of GDM mothers compared to non GDM mothers. Conclusion: In GDM, serum ferritin was increased, indicating a marker of inflammation or iron overload, which increases oxidative stress that might affect placental iron transfer and haemoglobin synthesis in the foetus.

Objective To evaluate the clinical and biochemical characteristics of pregnant women with different glucose tolerance status, and their secretion characteristics of insulin, glucagon and glucagon-like peptide-1 (GLP-1)after oral glucose challenge. Methods We analyzed 74 cases pregnant women with positive results of 50 g glucose challenge test in 24-28 gestational weeks, who received regular obstetrical follow-up in Peking Union Medical College Hospital from January 2009 to June 2012. A further 100 g oral glucose tolerance test (OGTT) was performed, based on which the included women were divided into three groups, namely gestational diabetes mellitus (GDM) group (n=25), impaired glucose tolerance (IGT) group (n=25) and normal glucose tolerance (NGT) group (n=24). The general clinical data and biochemical indexes of the three groups were compared, and the indexes about insulin resistance and the function of pancreatic islet beta cells were calculated. Glucose, insulin, glucagon and GLP-1 were measured in OGTT. The secretion characteristics of each of these hormones and their correlation with other indicators were evaluated. Results Compared with the NGT group, the GCT[(9.21±0.75) mmol/L vs.(8.52±0.50) mmol/L, P<0.05] and glycosylated hemoglobin A1c [(5.39±0.34)% vs.(5.18±0.20)%, P<0.05]were significantly higher in the GDM group. In OGTT, the area under curve (AUC) of glucose in the GDM group was significantly higher than that in the IGT group and NGT group[(26.58±2.02)mmol/(L·h) vs.(23.20±1.51) mmol/(L·h), (26.58±2.02)mmol/(L·h) vs.(19.84±1.95) mmol/(L·h), both P<0.05]. The peak values of insulin secretion in the GDM group and IGT group were delayed to 2 hours after OGTT.The 3-hour insulin level in the GDM group was significantly higher than that in the NGT group(P<0.05). Compared with the NGT group, the glucagon levels in each time point after OGTT and the AUC of glucagon levels were reduced in the GDM group and the IGT group, but with no significant differences. The peak glucagon levels in the 3 groups all appeared at 3 hours after OGTT. The GLP-1 levels in each time point of OGTT were gradually increased from the NGT group to the IGT group to the GDM group, but no significant differences were found. The peak value of GLP-1 level was presented at 1 hour after OGTT in the NGT group and the IGT group and at 2 hours after OGTT in the GDM group. The valley values of GLP-1 level in the 3 groups all appeared at 3 hours after OGTT. In comparison with the NGT group, the ratios of GLP-1 to blood glucose levels (GLP/BG) at 1-hour and 2-hour were significantly decreased in the GDM group (P<0.05). The AUC of glucagon levels in OGTT were negatively correlated with fasting blood glucose(r=-0.287, P=0.013) and 1-hour glucose levels(r=-0.266, P=0.022) in OGTT and positively correlated with insulin secretion sensitivity index(ISSI) (r=0.297, P=0.010) and HOMA-β(r=0.236, P=0.043). Moreover, the AUC of GLP-1 levels in OGTT was negatively correlated with the levels of C-reactive protein (r=-0.264, P=0.035). The AUC of GLP/BG in OGTT was positively correlated with ISSI (r=0.406, P<0.001). Conclusions Pregnant women with GDM and IGT in the second trimester have insulin resistance and dysfunction of pancreatic islet β cells.Potential GLP-1 resistance and inadequate secretion may exist in GDM patients. GLP/BG may be a better parameter to evaluate the secretion function of L cells in pregnancy and an effective parameter to estimate the compensatory function of pancreatic β cells indirectly.Glucagon levels may not start to change obviously before 28 gestational weeks. Key words: Gestational diabetes mellitus; Insulin resistance; Glucagon; Glucagon-like peptide-1

Gestational diabetes mellitus (GDM) is one of the commonest complications of pregnancy; but its pathophysiology is still not fully understood. Recently attention has been focused on the relation between iron metabolism and glucose intolerance in the genesis of GDM. The present study was conducted to investigate the association of body iron store with various covariates of metabolic syndrome. A total 100 subjects were included in this study: 43 were healthy nondiabetic and nonanemic pregnant women (Control group) and 57 were pregnant women having Diabetes Mellitus (GDM group). Glucose level was measured by using glucose-oxidase method, fasting serum C-peptide by chemiluminescent enzyme immunoassay, Glycosylated hemoglobin (HbA1c) by using a modified high performance liquid chromatography (HPLC) method and insulin sensitivity (HOMA%S) and insulin secretory capacity (HOMA%B) were calculated by Homeostasis Model Assessment. Serum transferrin receptor (STfR) was measured by Enzyme-Linked Immunosorbent Assay and serum ferritin level was assessed by Microparticle Enzyme Immunoassay. Serum iron concentration was measured by IRN method. The age of the study groups were found to be matched (p=0.522). Gestational weeks and parity of the study groups were significantly higher in GDM than Controls (p=0.004 and p=0.015 respectively). HbA1c level (%, M±SD) was significantly higher in GDM group (6.09±1.1) as compared to Control Among the marker of body iron status hemoglobin level showed no difference between GDM (11±1.25) and Control groups (10.6±0.8), but serum iron concentration [median (range)] was significantly lower in GDM group [6(2-19)] as compared to Control [12(2-36)].Serum Iron was strongly correlated with HOMA%B in univariate Spearman correlation analysis (r =0.347, P=0.008).On multivariate linear regression analysis also found Serum Iron associated (p=0.011) with HOMA% B in GDM group. GDM in Bangladeshi subjects does not seem to be associated with iron deficiency or elevated body iron store. GDM subjects may show lower serum iron, but this is probably related to chronic inflammatory state of diabetes rather than iron deficiency. DOI: http://dx.doi.org/10.3329/bmj.v40i3.18678 Bangladesh Medical Journal 2011 Vol.40(3):55-60

Objective To investigate the association between serum ferritin(SF) level at early and mid trimester of pregnancy and gestational diabetes mellitus (GDM) and insulin resistance (IR). Methods A total of 192 cases of women who were accepted antenatal examination from the first trimester of pregnancy at Yueqing People Hospital from July, 2012 to October, 2013 was prospectively analyzed and followed up. All cases were divided into two groups: 96 cases of GDM pregnant women who were diagnosed as GDM at mid trimester of pregnancy as GDM group, and 96 cases of pregnant women with normal glucose tolerance at the same time as the control, normal glucose tolerance (NGT group). The differences in clinical data were compared between two groups. The relationship between SF level and fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model assessment insulin resistance (HOMA-IR), and C-peptide was investigated with Spearman rank correlation analysis. The predictive values of SF and relative variables to GDM were calculated by receiver operating characteristic curve (ROC) or Logistic regression analysis. Results ⑴ There was statistically significant difference in body weight and body mass index (BMI) at prepregnancy and mid trimester of pregnancy, Hb, FPG, FINS, SF, and C-peptide at the first trimester of pregnancy, SF level and FPG and HOMA-IR and C-peptide at mid trimester of pregnancy between two groups (P 0.05). ⑶ The area under the ROC curve of SF at mid trimester of pregnancy for GDM was 0.653. The sensitivity and specificity were 68.8% and 59.4% in predicting GDM at the cut-off value of 16.61 ng/ml. As showed by Logistic regression analysis, high level of SF at mid trimester of pregnancy was a independent risk factor for GDM. Odds ratio (OR) was 1.032 (95% CI: 1.008~1.058, P<0.01). Conclusions The relationship between SF at different trimester of pregnancy and GDM is variant. There is relationship between high level SF of mid trimester of pregnancy in GDM pregnant women and IR. The level of SF might predict the occurrence of GDM. Key words: Ferritins/ME; Diabetes, gestational/ME; pregnancy

To assess the association between the single nucleotide polymorphisms (SNP) rs174575 and rs2845574 of the fatty acid desaturase 2 (FADS2) gene and gestational diabetes mellitus (GDM). A total of 1 514 pregnant women who visited West China Second University Hospital of Sichuan University between January 1, 2013 and December 31, 2021 were enrolled in this study. Among them, 583 were diagnosed with gestational diabetes mellitus (GDM group), and 931 had normal pregnancies (control group). The SNPs rs174575 and rs2845574 of the FADS2 gene were analyzed using Sanger DNA sequencing. Plasma levels of insulin (INS), apolipoprotein A1 (apoA1) and apolipoprotein B (apoB) were measured using enzymatic methods, chemiluminescence and immunoturbidimetry. This study was approved by the Medical Ethics Committee of the West China Second University Hospital of Sichuan University (Ethics No.: 2020-036). The main genotype at the rs174575 C/G and rs2845574 C/T loci were CC in both GDM and control groups. No significant difference was found between the GDM and control groups regarding the genotypic or allelic frequencies of rs174575 and rs2845574 sites (P > 0.05). Among the GDM group, individuals with the GG genotype at the rs174575 site had lower plasma HDL-C levels compared to those with the CC genotype (P < 0.05), and had higher atherogenic indices (AI) compared with the CC and CG genotype (P < 0.05; P < 0.05). Individuals with the TT genotype at the rs2845574 site had higher AI compared with the CT genotype (P < 0.05). Among the control group, individuals with the GG genotype had lower diastolic blood pressure (DBP) compared to those with the CC genotype (P < 0.05). Additional subgroup analysis demonstrated that the rs174575 polymorphism was associated with AI levels in obesity subgroup of GDM, TG levels in non-obese subgroup of control and DBP levels in the obese subgroup of control (P < 0.05; P < 0.05; P < 0.05). The FADS2 rs174575 and rs2845574 polymorphisms in GDM patients are associated wit HDL-C and AI levels, and the FADS2 rs174575 polymorphisms was also associated with DBP levels in normal pregnant women. The AI and DBP levels have a BMI-dependent effect.

Objective To evaluate the effects of gestational diabetes mellitus (GDM) and its treatment during pregnancy on neonatal respiratory diseases in late-preterm infants. Method From January 2013 to December 2016 , respiratory outcome of singleton infants (gestational age: 34-36 weeks) of GDM mothers(GDM group) was compared with infants delivered from mothers without GDM(non-GDM group). We also studied the relationship between maternal GDM treatment (insulin-treated GDM and diet-controlled GDM) and neonatal respiratory outcome, including incidences of respiratory diseases, mechical ventilation and oxygen supplementation. Result A total of 2 174 late-preterm infants were enrolled in this study, including 425 in GDM group and 1 749 non-GDM group. The average birth weight was (2 688±423) g, ranging from 1 320 g to 4 275 g, and mean gestational age was (35.5±0.7) weeks. Comparing with non-GDM group, the incidence of cesarean delivery was significantly higher in GDM group (35.5% vs. 30.5%, P 0.05). In the GDM group, a total of 91 infants were born to mothers with insulin-treated GDM and 334 diet-controlled GDM. Comparing with the diet-controlled group, insulin treatment group was associated with higher risk of neonatal RDS (6.6% vs. 1.8%, P 0.05). Conclusion The late-preterm infants born to GDM mothers with insulin treatment have higher incidences of neonatal RDS and mechanical ventilation, and they need much more care. Key words: Diabetes gestational; Respiratory system; Infant, premature, diseases

The aim of this study was to investigate the relationship of serum iron and ferritin concentrations in early pregnancy with gestational diabetes mellitus (GDM) complicated in pregnant metaphase through detecting the serum iron and ferritin concentrations in early pregnancy of normal pregnant women, so as to provide new ideas for the early detection and prevention of GDM. Spontaneously pregnant women with single fetus receiving prenatal routine examination in our hospital from December 2014 to October 2016 were selected. They were in good health before with normal fasting blood-glucose in early pregnancy without anemia during pregnancy and any medication history. The serum iron and ferritin concentrations were measured at 12 gestational weeks, the fasting blood-glucose was detected at 12 weeks of pregnancy, and 75g oral glucose tolerance test was performed at 24-26 weeks. According to the results of oral glucose tolerance test, the pregnant women were divided into GDM group (N.=52) and normal control group (N.=310). The detection results of pregnant women in the two groups were statistically analyzed. The serum ferritin and iron levels at 12 gestational weeks in GDM group were higher than those in normal pregnancy group (P<0.05). The cut-off values of serum ferritin and iron at 12 gestational weeks in the prediction of GDM were 67.8 μg/L and 52.9 mmol/L. The high concentrations of serum iron and ferritin in early pregnancy have a certain correlation with the incidence of GDM, and the early detection of serum iron and ferritin levels can improve the detection rate of GDM in pregnant metaphase.

No study has been conducted to specifically demonstrate the relationship between gestational diabetes mellitus (GDM) status, inflammatory factors, and postnatal umbilical coiling index (pUCI). Understanding this relationship could help select the best interventions to save the fetus. To evaluate the effects of maternal venous and umbilical cord blood levels of high sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-alpha) on pUCI in GDM and non-GDM groups. This prospective observational study included 40 participants in each of the GDM and non-GDM groups, matched for maternal age, ethnicity, and parity. The GDM diagnosis was confirmed by 24 to 28 weeks of gestation (WOG) and a 2-step strategy. The covariates of interest were maternal hs-CRP and TNF-α, measured at 37 to 40 WOG, and their UC analogous was measured during delivery. The gross morphologies were assessed immediately after delivery. The UC coiling was quantitatively assessed by the pUCI. To compare the GDM and non-GDM groups, the t test and the Mann-Whitney test were used for normal and non-normal variables, respectively. There was not a significant difference in hs-CRP and TNF-a levels in maternal venous blood or UC blood between the GDM and non-GDM groups. The mean (SD) of pUCI in the GDM and non-GDM groups were 0.28 (0.15) and 0.24 (0.21) (P = 0.441), respectively. In the GDM group, none of the 4 covariates of interest had significant effects on the UCI. Among the non-GDM participants, merely the UC hs-CRP had a direct association with the pUCI, with a Pearson correlation of 0.54 (P = 0.001). Impacts of hs-CRP and TNF-α on the pUCI were assessed using Poisson regression models and no significant findings were detected (95% CI, 0.999-1.001, for all parameters). In the GDM group, no apparent association was observed between inflammatory factors and pUCI, although a direct association was detected between UC hs-CRP and pUCI in the non-GDM.

To investigate the role of visfatin in the pathogenesis of gestational diabetes mellitus (GDM) and its correlation with insulin resistance. The study recruited 58 pregnant women of 24 to 28 gestational weeks in People's Hospital of Hebei Province from January to June 2013. Among them, 30 were patients with GDM (GDM group), 28 had normal oral glucose tolerance test and was referred as healthy pregnancy group (NGT group). Fourteen age-matched female who were first-degree relatives (FDR1) of type 2 diabetes mellitus patients, and 27 healthy nonpregnant women with normal oral glucose tolerance test were referred as high-risk group and normal controls (NC), respectively. The fasting plasma glucose (FPG), 1 hour and 2 hours postprandial glucose levels were measured by glucose oxidase method. The fasting insulin (FIN) levels were measured by radioimmunoassay and the homeostatic model assessment-insulin resistance index (HOMA- IR) was calculated. The levels of total cholesterol (TC), triglycerdes (TG), high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL) were determined. The visfatin levels were measured by ELISA. (1)The levels of FPG were significantly higher in GDM, FDR1 and NC group [(5.5 ± 0.7), (5.1 ±0.6), (5.2 ± 0.4)mmol/L] than that in NGT group [(4.5 ± 0.3) mmol/L], respectively (P < 0.05). (2) The levels of INS [(14 ± 6)mU/L], HOMA- IR (4.0 ± 2.0), 1 hour [(10.9 ± 1.8) mmol/L] and 2 hours [(8.6 ± 1.8) mmol/L] postprandial glucose levels of GDM group were significantly higher than those in NGT group [(12 ± 4) mU/L, 2.0 ± 1.0, (7. 4 ± 1.3) and (6.2 ± 0.9) mmol/L], respectively (P < 0.05). (3) The levels of TC, TG, HDL and LDL levels in GDM group were (5.5 ± 0.9), (2.8 ± 0.8), (1.8 ± 0.4) and (3.3 ± 0.8) mmol/L, and were(5.9 ± 0.8), (2.5 ± 0.7), (1.9 ± 0.4) and (3.4 ± 0.6) mmol/L in NGT group. The levels of lipid in the two groups were significantly higher than those in FDR1 or NC group, respectively(P < 0.05).(4)The levels of visfatin in GDM group and NGT group [(43 ± 10), (45 ± 12) µg/L] were significantly higher than that in FDR1 or NC group [(29 ± 9), (36 ± 7) µg/L], respectively (P < 0.05), but the visfatin levels in FDR1 group were significantly lower than that in NC group (P < 0.05). The visfatin levels in GDM group were slightly lower than that in NGT group, but the difference was not statistically significant (P > 0.05). (5)The visfatin levels in NGT group were negatively correlated to the levels of FPG, HOMA-IR and TC (r = -0.38, -0.44, -0.47, respectively, P < 0.05). But the visfatin levels in GDM group were not correlated with the levels of FPG, HOMA-IR, TC (r = -0.16, -0.01, 0.33, respectively, P > 0.05). While in NC group, the levels of visfatin were negatively correlated with FPG and 2 hours postprandial glucose(r = -0.48, -0.42, respectively, P < 0.05). Visfatin may be an important adipokine that involved in the carbohydrate and lipid metabolism in GDM, and is related to the pathogensis of GDM and insulin resistance.

Objective To investigate the characteristics of the daily blood glucose profiles in patients with gestational diabetes mellitus(GDM) by continuous glucose monitoring system(CGMS) so as to guide the clinical treatment. Methods The glucose level in the subcutaneous tissue was monitored by CGMS for 3 days in 7 patients with GDM and 20 participants with normal glucose tolerance(NGT). The average age was 28 and 41 yrs in GDM and NGT group, respectively. The average body mass index(BMI) was 25 and 24 kg/m2 in GDM and NGT group, respectively. After 3-day CGMS, the GDM patients were administrated with multiple daily insulin injections. The mean plasma glucose(MPG), standard deviation of blood glucose (SDBG), mean amplitude of glucose excursions(MAGE), postprandial glucose excursions(PPGE), mean of daily differences (MODD) and difference between maximal and minimal glucose (DMMG) were calculated with the data obtained from CGMS. The insulin dose was recorded when glucose level achieved the target. The t test was used to compare the difference between groups and the difference of postprandial glucose excursions in GDM group. Results The MAGE, PPGE and DMMG were significantly higher in GDM group (MAGE (4.3±0.2) vs (1.6±0.3) mmol/L; the breakfast postprandial glucose excursions (BPPGE) (5.5±1.1) vs (1.8±0.4) mmol/L; lunch PPGE(LPPGE) (3.1±0.3) vs (1.3±0.2) mmol/L; dinner PPGE(DPPGE) (3.4±0.4) vs (1.5±0.2) mmol/L and DMMG (6.0±2.7) vs (2.9±0.2) mmol/L; t=4.4, 5.6, 2.3, 2.8, 6.1, all P<0.05). There was no significant difference in MBG, SDBG and MODD between GDM and NGT group. Postprandial glucose excursion was higher at breakfast than those at lunch and dinner in GDM group(t=3.1, 2.6, both P<0.05). The basal insulin requirement accounted for 15% of the total daily insulin usage. Pre-breakfast insulin dosage was higher than pre-lunch and pre-dinner doses. The pre-breakfast insulin dosage accounted for 33.5% of total daily insulin usage. Conclusions CGMS is an effective method to assess glycemic excursions in patients with GDM. GDM is characterized by hyper-postprandial glucose and postprandial glucose excursion. Preprandial insulin dose accounts for a majority proportion of total daily dose, within which the pre-breakfast dose is the highest. Insulin dose is consistent with the glucose excursion in GDM patients. Key words: Diabetes, gestational; Insulin; Continuous glucose monitoring system

To investigate the relationship of different types of gestational diabetes mellitus (GDM) and pregnancy outcomes. A total of 4090 cases, who received prenatal examination and delivered in Peking University First Hospital and performed a 75 g oral glucose tolerance test (75 g OGTT) at 24-28 gestational weeks, from January. 1(st), 2011 to Jul 31(st), 2012 , were divided into 2 groups. Normal blood glucose group:the result of OGTT (fasting plasma glucose, 1 hour glucose and 2 hour glucose ) was normal; Gestational diabetes mellitus group (GDM group): the result of OGTT was abnormal at any time point. GDM group were separated into A, B and C. GDM A means fasting plasma glucose annormal but others were normal, GDM B:fasting plasma glucose, 1 hour and/or 2 hour glucose abnormal, GDM C:fasting plasma glucose normal. To analyse the effect of different number of abnormal result of OGTT on pregnancy outcomes, GDM group were divided into I, II and III.GDMI means one abnormal blood glucose of OGTT result, GDM II: two abnormal blood glucose and GDM III:three abnormal blood glucose. We analyzed the pregnant outcomes of each group. (1) Among the 4090 cases, 858 cases (21.98%) were diagnosed as GDM (GDM group), and 82 cases (9.6%, 82/858) were treated with insulin.other 3232 cases with normal blood glucose (normal blood glucose group). In GDM group, the rate of cesarean section (51.9%, 445/858), premature delivery (8.4%, 72/858) and LGA (5.9%, 51/858) were respectively significantly higher than those of normal blood glucose group [ (43.5%, 1406/3232), (5.8%, 189/3232) and(4.2%, 137/3232)] (P < 0.05). But, there was no statistically significant differences for the rate of macrosomia (P > 0.05) between the GDM group(6.8%, 58/858) and normal blood glucose group (6.2%, 199/3232) . (2) In the GDM group, GDM A was 317 cases (36.9%), GDM B 239 cases (27.8%), GDM C 302 cases (35.2%). The incidence of Macrosomia and LGA in GDM B was significantly higher than that in GDM C and normal blood glucose group (P < 0.05). Comparing with GDM A , there was no statistically significance in GDM B and GDM C (P > 0.05). (3) In GDM group, GDMIwas 521 cases (60.7%), GDM II203 cases (15.6%), GDM III 134 cases (23.7%). Compared with the normal blood glucose group, GDM III had a significantly higher incidence of macrosomia and LGA and cesarean section(P < 0.01);and GDM IIhad only a significantly higher incidence of cesarean section(P < 0.01). (4) Among the 4090 cases, there were 1118 patients (27.3%) whose fasting blood glucose was below 4.4 mmol/L, of which 55 cases were diagnosed as GDM. There were 4 premature infants and 1 macrosomia. The GDM group with more than FBG ≥ 5.1 mmol/L had a higher incidence of adverse pregnancy outcomes, it suggested that we should pay more attention and take actively intervented; the pregnant woman is not recommended for 75g OGTT detection when fasting blood glucose was below 4.4 mmol/L because of the low rate of GDM and adverse pregnancy outcomes among them.

INTRODUCTION: Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy that can have negative effects on maternal and neonatal outcomes. Literature shows that elevated serum maternal ferritin levels may cause dysregulation in glucose metabolism in GDM. This study aims to determine the association between serum ferritin, iron, and hemoglobin levels in GDM patients at the time of delivery as well as cord hemoglobin and iron levels in newborns. METHODS: In this case–control study, a total of 100 patients were included, ie, 50 cases (GDM) and 50 controls (non-GDM) having aged-matched individuals of normal pregnancy. The hemoglobin, iron, serum ferritin, and hsCRP levels of the mother were determined using maternal blood. A cord blood sample was taken to determine neonatal iron and hemoglobin levels. RESULTS: The mean age of the study participants was 29.2±5.6 years. The ferritin levels of GDM mothers (42.3±6.7) were significantly higher than non-GDM patients (34.4±3.8) with P&lt;.001. Similarly, cord hemoglobin levels of newborns of GDM mothers were significantly lower than newborns of non-GDM patients (P&lt;.01). In GDM mothers, maternal ferritin levels were inversely correlated to cord hemoglobin levels (r=−0.29, P=.004). This means that increased serum ferritin levels mean lower levels of cord hemoglobin levels. CONCLUSIONS/IMPLICATIONS: Elevated maternal serum ferritin levels are linked to increased oxidative stress and affect fetal intrauterine and postpartum health. This oxidative stress might affect placental iron transfer and fetal hemoglobin synthesis.

Background: Gestational diabetes mellitus (GDM) is a growing public health concern globally, particularly in the context of rising maternal obesity and glucose intolerance. GDM poses significant risks to both neonatal and maternal health, including fetal overgrowth, birth complications, and long-term metabolic disorders. This study aimed to evaluate the impact of GDM on neonatal birth weight and maternal postpartum metabolic changes. The primary objective was to assess the incidence of macrosomia and small-for-gestational-age (SGA) births in pregnancies complicated by GDM. Secondary objectives included evaluating postpartum glycemic and lipid profiles, comparing metabolic parameters at six weeks and six months between GDM and non-GDM groups, and identifying predictive and moderating variables such as glycemic control, pre-pregnancy BMI, and gestational weight gain.Methodology: A prospective cohort study was conducted over an 18-month period (October 2023 to April 2025) at Health Net Hospital, a tertiary care and referral center located in Peshawar, Pakistan. A total of 219 pregnant women were initially screened for eligibility. Following the application of inclusion and exclusion criteria, 189 women were enrolled, 94 diagnosed with GDM and 95 without GDM, serving as matched controls. Data were collected at three time points: during the second trimester (baseline), at delivery, and during postpartum follow-up at six weeks and six months. Maternal metabolic markers, including glycemic and lipid profiles, were assessed longitudinally, while neonatal outcomes such as birth weight, NICU admission, and hypoglycemia were documented at birth. Follow-up adherence was ensured through scheduled reminders and flexible appointment rescheduling. Clinical and laboratory data were collected using standardized protocols by trained staff. Logistic regression analysis was used to identify independent predictors of adverse maternal and neonatal outcomes, with adjustments for potential confounders. Data analysis was performed using IBM SPSS Statistics for Windows, Version 29.0.2.0 (IBM Corp., Armonk, New York, United States).Results: Neonates of GDM mothers had significantly higher birth weights (mean 3689 g vs. 3143 g; p<0.0001), with increased incidence of neonatal hypoglycemia in 16 (17%) GDM cases compared to four (4.2%) non-GDM cases and NICU admissions in 19 (20.2%) GDM neonates versus five (5.3%) non-GDM neonates. GDM mothers exhibited elevated fasting glucose at six weeks (mean 98.5 mg/dL) and six months (94.1 mg/dL) postpartum, compared to non-GDM mothers (85.3 mg/dL and 83.2 mg/dL, respectively; p<0.0001). Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and triglyceride levels were also significantly higher in the GDM group. GDM (OR=2.8), higher pre-pregnancy BMI, and poor glycemic control (HbA1c >5.9%) were independent predictors of neonatal macrosomia and maternal insulin resistance.Conclusion: GDM significantly increases the risk of macrosomia, neonatal complications, and sustained maternal metabolic dysfunction postpartum. These findings underscore the importance of early diagnosis, effective glycemic control, and structured postpartum follow-up to mitigate long-term risks.