Correlation between plasma ferritin level and gestational diabetes mellitus and its impact on fetal macrosomia.

Objective To investigate the relationships between fasting plasma glucose (FPG) level in early pregnancy and gestational diabetes mellitus (GDM).Methods Data of 11 477 pregnant women who accepted prenatal care in Beijing Obstetrics and Gynecology Hospital from October 2011 to September 2012 were collected.FPG was tested during 8 to 12 weeks of pregnancy in all women and those with FPG＜7.00 mmol/L were recruited.Women accepted 75 g oral glucose tolerance test (OGTT) during 24 to 28 weeks of pregnancy.The GDM diagnostic criteria was with reference to the criteria of International Association of Diabetes and Pregnancy Study Group.Mann-Whitney U test was used to analyze the difference of early pregnancy FPG between normal pregnant women and GDM women.Receiver operating characteristic (ROC) curve was used to analyze the validity and applicability of using early pregnancy FPG in GDM diagnosis.Chi-square test was used to analyze the relationship between the FPG levels and GDM diagnosis.Results There were 1 535 (13.4％) women diagnosed as GDM in 24 to 28 weeks of pregnancy (the rest 9 942 normal cases were taken as the controls).The median FPG level of the GDM group was 4.89 mmol/L (4.62-5.15 mmol/L),which was higher than that of the controls [4.75 mmol/L(4.53-4.98 mmol/L)] (Z=-13.994,P=0.000).The maximum area under curve (AUC),which was used to predict GDM with early pregnancy FPG,was 0.599 (95％ CI:0.582-0.617).Taking FPG 4.88 mmol/L as the cutoff value,the sensitivity was 0.523 and the specificity was 0.645.While taking FPG 5.10 and 5.60 mmol/L as the cutoff value,the sensitivity was 0.334 and 0.068,and the specificity was 0.811 and 0.983,respectively.When the FPG level ≤ 4.09,-4.60,-5.10,-5.60,-6.10 and ≥ 6.10 mmol/L,the GDM diagnostic rate gradually increased [8.5％(23/212),9.9％(335/3 379),12.3％(719/5 858),20.7％(359/1 734),40.2％ (78/194) and 52.5％ (21/40)] (x2=300.523,P=0.000).GDM diagnostic rate in FPG ≤ 4.09,-4.60,-5.10 and-5.60 mmol/L group were lower than that in FPG ≥ 5.60 but ＜6.10 mmol/L group and ≥ 6.10 mmol/L group (x2 were 67.242,164.680,128.125,37.860,55.843,76.856,58.589 and 23.484,all P=0.000) ; GDM diagnostic rate in FPG ≤ 4.09,-4.60,-5.10 mmol/L group were lower than that in FPG ≥ 5.10 but ＜5.60 mmol/L group (x2 were 22.877,113.717 and 78.040,all P=0.000); GDM diagnostic rate in FPG ≥ 4.09 but ＜4.60 mmol/L group was lower than that in FPG ≥ 4.60 but ＜5.10 mmol/L group (x2=11.803,P=0.001).When using abnormal fasting and postprandial OGTT level as GDM diagnostic criteria,the ratio of GDM in early pregnancy FPG level ≥ 5.60 but ＜6.10 mmol/L group and FPG ≥ 6.10 mmol/L group were higher than that of the FPG level ＜5.60 mmol/L group [50.0％ (39/78) and 71.4％ (15/21) vs24.1％ (346/1 436),x2 were 12.456 and 21.443,all P＜0.003].Conclusions Early pregnancy FPG level is not proper to be used as an early diagnostic tool of GDM.However,when early pregnancy FPG level is equal to or greater than 5.60 mmol/L,the incidence of GDM in late pregnancy will increase significantly. Key words: Blood glucose; Pregnancy trimester, first; Diabetes, gestational

ObjectiveBoth of the above studies aimed to evaluate whether or not low levels of 25-hydroxyvitamin D in pregnancy were associated with an increased risk of developing GDM.The Parlea study measured vitamin D levels in the first trimester between weeks 15 and 18, while the Burris study tested for vitamin D levels during the second trimester between weeks 26 and 28.

Objective To analyze the relationship between the fasting plasma glucose(FPG)of pre-pregnancy women and occurrence of gestational diabetes mellitus(GDM), and to explore the value of risk evaluation of GDM by lowerling cut-point for impaired fasting glucose (IFG). Methods The general clinic check information before pregnancy, the plasma glucose levels during 24-28 weeks of pregnancy and pregnancy outcomes were collected prospectively in Weifang and Zhucheng Maternal and Child Health Hospital between February 2014 and November 2014. The FPG levels of the recruited women were lower than 6.1 mmol/L. According to the criteria for GDM of Ministry of Health (MOH)of China in 2011, and based on the results of 75 g oral glucose tolerance test, pregnant women who underwent screening for GDM were recruited and separated into normal group and GDM group. Based on the FPG levels before pregnancy and according to the recommendation as American Diabetes Association (ADA)suggested in 2003, recruited women with normal FPG level according to World Health Organization (WHO)criteria(1999)were divided into 5.6-6.1 mmol/L and<5.6 mmol/L groups. Results Among the child-bearing age women with FPG<6.1 mmol/L, the incidences of GDM and macrosomia were 19.2% and 8.2% respectively. In the group with FPG between 5.6 and 6.1 mmol/L, incidences of GDM and macrosomia were 34.2% and 4.7% respectively. While in the group with FPG<5.6 mmol/L, incidences of GDM and macrosomia were 13.2% and 15.3% respectively. The risks of GDM and macrosomia were increased by 2.6 times and 3.3 times respectively in group with FPG between 5.6 and 6.1 mmol/L (34.5%), compared with that in group with FPG<5.6 mmol/L(P<0.01). Age, FPG, and body mass index before pregnancy in GDM group were significantly higher than those in normal group. The receiver operating characteristic curves in predicting GDM showed that the optimum cut-points for age, FPG, and body mass index were 30 years old, 5.55 mmol/L, and 23.7 kg/m2 respectively. Conclusions The risk of GDM in childbearing aged women with FPG from 5.55 to 6.10 mmol/L was markedly increased. The optimum cut-point for FPG (5.55 mmol/L) in predicting GDM was close to the low limit for IFG (5.6 mmol/L) suggested by ADA in 2003. Decreasing the lower limit of IFG to 5.6 mmol/L among women who checked before pregnancy and paying attention to those women with FPG from 5.6 to 6.1 mmol/L would have advantage to the evaluation and prevention of GDM. (Chin J Endocrinol Metab, 2016, 32: 475-479) Key words: Pre-pregnant; Impaired fasting glucose; Diabetes mellitus, gestational; Macrosomia

Concept of Diabetes Mellitus: Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long‐term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder.

Objective To explore the correlations among the body mass index (BMI), levels of C-reactive protein (CRP), glycosylated hemoglobin (HbA1c) and gestational diabetes mellitus (GDM) of pregnant women, as well the predictive values of these 3 indexes for GDM. Methods A total of 100 pregnant women with GDM were selected as research subjects and included in GDM group, who received intervention treatment and gave birth in Nanjing Integrated Traditional Chinese and Western Medicine Hospital from December 2016 to December 2018. Meanwhile, a total of 60 healthy pregnant women who had prenatal examinations and gave birth at the same hospital were selected and included in control group. The levels of fasting plasma glucose (FPG), 2 h postprandial blood glucose (2 h PPG), BMI, CRP and HbA1c of pregnant women, also the incidence rates of indexes of perinatal outcomes of pregnant women were statistically compared between two groups by independent-samples t test and chi-square test. The correlation among BMI, CRP, HbA1c, respectively, with FPG and 2 h PPG of the pregnant women in GDM group were analyzed by Pearson correlation analysis. This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and all participants confirmed and signed consent forms for clinical trials. Results ① The levels of FPG, 2 h PPG, BMI, CRP and HbA1c of pregnant women in GDM group were (7.8±1.0) mmol/L, (11.0±1.6) mmol/L, (25.8±1.2) kg/m2, (12.8±2.9) mg/L and (8.5±1.7)%, respectively, which were all much higher than those of (5.6±0.6) mmol/L, (7.6±1.1) mmol/L, (22.2±1.1) kg/m2, (7.7±2.4) mg/L and (4.0±1.0)% in control group, and the differences were statistically significant (t=14.139, 13.394, 17.455, 10.726, 16.705, all P<0.001). ② Pearson correction analysis showed those indexes of BMI, CRP and HbA1c of GDM pregnant women had positive correlation with FPG and 2 h PPG, respectively, (r=0.438, 0.408, P<0.001; r=0.389, 0.410, P<0.001; r=0.413, 0.442, P<0.001). ③ The incidence rates of preterm birth, premature rupture of membranes, polyhydramnios, deliver macrosomia, fetal distress and postpartum hemorrhage of pregnant women in GDM group were 21.1%, 23.3%, 22.2%, 17.8%, 16.7%, 12.2%, respectively, which were all much higher than those of 6.0%, 8.0%, 6.0%, 4.0%, 4.0%, 2.0% in control group, and the differences were statistically significant (χ2=5.542, P=0.019; χ2=5.152, P=0.023; χ2=6.161, P=0.013; χ2=5.446, P=0.020; χ2=4.834, P=0.028; χ2=4.286, P=0.038). The 1-minute Apgar score of newborns birthed by pregnant women in GDM group was (7.1±0.7) scores, which was lower than that of (8.3±1.0) scores in control group, and the difference was statistically significant (t=8.469, P<0.001). Conclusions The levels of BMI, CRP and HbA1c of pregnant women are associated with the occurrence of GDM, and early monitoring of these 3 indexes are recommended to predict GDM earlier. Key words: Body mass index; C-reactive protein; Hemoglobin A, glycosylated; Diabetes, gestational; Pregnant women

The purpose of this study is to investigate the relationship between serum ferritin levels and metabolic risk factors in nonobese Korean young adults. We analysed the fourth annual Korea National Health and Nutrition Examination Survey (KNHANES) in young adults (aged 19-39 years), conducted between 2007 and 2008. A total of 1542 nonobese [body mass index (BMI) <25 kg/m(2) ] young adults (684 men and 858 women) were enrolled. Using blood pressure and levels of serum triglycerides, plasma glucose and high-density lipoprotein (HDL) cholesterol, the Asian criteria for abdominal obesity (Waist circumference ≥90 cm in men or ≥80 cm in women) was used to identify individuals with metabolic syndrome. Data on anthropometry, fasting plasma glucose, insulin, lipid profile and ferritin levels were analysed. The prevalence of metabolic syndrome was 4·1% for men and 2·7% for women. High fasting glucose and the prevalence of metabolic syndrome increased progressively across three different tertiles of ferritin levels in men. However, high ferritin levels were associated with high triglycerides, low HDL cholesterol and metabolic syndrome in women. After adjustment for age, smoking, alcohol consumption, BMI and ALT levels, low HDL cholesterol (OR 1·66, 95% confidence interval (CI) 1·16-2·36) and the presence of metabolic syndrome (OR 3·87, 95% CI 1·34-11·2) were independently associated with high serum ferritin levels in Korean nonobese young women. Our results suggest that elevated serum ferritin levels may be employed as a marker of metabolic syndrome in nonobese young adult women.

PurposeOur previous studies have suggested that the first trimester fasting plasma glucose (FPG) level is associated with gestational diabetes mellitus (GDM) and is a predictor of GDM. The aim of the present study was to provide valuable insights into the accuracy of the first trimester FPG level in the screening and diagnosis of GDM in southern China.MethodsThis retrospective study included pregnant women who had their first trimester FPG level recorded at 9–13+6 weeks and underwent screening for GDM using the 2-h 75 g oral glucose tolerance test (OGTT) between the 24th and 28th gestational weeks. Differences between the GDM and non-GDM groups were assessed by Student’s t test and the chi-squared test according to the nature of the variables. A restricted cubic spine was used to explore the relationship between the first trimester FPG level and the odds ratio (OR) of GDM in pregnant women. Cut-off values of first trimester FPG were determined using receiver operating characteristic (ROC) curves and the area under the curve (AUC), and 95% confidence intervals (CIs), the positive predictive value (PPV) and the negative predictive value (NPV) were calculated.ResultsThe medical records of 28,030 pregnant women were analysed, and 4,669 (16.66%) of them were diagnosed with GDM. The average first trimester FPG level was 4.62 ± 0.37 mmol/L. The OR of GDM increased with increasing first trimester FPG levels and with a value of first trimester FPG of approximately 4.6 mmol/L, which was equal to 1 (Chi-Square = 665.79, P < 0.001), and then started to increase rapidly afterwards. The ROC curve for fasting plasma glucose in the first trimester (4.735 mmol/L) for predicting gestational diabetes mellitus in pregnant women was 0.608 (95% CI: 0.598–0.617), with a sensitivity of 0.490 and a specificity of 0.676.ConclusionBased on the research, we recommend that all pregnant women undergo FPG testing in the first trimester, particularly at the first antenatal visit. Furthermore, we suggest that the risks of GDM should be given increased attention and management as soon as the first trimester FPG value is more than 4.7 mmol/L. First trimester FPG levels should be considered a screening marker when diagnosing GDM in pregnant women but this needs to be confirmed by more prospective studies. These factors may have a significant impact on the clinical treatment of pregnant women.

Objective We aimed to investigate the performance of fasting plasma glucose (FPG) level, checked between 24 and 28 weeks of gestation, for the diagnosis of gestational diabetes mellitus (GDM) in order to find out whether FPG level would help to identify potential GDM cases or not in pregnancies which do or do not undergo oral glucose tolerance test (OGTT). Methods This study was performed retrospectively in a tertiary center by accessing the records of 2950 patients who underwent 75-g OGTT in between 24 and 28 weeks of gestation. GDM diagnosis was established according to the one-step screening test results. In the patients diagnosed with GDM, the most successful threshold value for the diagnosis calculated statistically was determined for FPG. The specificity and sensitivity values were calculated for FPG. Results After applying the exclusion criteria, 1736 of 2043 pregnant women were normal and 307 (15%) of them were diagnosed with GDM. The mean age was higher in the pregnant women with GDM than the healthy pregnant women when they were compared according to the demographic characteristics (28.6±4.3 vs. 26.2±4.1, p&lt;0.001). Body mass index was also higher in the pregnant women with GDM compared to the health pregnant women (26±2.1 vs. 24±3.1 kg/m2, p&lt;0.001). Other characteristics were similar in both groups. ROC analysis was performed for FPG and the most significant threshold value was found 88 mg/dL (p&lt;0.001, area under curve 0.876, 95% confidence interval 0.850–0.903). Conclusion When FPG is &gt;88 mg/dl in pregnant women who do not want to undergo OGTT, they should be informed in detail about both OGTT and GDM and its potential complications. Thus, the number of GDM cases without diagnosis and its potential complications would decrease.

Background: The association of bisphenol A (BPA) and gestational diabetes mellitus (GDM) has been investigated in only a small number of studies, and research on the associations between BPA substitutes and GDM is scarce.Objective: We aimed to investigate the associations of four bisphenols [bisphenol A (BPA), bisphenol S (BPS), bisphenol F (BPF), and bisphenol AF (BPAF)] levels in urine sample with the risk of gestational diabetes mellitus (GDM) and plasma glucose levels.Methods: A total of 1,841 pregnant women from a cohort study were recruited at their first prenatal examination between 2013 and 2015 in Wuhan, China. Concentrations of four bisphenols (BPA, BPS, BPF, BPAF) were measured in first-trimester urine samples using Ultra-high performance liquid chromatography system coupled to a Triple Quadrupole mass spectrometer (UHPLC-TQMS). An oral glucose tolerance test (OGTT) was performed at 24–28 gestational weeks and GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. We used multivariable logistic regression models to examine the associations of urinary bisphenols with the risk of GDM, and multiple linear regression models to determine the associations between bisphenols exposure and plasma glucose levels.Results: Urinary BPAF was associated with increased odds of GDM among women with normal pre-pregnancy BMI [adjusted odds ratio (aOR) = 1.70 (95% CI: 1.08, 2.67) for the highest group compared to the lowest group], and the association remained significant after additional adjustment for other bisphenols [aOR = 1.68 (95% CI: 1.03, 2.72)]. No significant associations were observed for other bisphenols and GDM. Consistent with the result of GDM, women in the highest BPAF category had a mean of 0.05 mmol/L (95% CI: 0.01, 0.09) higher fasting plasma glucose (FPG) levels than women in the lowest category. For BPA and plasma glucose, non-linear associations were observed between urinary BPA and FPG and the sum of the PG z-score among women who were overweight (p for non-linear association < 0.05). We also found that the per-unit increase in natural log transformed specific gravity adjusted BPS [ln (SG-adj BPS)] was associated with a 0.03 mmol/L (95% CI: 0.01, 0.04) increase in FPG levels and the associations might be modified by fetal sex (p for interaction < 0.05). Among women with female fetus, a per-unit increase in ln (SG-adj BPS) was associated with a 0.04 mmol/L (95% CI: 0.02, 0.06) increase in FPG, a 0.11 mmol/L (95% CI: 0.04, 0.17) increase in 1 h-PG and a 0.19 mmol/L (95% CI: 0.08, 0.30) increase in the sum of PG z-score.Conclusions: Our results provide evidence that BPAF and BPS might be potential risk factors of GDM, which require to be studied further.

Objective To examine the accuracy of maternal serum glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels in predicting gestational diabetes at the first trimester in Turkish women with a low-risk pregnancy and its relationship with fetal birth weight. Methods This cohort study was conducted retrospectively in a tertiary referral hospital from January 2010 to January 2017. HbA1c and FPG serum concentrations were measured in 670 pregnant women at the first-trimester screening. HbA1c and FPG concentrations of women who subsequently developed gestational diabetes mellitus (GDM) were compared to those who did not, and its relationship with fetal weight was investigated. Results First-trimester screening was performed on 608 pregnant women, of whom 69 (11.3%) women had developed GDM. Median HbA1c and FPG concentrations were significantly higher in women developing GDM (n = 69) in comparison to those with uncomplicated pregnancies (n = 539) (5.31 ± 0.58% versus 5.01 ± 0.45%, p < .001 and 89.74 ± 8.71% versus 84.09 ± 9.16%, p < .001, respectively). The cut-off value calculated with the highest Youden index was HbA1c levels above 5.6% with a sensitivity of 34.78%, specificity of 89.8%, with a diagnostic accuracy of 83.55%, and FPG levels above 86.85 mg/dl with a sensitivity of 69.57%, specificity of 61.78%, with a diagnostic accuracy of 62.66%. The calculated odds ratio (OR) for HbA1c > 5.6% and FPG > 86 mg/dl were 4.69 (95% CI: 2.66–8.29), and 3.7 (95% CI: 2.15–6.35), respectively. HbA1c and FPG combined had improved the predictive capability for GDM (OR: 7.26, 95% CI: 3.71–14.19). According to correlation analyses, a noteworthy positive correlation was found between HbA1c and, FPG, 50 g GCT, age, BMI, parity, and birth weight. However, there was no correlation between FPG and birth weight. Conclusion Diagnostic accuracy of HbA1c for GDM prediction in Turkish women with a low-risk pregnancy is 83.55% with a very good negative predictive value of 91.49%. HbA1c and FPG combined enhanced the predictive capability for GDM. In addition, there is a positive relationship between HbA1c and 50 g GCT, and birth weight. However, to suggest HbA1c as a potential screening test for gestational diabetes mellitus, further research is warranted.

Objective To investigate the plasma glucose level in the aircrews of different aircrafts and to analyze its reasons,so as to provide the basis for stabilizing aircrew's plasma glucose level and ensuring flight safety.Methods Five hundred and thirty-two pilots,who were examined in our sanatorium from Jan of 2011 to Aug of 2013,were divided into 3 age groups (＜30 yr.,30-39 yr.and ≥40 yr.),and 3 flying hour groups (＜1 000 h,1 000-1 999 h and ≥2 000 h).Their fasting plasma glucose (FPG) levels were analyzed and compared.Results ①The average level of aircrew's FPG was (4.55±0.54) mmol/L.Helicopter aircrews showed significant different FPG levels among age groups and flying hour groups (F＝4.290,5.157,P＜0.05 or 0.01).FPG level in bomber aircrew was significant different among age groups (F＝4.582,P＜0.05).FPG level in other aircraft aircrews was insignificant neither among age groups nor among flying hour groups (P＞0.05).②The FPG level of the fighter pilots in ＜30 yr group was significantly higher than that of helicopter,bombers and early warning aircraft aircrews (P ＜ 0.01).FPG level of trainer aircrews was significantly higher than that of bomber and early warning aircraft aircrews (P＜0.05).FPG level of the fighter,helicopter and trainer aircrews was significantly higher than that of bomber aircrews (P＜0.01).FPG level of helicopter and trainer aircrews was significantly higher than that of early warning aircrews (P＜0.05).For the aircrews in ≥40 yr group there were no significant FPG level differences among aircraft types (P＞ 0.05).③For ＜ 1 000 h group,the FPG level of fighter pilots was significantly higher than that of helicopter,bomber and early warning aircraft aircrews (F＝ 7.655,P＜0.01).In 1 000-1 999 h group,FPG level of fighter,trainer aircrews was significantly higher than that of bomber aircrews (P＜0.01 or 0.05).FPG level of fighter,helicopter and trainer aircrews was significantly higher than early warning aircraft aircrews' (P＜ 0.05).For flying hour ≥ 2 000 h group,FPG level of fighter,helicopter and trainer aircrews was significantly higher than bomber aircrews' (P＜0.05 or 0.01).Conclusions There are differences in different aircraft aircrews' FPG level.We should pay enough attention to them. Key words: Blood glucose; Age factors; Occupationa exposure; Epidemiological studies

Background: The main component of mung bean protein, accounting for more than 80%, is 8Sα globulin. Its structure closely resembles that of soybean β-conglycinin. Thereby, the mung bean protein is expected to have similar physiological effects to those of β-conglycinin, but there is no clinical evidence for these effects.Purpose of this study: The aim of this study was to confirm the positive effects of mung bean protein (GLUCODIATM) on glucose metabolism in clinical trials.Method: This clinical study was conducted using a double-blind placebo-controlled design with 45 prediabetes patients.Results: Many of the subjects were pre-diabetes with blood glucose levels exceeding 140 mg/dL by 2-hour plasma glucose level. However, the initial mean fasting plasma glucose level was less than 100 mg/dL. Therefore, mung bean protein did not lower fasting plasma glucose levels. The test period extended from summer to autumn, and increased fasting plasma glucose levels in the placebo group were observed due to seasonal factors. However, this increase was suppressed in the test group. Similarly, the mean insulin level increased in the placebo group, but the increase was also suppressed in the test group. Among obese subjects with a high body mass index, significant increases in fasting plasma glucose and insulin levels in the placebo group were observed. In the comparison between the test and the placebo groups with the average elevation value, there was a significant difference in fasting blood glucose level and significant tendencies in insulin level and homeostatic model assessment for insulin resistance value between the two groups.Conclusion: Mung bean protein suppresses fasting plasma glucose and insulin levels. Consequently, it may have an inhibitory effect on insulin resistance, a trigger of metabolic syndrome.Key words: mung bean protein, insulin, obesity, body mass index, randomized clinical trial, seasonal variation.

Objectives: To examine the association between vitamin E (VE) status and gestational diabetes mellitus (GDM). Methods: A retrospective cohort study was conducted by using data of 52,791 women at 137 hospitals across 22 provinces of China. A fasting plasma glucose (FPG) level of ≥5.1 mmol/L between the 24th and 40th weeks of gestation was used as the criteria for the diagnosis of GDM. Mean FPG level and GDM rate were calculated within each combination of the first-trimester VE concentration categories and gestational change categories. The associations of the first-trimester VE concentrations and gestational VE change with FPG and GDM were examined by employing generalized additive models (GAMs). Results: 7162 (13.57%) cases were diagnosed with GDM. The GDM rate was 22.44%, 11.50%, 13.41%, 12.87%, 13.17%, 13.44%, 12.64%, and 14.24% among women with the first-trimester VE concentrations of <7.2, 7.2–7.9, 8.0–9.3, 9.4–11.0, 11.1–13.2, 13.3–15.8, 15.9–17.7, and 17.8–35.9 mg/L, respectively. The GDM rate was 15.96%, 13.10%, 13.64%, and 12.87% among women with gestational VE change of <0, 0–0.19, 0.20–0.29, ≥0.30 mg/L per week, respectively. Multivariable adjusted GAM analyses found that the first-trimester VE concentration was associated with the FPG levels and GDM risk in an L-shaped pattern; the FPG levels and GDM risk decreased sharply to a threshold (around 7 mg/L), and then were keep flat. Gestational VE decreases when the first-trimester VE level was less than 11 mg/L were related to increased FPG levels and GDM risk. Conclusions: Both low first-trimester VE levels and subsequent gestational VE decrease were related with increased risk of GDM. The findings suggest the necessity of having VE-rich foods and appropriate VE supplementation to prevent GDM for pregnant women with low baseline VE levels.

Objective To investigate the relationship between fasting plasma glucose (FPG) in early pregnancy and diagnosis of gestational diabetes mellitus (GDM) and to confirm the rationality of the new standard for GDM diagnosis in early pregnancy set by the International Association of Diabetes and Pregnancy Study Groups (IADPSG).Methods Clinical materials of 2761 pregnant women without diabetes mellitus,who accepted prenatal cares in Peking University First Hospital from April 1,2011 to December 31,2011,were collected and analyzed.The difference between FPG levels of GDM and non-GDM women was compared.According to the early pregnancy FPG level,the subjects were divided into group A (FPG＜5.1 mmol/L,n=2431) and B (FPG≥5.1 mmol/L,n=330).The incidence of GDM and pregnant outcomes of the two groups were compared with t or Chi-square test.Relationship between FPG and GDM was analyzed by Logistic regression and receiver operating characteristic curve.Results (1) Among the 2761 subjects,515 were diagnosed as GDM (18.7％) and the early pregnancy FPG level in GDM group was significantly higher than that in non-GDM group [(4.84±0.46) mmol/L vs (4.57 ± 0.35) mmol/L,t =11.924,P =0.000].In early pregnancy,the risk of GDM increased by 7.984-fold (OR=8.984,95％CI:6.605-12.220) with every 1 mmol/L increase of the FPG level.(2) The diagnostic rate of GDM during mid-and last-trimester in group A (15.2％,370/2431) was lower than that of group B (43.9％,145/330),x2 =123.976,P =0.000.(3) Receiver operating characteristic curve analysis of FPG in early pregnancy and diagnosis of GDM:The largest area under the curve was 0.718 (95％ CI:0.690-0.747).The sensitivity and specificity were 0.600 and 0.612,or 0.735 and 0.726 respectively,when 4.795 mmol/L or 4.785 mmol/L were set as the cut-off value.(4) Among the 1208 cases delivered,GDM was diagnosed in 227 cases.The cesarean section rate (54.2％,123/227) of GDM women was higher than that (39.2％,385/981) of non-GDM women (x2 =16.884,P=0.000).There were no differences in the incidences of macrosomia,neonatal hyperbilirubinemia,low birthweight infant,premature delivery,fetal growth restriction and preeclampsia between GDM and non-GDM group (all P＞0.05).The incidence of premature birth in GDM women with FPG＜ 5.1 mmol/L was lower (5.8％,10/173) than that (14.8％,8/54) of women with FPG≥5.1 mmol/L (x2=4.601,P＜0.05).The incidence of cesarean section,insulin administration,macrosomia and preeclampsia increased from low FPG group to high FPG group,however there was no statistical significances.Conclusions Diagnosing GDM with FPG≥5.1 mmol/L in early pregnancy is not recommended as over diagnosis might happen.But this cut-off value might indicate that the patient are at risk of GDM,and this population should not be ignored. Key words: Pregnancy trimester, first; Diabetes, gestational; Blood glucose

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.