Gestational Glucose Metabolism Research Articles

Serum selenium, selenoprotein P, and glutathione peroxidase 3 during early and late pregnancy in association with gestational diabetes mellitus: Prospective Odense Child Cohort

BackgroundDiet is an important modifiable risk factor for gestational diabetes mellitus (GDM) and its related complications; however, the role of essential micronutrients such as selenium (Se), particularly in populations with low Se intake, is inconclusive. ObjectivesThe aim was to investigate the association of 3 established biomarkers of Se status with GDM, gestational glucose metabolism, and large for gestational-age offspring. MethodsThis study included 1346 pregnant females with 2294 serum samples from the prospective, population-based Odense Child Cohort study, Denmark. Serum Se, selenoprotein P (SELENOP) concentrations, and glutathione peroxidase 3 (GPX3) activity were measured in early and late pregnancy, and fasting glucose and insulin assessments in late pregnancy. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was calculated, and the GDM definition was according to the WHO 2013 threshold of fasting venous plasma glucose of ≥5.1 mmol/L. A subcohort underwent an oral glucose tolerance test. Regression models adjusted for various confounders quantified dose-dependent associations. ResultsSe and SELENOP declined during pregnancy. There were dose-dependent inverse associations of early GPX3 with late pregnancy GDM (WHO 2013), fasting glucose, insulin, HOMA-IR, and 2 h glucose. The odds ratio (OR) of GDM was 0.33 (95% CI: 0.16, 0.65) for 1 log-scale-increment in early GPX3 activity. Late pregnancy GPX3 and SELENOP were inversely associated with GDM and HOMA-IR; the OR of GDM was 0.21 (95% CI: 0.12, 0.38) and 0.52 (95% CI: 0.35, 0.77), for 1 log-scale-increment of GPX3 and SELENOP, respectively. A decline in Se biomarkers during pregnancy was associated with a higher risk of GDM and higher HOMA-IR. Low GPX3 activity in late pregnancy was associated with a higher risk of large for gestational-age offspring, partly (∼20%) mediated by fasting glucose concentrations (P = 0.006). ConclusionsLow serum Se in pregnancy, particularly GPX3 activity, is independently associated with risk of GDM and large for gestational age. Offering Se status assessment in pregnancy identifies females at high risk for GDM who may benefit from Se substitution.

The Gut Microbiome Dynamically Associates with Host Glucose Metabolism throughout Pregnancy: Longitudinal Findings from a Matched Case-Control Study of Gestational Diabetes Mellitus.

Though gut microbiome disturbance may be involved in the etiology of gestational diabetes mellitus (GDM), data on the gut microbiome's dynamic change during pregnancy and associations with gestational glucose metabolism are still inadequate. In this prospective study comprising 120 pairs of GDM patients and matched pregnant controls, a decrease in the diversity of gut microbial species and changes in the microbial community composition with advancing gestation are found in controls, while no such trends are observed in GDM patients. Multivariable analysis identifies 10 GDM-related species (e.g., Alistipes putredinis), and the integrated associations of these species with glycemic traits are modified by habitual intake of fiber-rich plant foods. In addition, the microbial metabolic potentials related to fiber fermentation (e.g., mannan degradation pathways) and their key enzymes consistently emerge as associated with both GDM status and glycemic traits. Microbial features especially those involved in fiber fermentation, provide an incremental predictive value in a prediction model with established risk factors of GDM. These data suggest that the gut microbiome remodeling with advancing gestation is different in GDM patients compared with controls, and dietary fiber fermentation contributes to the influence of gut microbiome on gestational glycemic regulation.

Maternal Pre-Pregnancy Obesity Combined With Abnormal Glucose Metabolism Further Increases Adverse Pregnancy Outcomes in Chinese Pregnant Women.

AimsOur aim was to evaluate the separate and combined effects of maternal pre-pregnancy obesity and gestational abnormal glucose metabolism (GAGM) on adverse perinatal outcomes.MethodsA total of 2,796 Chinese pregnant women with singleton delivery were studied, including 257 women with pre-pregnancy obesity alone, 604 with GAGM alone, 190 with both two conditions, and 1,745 with neither pre-pregnancy obesity nor GAGM as control group. The prevalence and risks of adverse pregnancy outcomes were compared among the four groups.ResultsCompared with the normal group, pregnant women with maternal pre-pregnancy obesity alone, GAGM alone, and both two conditions faced significantly increased risks of pregnancy-induced hypertension (PIH) (odds ratio (OR) 4.045, [95% confidence interval (CI) 2.286–7.156]; 1.993 [1.171–3.393]; 8.495 [4.982–14.485]), preeclampsia (2.649 [1.224–5.735]; 2.129 [1.128–4.017]; 4.643 [2.217–9.727]), cesarean delivery (1.589 [1.212–2.083]; 1.328 [1.095–1.611]; 2.627 [1.908–3.617]), preterm delivery (1.899 [1.205–2.993]; 1.358 [0.937–1.968]; 2.301 [1.423–3.720]), macrosomia (2.449 [1.517–3.954]; 1.966 [1.356–2.851]; 4.576 [2.895–7.233]), and total adverse maternal outcomes (1.762 [1.331–2.332]; 1.365 [1.122–1.659]; 3.228 [2.272–4.587]) and neonatal outcomes (1.951 [1.361–2.798]; 1.547 [1.170–2.046]; 3.557 [2.471–5.122]). Most importantly, there were no obvious risk differences in adverse pregnancy outcomes between maternal pre-pregnancy obesity and GAGM group except PIH, but pregnant women with both obesity and GAGM exhibited dramatically higher risks of adverse pregnancy outcomes than those with each condition alone.ConclusionsMaternal pre-pregnancy obesity and GAGM were independently associated with increased risks of adverse pregnancy outcomes. The combination of pre-pregnancy obesity and GAGM further worsens adverse pregnancy outcomes compared with each condition alone.

Genetic Studies of Gestational Diabetes and Glucose Metabolism in Pregnancy.

In this review, we summarize studies investigating genetics of gestational diabetes mellitus (GDM) and glucose metabolism in pregnancy. We describe these studies in the context of the larger body of literature on type 2 diabetes (T2D) and glycemic trait genomics. We reviewed 23 genetic association studies for GDM and performed a meta-analysis, which revealed variants at eight T2D loci significantly associated with GDM after the Bonferroni correction. These studies suggest that GDM and T2D share a number of genetic risk loci. Only two unbiased genome-wide association studies (GWASs) have successfully revealed genetic associations for GDM and related glycemic traits in pregnancy. A GWAS for GDM in Korean women identified two loci (near CDKAL1 and MTNR1B) known to be associated with T2D, though the association of the MTNR1B locus with GDM appears to be stronger than that for T2D. A multi-ethnic GWAS for glycemic traits in pregnancy identified two novel loci (near HKDC1 and BACE2) which appear to be associated with post-load glucose and fasting c-peptide specifically in pregnant women. There are ongoing efforts to use this genetic information, in the form of polygenic scores, to predict risk of GDM and postpartum T2D. The body of literature examining genetic associations with GDM is limited, especially when compared to the available literature on T2D and glycemic trait genomics. Additional genetic discovery for glucose metabolism in pregnant women will require larger pregnancy cohorts and international collaborative efforts. Studies on the clinical implications of these findings are also warranted.

Maternal glucose homeostasis is impaired in mouse models of gestational cholestasis

Women with intrahepatic cholestasis of pregnancy (ICP), a disorder characterised by raised serum bile acids, are at increased risk of developing gestational diabetes mellitus and have impaired glucose tolerance whilst cholestatic. FXR and TGR5 are modulators of glucose metabolism, and FXR activity is reduced in normal pregnancy, and further in ICP. We aimed to investigate the role of raised serum bile acids, FXR and TGR5 in gestational glucose metabolism using mouse models. Cholic acid feeding resulted in reduced pancreatic β-cell proliferation and increased apoptosis in pregnancy, without altering insulin sensitivity, suggesting that raised bile acids affect β-cell mass but are insufficient to impair glucose tolerance. Conversely, pregnant Fxr−/− and Tgr5−/− mice are glucose intolerant and have reduced insulin secretion in response to glucose challenge, and Fxr−/− mice are also insulin resistant. Furthermore, fecal bile acids are reduced in pregnant Fxr−/− mice. Lithocholic acid and deoxycholic acid, the principal ligands for TGR5, are decreased in particular. Therefore, we propose that raised serum bile acids and reduced FXR and TGR5 activity contribute to the altered glucose metabolism observed in ICP.

Genetic predisposition to gestational glucose metabolism and gestational diabetes mellitus risk in a Chinese population.

Genome-wide association studies (GWAS) have identified several genetic variants affecting gestational glucose metabolism. However, information regarding their known associations with gestational diabetes mellitus (GDM) risk remains scarce. This study examined the associations of 12 gestational glucose metabolism-related variants with GDM risk in a Chinese population (964 GDM cases, 1021 controls). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by logistic regression analysis. Rs10830963 in melatonin receptor 1B (MTNR1B) was found to be associated with an increased risk of GDM, after adjusting for age, prepregnancy body mass index, parity, abnormal pregnancy history, and family history of diabetes (OR 1.20; 95% CI 1.05-1.36; P = 0.007). Compared with women with a family history of diabetes, there was a significant association of rs7936247 with GDM risk among pregnant women without a family history of diabetes (OR 1.20; 95% CI 1.04-1.38; P = 0.014; Pheterogeneity = 0.035). Further functional annotations showed that rs10830963 and rs7936247 fell in the functional elements of human pancreatic islets. Genotype-phenotype associations indicated that the variants may contribute to GDM risk by affecting the expression of nearby or distant genes. The findings of this study suggest that rs10830963 and rs7936247 may be markers for susceptibility to GDM in a Chinese population. Additional studies are warranted to validate our findings and clarify the underlying mechanism.

Gestational diabetes mellitus: different management strategies should be adopted for different subsets of patients diagnosed by oral glucose tolerance test.

To compare women diagnosed with gestational diabetes mellitus (GDM) according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria based on the number of OGTT diagnostic criteria, which OGTT parameters are altered and the glycemic deviation from proposed diagnostic cutoffs. Cross-sectional, multicentric study of women diagnosed with GDM between 24-28 weeks of pregnancy according to the IADPSG criteria, in Portugal, between 2012-2014. Primary outcomes: large for gestational age (LGA) and maternal glucose metabolism status after delivery. Secondary outcome: small for gestational age (SGA). Three-thousand three-hundred fourteen patients were included; 67% had 1 OGTT altered value; 3.6% had LGA and 13% had SGA newborns; 7% had prediabetes/diabetes after delivery. Three diagnostic criteria in OGTT (OR 3.02; p < 0.001), a diagnostic value at 0 min (OR 2.09; p = 0.002) and 60 min (OR 1.70; p = 0.022) and glucose deviation at 0 min (OR 1.02; p = 0.014) were predictors of LGA. Having 2 (OR 1.94; p < 0.001) or 3 (OR 3.93; p < 0.001) diagnostic criteria in OGTT, a diagnostic value at 0 min (OR 1.76; p = 0.002), at 60 min (OR 1.57; p = 0.007) and at 120 min (OR 3.11; p < 0.001), the glucose deviation at 0 (OR 1.02; p = 0.017) and 120 min (OR 1.02; p < 0.001) were predictors of prediabetes/diabetes after delivery. Insufficient weight gain in pregnancy (OR 1.49; p < 0.001) and lower maternal BMI (OR 0.97; p = 0.024) were associated with SGA. IADPSG diagnostic criteria include a heterogeneous group of women, for whom different management strategies should be adopted to obtain ideal pregnancy outcomes.

Influence of gestational abnormal glucose metabolism on the birth outcome and long-term weight of neonates

Objective To investigate the influence of gestational abnormal glucose metabolism on the birth outcome and long-term weight of neonates. Methods Thirty pregnant women with gestational diabetes mellitus(GDM) were enrolled in this study.30 pregnant women with gestational impaired glucose tolerance(GIGT) were selected, and 30 normal pregnant women(NGT) were selected as control group.The weight, length and weight index(PI) of the three groups were collected.The incidence rates of adverse outcomes were collected in the three groups.The long-term weight of the newborns was investigated.According to whether breastfeeding, they were divided into breastfeeding group and non-breastfeeding group.The body mass index(BMI) was compared between 42 days, 3 months, 6 months and 12 months, respectively. Results There were statistically significant differences in body weight and PI of neonates except length between the control group and the GDM group(t=1.60, P=0.06; t=5.09, P=0.00; t=6.94, P=0.00). There were statistically significant differences in body weight and PI of neonates except length between the control group and the GIGT group(t=1.57, P=0.06; t=4.21, P=0.01; t=5.88, P=0.00). There were no statistically significant differences in the above indices between the GDM group and the GIGT group(all P>0.05). The incidence rate of macrosomia in the GDM group and the GIGT group was significantly higher than that of the control group(χ2=10.59, P=0.00). The incidence rates of respiratory failure syndrome, cardiovascular disease, hyperbilirubinemia and birth injury among the three groups had no statistically significant differences(χ2=1.23, P=0.54; χ2=2.09, P=0.35; χ2=2.02, P=0.36; χ2=2.09, P=0.35; χ2=4.03, P=0.13). At the birth of 42 days, 3 months, 6 months, 12 months, the BMI of neonates in the GDM group and the GIGT group were slightly higher than those in the control group, but there were no statistically significant differences in BMI index among the three groups of breastfed newborns(F=0.71, P=0.28; F=0.97, P=0.12; F=0.98, P=0.12; F=0.77, P=0.22). At the birth of 42 days, 3 months, 6 months, 12 months, the BMI of neonates in the GDM group and the GIGT group were slightly higher than those in the control group, but there were no statistically significant differences in BMI index among the three groups of breastfed newborns(F=0.77, P=0.34; F=0.89, P=0.10; F=1.12, P=0.09; F=0.55, P=0.67). Conclusion Abnormal glucose metabolism in pregnant women can lead to a significant increase in the incidence of neonatal macrosomia.The body weight and PI of neonates are higher than those without abnormal glucose metabolism in pregnant women, but the abnormal maternal glucose metabolism in pregnant women has no significant influence on the long-term body weight of neonates, and there is no significant difference between NGT and neonates. Key words: Glucose metabolism disorders; Pregnancy complications; Diabetes, gestational

Relationship between the weight gain in the first and second trimesters and gestational glucose metabolism

Objective To study the difference of body weight gain in the first and second trimesters between pregnant women with abnormal gestational glucose metabolism and those with normal gestational glucose metabolism. Methods We retrospectively analyzed the data of pregnant women visited the obstetric clinic of Peking Union Medical College Hospital from January 2010 to May 2011, with or without abnormal glucose metabolism. The data of body weight gain in the first and second trimesters, body mass index (BMI) before pregnancy, BMI in the end of second trimester, age, obesity history, diabetes family history, insulin level in the oral glucose tolerance test (OGTT), and lipid profile of these women were collected. Results Altogether 216 pregnant women with abnormal glucose metabolism (case group) and 230 pregnant women with normal glucose metabolism (control group) were included in this study. In the case group, the increment of body weight in the first and second trimesters was 10.0(8.1, 12.5)kg, and the increment of BMI was (4.01±1.43)kg/m2, BMI in the end of the second trimester was (25.84±3.14)kg/m2; in comparison, the increments of body weight and BMI in the first and second trimesters were 9.5 (7.0, 11.5)kg and (3.60±1.43)kg/m2, respectively, BMI in the end of the second trimester was (25.1 ±3.00)kg/m2 in the control group, all significantly lower than in the case group (all P 0.05). Compare with the control group, the case group had older age [(33.17±3.65)years vs. (31.68±3.36)years], higher fasting insulin level [11.2 (7.1, 16.3)mU/L vs. 8.9 (6.5, 13.7)mU/L], higher peak insulin level in OGTT [135.3(99.7, 208.0)mU/L vs. 104.9(75.6, 144.4)mU/L], higher homeostasis model assessment for insulin resistance (HOMA-IR)[2.40(1.49, 3.47) vs. 1.82(1.28, 2.71)], and triglyceride [2.62(2.04, 3.31)mmol/L vs. 2.18(1.81, 2.81)mmol/L], all with significant differences (all P 0.05). Conclusions The body weight gain is higher in the pregnant women with abnormal glucose metabolism than in those with normal glucose metabolism in the first and second trimesters. Large increment of body weight is likely to be a risk factor for abnormal gestational glucose metabolism. Key words: Gestational diabetes mellitus; Gestational weight gain; Body mass index

Analysis of risk factors of abnormal glucose metabolism during pregnancy

Objective To understand the glucose metabolic pregnant women of the abnormal situation ,to ex-plore the risk factors of abnormal glucose metabolism during pregnancy .Methods 1 823 cases of pregnant women were collected ,use case-control study , pregnancy women with abnormal glucose metabolism during the same period were selected as case group ,select the same period in the hospital expectant healthy pregnant women ascontrol group , Using single factor and multi-factor Logistic regression to analysis of risk factors of gestational abnormal glucose me-tabolism.Results Sugar metabolism abnormal incidence of pregnant women was 5.76%;there were 31 cases of dia-betes,impaired glucose tolerance in 74 cases.The two groups of subjects of age ,BMI before pregnanly ,family history of diabetes,production times were significant difference （all P〈0.05）.With the increase of age,the incidence of abnormal blood glucose increase , but there was no difference between the age of diabetes and impaired glucose tolerance（P〉0.05）.The multi-factor Logistic regression of gestational abnormal glucose metabolism showed ：age （OR=3.786,P=0.001）,BMI before pregnanly（OR=2.424,P=0.013）and family history of diabetes（OR=1.554,P=0.003）were risk factors.Conclusion Age,family history of diabetes and pre pregnancy BMI are the risk factors of abnormal glucose metabolism during pregnancy . Key words: Glucose metabolism disorders ; Pregnancy; Risk factors

A prospective study on outcomes of glucose and lipid metabolism 1 year postpartum in patients with prior gestational abnormal glucose metabolism

Objective To elaborate the glucose and lipid metabolism 1 year postpartum on the foundation of postpartum 6-12 weeks in patients with prior gestational abnormal glucose metabolism in Beijing area.Methods Seventy-three patients who delivered during February to December,2007,aged (32.0 ± 3.6) years,were enrolled.46 cases (63％) were diagnosed as cases of gestational diabetes mellitus (GDM) while 27 (37％) as gestational impaired glucose tolerance (GIGT).All of the patients were revisited twice by 6-12 weeks and 1 year postparaum.Body weight,waist andhip circumferences,oral glucose tolerance test(OGTT),and lipids profile were determined.Results Compared with 6-12 weeks postpartum,the body weight,waist and hip circumferences,and waist-to-hip ratio were decreased by 1 year postpartum,fasting plasma glucose was increased [(5.19 ± 0.06) vs (4.84 ± 0.57) mmol/L,P＜0.01],and 4 cases were diagnosed as cases with impaired fasting glucose (IFG; 4 vs 0).By 6-12 weeks and 1 year postpartum,postprandial plasma glucose levels were (6.84± 1.93) and (7.33 ± 1.50) mmol/L(P=0.017),and the incidences of impaired glucose tolerance(IGT) were 28.8％ and 38.4％ (P=0.167),respectively,with 6 cases of newly diagnosed IGT by 1 year postpartum.There were more cases of hypertriglyceridenia (19.2％ vs 13.7％),less cases of hypercholesterolemia(19.7％ vs 30.0％,P＜0.01),more cases with improved high-densit.y lipoprotein-cholesterol (21.9％ vs 4.1％,P＜0.01),and less cases with raised low-density lipoproteincholesterol(21.9％ vs 49.3％,P＜0.01).No difference was found in body weight,body mass index,waist circumference,hip circumference,and waist-to-hip ratio between GIGT and GDM groups.Conclusion GDM is an important cause of the increasing prevalence of diabetes in women of reproductive age.Although body weight and waist-to-hip ratio have been improved,they would still develop glucose intolerance and dyslipidemia 1 year postpartum. Key words: Diabetes mellitus, gestational; Diabetes mellitus, type 2 ; Postpartum

Relation of Periodontitis and Metabolic Syndrome With Gestational Glucose Metabolism Disorder

Gestational diabetes mellitus (GDM) and metabolic syndrome have been related to periodontitis. This study's objective is to establish the relationship between them in pregnant women affected by gestational glucose metabolism disorder. In 188 pregnant women with positive O'Sullivan test (POT) results, an oral glucose tolerance test (OGTT) was performed to diagnose GDM. The mother's periodontal parameters, age, prepregnancy weight and height and body mass index (BMI), blood pressure, gestational age, and birth weight were recorded at 24 to 28 weeks of pregnancy, as well as levels of glucose, C-reactive protein, triglycerides, glycated hemoglobin (HbA1c), and total, low-density lipoprotein, high-density lipoprotein (HDL), and very-low-density lipoprotein (VLDL) cholesterol levels. Prepregnancy weight, prepregnancy BMI, systolic and diastolic blood pressure, VLDL cholesterol, and glucose parameters were higher in GDM compared with POT (P <0.05). VLDL cholesterol, triglycerides, and 2-hour OGTT were higher in patients with periodontitis than in patients without periodontitis (P <0.05). HbA1c, triglycerides, and 1- and 2-hour OGTT were positively related with probing depth and clinical attachment level; blood glucose was related only to bleeding on probing (P <0.05). HbA1c, basal OGTT, and 1- and 2-hour OGTT were positively related to prepregnancy BMI and blood pressure; HDL cholesterol was negatively related to prepregnancy BMI; C-reactive protein was positively related to prepregnancy BMI and diastolic blood pressure (P <0.05). These data support the relationships among periodontal disease and some biochemical parameters such as lipid and glucose data in pregnancy, and also among metabolic syndrome and biochemical parameters.

The Common C49620T Polymorphism in the Sulfonylurea Receptor Gene SUR1 (ABCC8) in Patients with Gestational Diabetes and Subsequent Glucose Metabolism Abnormalities

Aim. The aim of this study is to investigate the relationship between the common C49620T polymorphism in the sulfonylurea receptor (SUR1) gene and glucose metabolism, β-cell secretory function and insulin resistance in women with a history of gestational diabetes (GDM). Material and Methods. Study group included 199 women, diagnosed GDM within the last 5–12 years and control group of comparable 50 women in whom GDM was excluded during pregnancy. Blood glucose and insulin levels were measured during oral glucose tolerance test. Indices of insulin resistance (HOMA-IR) and β-cell function (HOMA %B) were calculated. In all patients, the C49620T polymorphism in intron 15 of the SUR1 gene was determined. Results. The distribution of the studied polymorphism in the two groups did not differ from each other (χ 2 = 0.34, P = 0.8425). No association between the distribution of polymorphisms and coexisting glucose metabolism disorders (χ 2 = 7,13, P = 0, 3043) was found. No association was also observed between the polymorphism and HOMA %B or HOMA-IR. Conclusions. The polymorphism C49620T in the SUR1 gene is not associated with insulin resistance and/or insulin secretion in women with a history of GDM and does not affect the development of GDM, or the development of glucose intolerance in the studied population.

Relationship between fasting plasma glucose in early pregnancy and gestational glucose metabolic disorders

Objective To investigate the relationship between early pregnancy fasting plasma glucose (FPG) and gestational glucose metabolism disorders. Methods Six hundred and fifty-six pregnant women who were singleton, non-diabetes before pregnancy and had FPG examined during 5-13 weeks of pregnancy were admitted into this study from January 1, 2009 to May 31, 2009. All these subjects had routine prenatal examination and finally delivered in the Department of Obstetrics of Peking University First Hospital. The FPG, 50 g glucose challenge test (GCT) after 24 weeks of pregnancy, 75 g oral glucose tolerance test (OGTT), gestational diabetes mellitus (GDM),gestational impaired glucose tolerance (GIGT) were analyzed with receiver operating characteristic (ROC) curve. Results (1) Relationship between FPG and GCT were analyzed with ROC curve.The maximum area under curve was 0. 539 (95% CI: 0. 493-0. 586) and there was no correlation between the FPG and GCT results(P=0. 057). (2) Relationship between early pregnancy FPG and abnormal FPG examined after 24 gestational weeks were also analyzed . The maximum area under curve was 0. 796(95% CI: 0. 672-0. 920). If 5. 05 mmol/L was taken as the cutoff value, the sensitivity and specificity was 54. 5% and 83. 2%, respectively. There was significant relationship between the two values (r=0. 432, P=0. 000). (3) There were no relationship between early pregnancy FPG and the blood glucose value of 1, 2 and 3 h in 75 g OGTT (r=0. 093, 0. 036 and 0. 107, P=0.122, 0. 549 and 0. 074 respectively). OGTT 0 h value was positively related to OGTT 1, 2 and3 h glucose level (r=0.493, 0.421 and 0.368, P=0.000, respectively). (4) All early pregnant FPG values in this study were under 6.1 mmol/L. Twenty-two GDM and 27 GIGT patients were diagnosed in this study. Early pregnancy FPG did not relate to the GDM and GIGT diagnosis.Conclusions Early pregnancy FPG could not replace 50 g GCT as an early screening for glucose metabolic abnormality in pregnancy, but FPG during early pregnancy is necessary. Key words: Fasting plasma glucose; Early pregnancy; Sugar metabolic abnormalities; ROC curve

Appropriate weight gain during pregnancy in women complicated with gestational abnormal glucose metabolism

Objective To investigate the appropriate range of gestational weight gain in pregnant women with abnormal glucose metabolism.Methods A retrospective study was conducted on 661 term singleton pregnant women with gestational abnormal glucose metabolism,who delivered in the Department of Obstetrics and Gynecology of Peking University First Hospital from Jan.2005 to Dec.2007,by reviewing the medical records.All sujects were divided into 4 groups according to their body mass index (BMI) before pregnancy:group Ⅰ (n=40):BMI<18.5;group Ⅱ (n=400):BMI18.5-23.9;group Ⅲ (n=162):BMI 24.0-27.9;group Ⅳ (n=59):BMI≥28.0.The weight gain among different groups and that between women who delivered normal birth weight infant and maerosomia were analyzed.The weight gain of pregnant women who delivered babies weighing 3000～3500 g in each group was determined as the appropriate weight gain for that group.Results The same results were achieved that the weight gain in pregnant women who delivered macrosomia was significantly higher than those who delivered normal birth weight newborns in each group,ie,the weight gains for women who had macrosomia and normal birth weight infants were (17.0±5.2) kg and (14.1±4.7) kg in group Ⅱ,(16.8±7.3) kg and (11.9±5.1) kg in group Ⅲ and (18.3±6.7) kg and (11.2±5.4) kg in group Ⅳ,respectively (P<0.05).The appropriate ranges of weight gain for each group were (15.6±3.3) kg,(14.0-18.0) kg for group Ⅰ,(13.9±4.6) kg,(11.0-16.5) kg for group ]],(11.5±5.2)kg,(9.0-15.0) kgforgroup Ⅲ,(10.1±2.9) kg,(7.0-12.7) kg forgroup Ⅳ.Conclusions Appropriate weight gain based on prepregnant BMI,together with glucose monitoring in women with gestational abnormal glucose metabolism,is helpful for fetal weight control. Key words: Diabetes,gestational; Glucose metabolism disorders; Weight gain; Birth weight

Clinical analysis of 380 cases pregnant women with abnormal glucose metabolism

Objective To study the relationship between blood lipid levels, insulin therapy of pregnant women with abnormal glucose metabolism and perinatal outcomes. Methods 380 pregnant women who were diag-nosed and treated for abnormal glucose metabolism were enrolled in this study,including 24 cases with diabetes melli-tus(DM),164 eases with gestation diabetes mellitus (GDM), 192 cases with gestation impaired 81ucose tolerance (GIGT). Among the 380 cases, 136 cases were performed insulin therapy with diet controlling,244 cases diet control-ling. Results The incidence of pre-eclampsia and preterm labor in the DM group(41.7% and 41.7% )was higher than that in GIGT group(15.6% and 20.7%)and GDM group(15.9% and 18. 3%) (P 0.05 ). While the incipience of neonatal asphyxia,hypoglycemia in the DM group were all higher than that in GDM and GIGT group ( P<0.01 ). The newborn weights in insulin therapy group( 2891.5±1330.4 g) was lower than that in diet controlling group(3751.2±1025.3 g) ( P<0.05 ). Conclusion The blood lipid level of pregnant women with gestational ab-normal glucose metabolism is one of the effective indexes to prognose perinatal outcomes. Reducing blood lipid levelcan decrease the incidence of pre-eclampsia and preterm labor,neonatal asphyxia and hypoglycemia significantly. Di-agnosing and beginning therapy as soon as possible and using insulin are important,especially to reduce the rate of macrosomia and newbem weights. Key words: Pregnant women; Glucose to lerance test; Insulin

A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women

Can gestational weight gain in obese women be restricted by 10-h dietary consultations and does this restriction impact the pregnancy-induced changes in glucose metabolism? A randomized controlled trial with or without restriction of gestational weight gain to 6-7 kg by ten 1-h dietary consultations. Fifty nondiabetic nonsmoking Caucasian obese pregnant women were randomized into intervention group (n=23, 28+/-4 years, prepregnant body mass index (BMI) 35+/-4 kg m(-2)) or control group (n=27, 30+/-5 years, prepregnant BMI 35+/-3 kg m(-2)). The weight development was measured at inclusion (15 weeks), at 27 weeks, and 36 weeks of gestation. The dietary intakes were reported in the respective weeks by three 7-day weighed food records and blood samples for analyses of fasting s-insulin, s-leptin, b-glucose, and 2-h b-glucose after an oral glucose tolerance test were collected. The women in the intervention group successfully limited their energy intake, and restricted the gestational weight gain to 6.6 kg vs a gain of 13.3 kg in the control group (P=0.002, 95% confidence interval (CI): 2.6-10.8 kg). Both s-insulin and s-leptin were reduced by 20% in the intervention group compared to the control group at week 27, mean difference: -16 pmol l(-1) (P=0.04, 95% CI: -32 to -1) for insulin and -23 ng ml(-1) (P=0.004, 95% CI: -39 to -8) for leptin. At 36 weeks of gestation, the s-insulin was further reduced by 23%, -25 pmol l(-1) (-47 to -4, P=0.022) and the fasting b-glucose were reduced by 8% compared with the control group (-0.3 mmol l(-1), -0.6 to -0.0, P=0.03). Restriction of gestational weight gain in obese women is achievable and reduces the deterioration in the glucose metabolism.

Analysis of insulin and C-peptide releasing test in women with abnormal glucose metabolism during pregnancy

目的 观察正常妊娠妇女、妊娠期合并糖耐量减低(GIGT)及妊娠期糖尿病(GDM)患者孕期胰岛素、C肽水平的变化,探讨妊娠期糖代谢变化的规律,了解其胰岛β细胞的功能状况.方法用放射免疫法测定正常妊娠妇女31例(Ⅰ组)、妊娠期合并糖耐量减低(GIGT)患者36例(Ⅱ组)、妊娠期糖尿病(GDM)患者31例(Ⅲ组)的外周血胰岛素、C肽水平.结果Ⅰ、Ⅲ组胰岛素、C肽均随孕周逐渐上升,Ⅱ、Ⅲ组孕31周时胰岛素水平[(13.95±3.15)mIU/L、(15.10±2.96)mIU/L]和C肽水平[(0.60±0.21)pmol/ml、(0.80±0.31)pmol/ml]明显高于Ⅰ组[(11.40±3.27)mIU/L、(0.44±0.26)pmol/ml,P＜0.05],产后各组胰岛素、C肽水平均下降.Ⅰ、Ⅱ、Ⅲ组孕38周胰岛素水平[(17.90±3.85)mIU/L、(18.31±3.83)mIU/L、(19.02±4.16)mIU/L,P＞0.05]、C肽水平[(0.69±0.28)pmol/ml、(0.75±0.22)pmol/ml、(0.93±0.46)pmol/ml,P＞0.05],产后胰岛素水平[(7.71±2.23)mIU/L、(8.28±2.34)mIU/L、(8.76±3.31) mIU/L,P＞0.05]和C肽水平[(0.24±0.14)pmol/ml、(0.26±0.13)pmol/ml、(0.27±0.13)pmol/ml,P＞0.05]之间无显著差异.Ⅰ组胰岛素、C肽分泌高峰在餐后1 h,Ⅱ、Ⅲ组则延迟至餐后2 h.结论妊娠期存在胰岛素抵抗且随孕周的增加而逐渐增强,糖代谢异常者因更强的胰岛素抵抗而导致胰岛素分泌功能受损,其胰岛素、C肽分泌高峰延迟至餐后2 h,提示胰岛β细胞功能缺陷及胰岛素抵抗增强,故应对GIGT、GDM患者长期随诊。

Long-term risk of malignant neoplasm associated with gestational glucose intolerance.

Previous studies have demonstrated an association between diabetes mellitus and cancer risk. However to the author's knowledge, no data regarding the risk of cancer associated with subclinical impaired glucose tolerance have been published to date. An association between various types of cancer and any continuum of risk across the spectrum of glucose tolerance may be important in determining the nature of the association between diabetes mellitus and the risk of malignancy. The current study was conducted to examine the long-term risk of malignant neoplasms associated with maternal glucose intolerance. A 20-year follow-up study of a cohort of women who had previously taken part in a study in 1980 that investigated maternal glucose metabolism and fetal outcome was performed. Gestational glucose metabolism, smoking behavior, and weight and height measured at the time of index pregnancy, as well as weight, height, and smoking behavior assessed by questionnaire in 1999, were examined. The main endpoint of the study was hospital admission with a diagnosis of malignant neoplasm as ascertained by linkage data. Thirty-four of the 753 women living in Grampian (4.5%) were admitted to the hospital with a diagnosis of malignant neoplasm; of these, 18 cases were malignant neoplasms of the breast. After adjustment for known risk factors, both malignant neoplasm and malignant neoplasm of the breast were found to be significantly associated with gestational glucose intolerance. Subclinical glucose intolerance during pregnancy was found to be associated with a dose-related increase in the risk of malignant neoplasm, particularly malignant neoplasm of the breast.

Animal models for assessing the consequences of intrauterine growth restriction on subsequent glucose metabolism of the offspring: a review

Objective: The aim of this article was to review the most current animal models for intrauterine growth restriction.Methods: The databases of MEDLINE and Pubmed were searched for articlespublished between 1969 and 2001. Additional sources included abstract proceedings and relevant reference lists of articles identified by database review. Key words included intrauterine growth retardation,small for gestational age, animal models and glucose metabolism. The inclusion criteria used to select studies included animal models of intrauterine growth retardation in which glucose metabolism was assessedafter birth.Results: A variety of physiological and metabolic variables regulate fetal growth, and alteration of these variables can result in fetal growth restriction. Fetal growth restrictionis secondary to initiation of fetal adaptation measures in response to inadequate supply of oxygen and nutrients. Several animal models have led to a greater understanding of the pathophysiology and consequencesof intrauterine growth restriction. These observations are comparable to those observed in humans born small for gestational age, and are of interest because of the known association between poor fetalgrowth and development of glucose intolerance and type 2 diabetes mellitus later in life.Conclusion: Experimental manipulations have apparently altered a number of metabolic and physiologicalvariables, but the pattern of alterations seems to vary with the procedure employed. This allows only a preliminary conclusion to be drawn at best. Either the laboratory procedures vitiate the natural processunder study, or the process itself is variable with respect to the triggering mechanism. As yet, we cannot tell which.