Hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.LBW,defined as a birth weight of less than 2500 g,can result from various factors,including maternal nutrition,health status,and metabolic conditions like hypoglycemia.Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus,leading to restricted fetal development and growth.This condition poses significant risks not only during pregnancy but also for the long-term health of the child,increasing the likelihood of developmental delays,health issues,and chronic conditions later in life.Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development,with studies suggesting that alterations in placental blood flow and nutrient transport,as well as direct effects on fetal insulin levels and metabolism,may play a role.Given the potential impact of maternal hypoglycemia on neonatal health outcomes,early detection and management are crucial to minimize risks for LBW and its associated complications.Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth,as well as to develop targeted interventions to support the health of both mother and child.Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.

Association of hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

BACKGROUND Gestational diabetes mellitus(GDM) is a common metabolic derangement in pregnant women. In the women identified to be at high risk of GDM, a 75 g oral glucose tolerance test(OGTT) at 24-28 wk gestation is the recommended screening test in the United Kingdom as per National Institute for Health and Care Excellence(NICE). Hypoglycaemia following the glucose load is often encountered and the implication of this finding for the pregnancy, fetus and clinical care is unclear.AIM To determine the prevalence of hypoglycaemia at any time during the screening OGTT and explore its association with birth weight.METHODS All deliveries between 2009 and 2013 at the local maternity unit of the University hospital were reviewed. Of the total number of 24,154 women without preexisting diabetes, those who had an OGTT for GDM screening based on NICE recommended risk stratification, who had a singleton delivery and had complete clinical and demographic data for analysis, were included for this study(n =3537). Blood samples for fasting plasma glucose(FPG), 2-hour plasma glucose(2-h PG) and HbA1 c had been obtained. Birth weight was categorised as low(≤ 2500 g), normal or Macrosomia(≥ 4500 g) and blood glucose ≤ 3.5 mmol/L was used to define hypoglycaemia. Binary logistic regression was used to determine the association of various independent factors with dichotomized variables; the differences between frequencies/proportions by χ~2 test and comparison between group means was by one-way ANOVA.RESULTS Amongst the study cohort(3537 deliveries), 96(2.7%) women had babies with LBW(< 2500 g). Women who delivered a LBW baby had significantly lower FPG(4.3 ± 0.6 mmol/L, P = 0.001). The proportion of women who had a 2-h PG ≤ 3.5 mmol/L in the LBW cohort was significantly higher compared to the cohorts with normal and macrosomic babies(8.3% vs 2.8% vs 4.2%; P = 0.007). The factors which predicted LBW were FPG, Asian ethnicity and 2-h PG ≤ 3.5 mmol/L,whereas maternal age, 2-h PG ≥ 7.8 mmol/L and HbA1c were not significant predictors.CONCLUSION A low FPG and 2-h PG ≤ 3.5 mmol/L on 75-gram OGTT are significantly associated with low birth weight in women identified as high risk for GDM.Women of ethnic backgrounds(Asians) appear to be more susceptible to this increased risk and may serve as a separate cohort in whom we should offer more intensive follow up and screening for complications. Cost implications and resources for follow up would need to be looked at in further detail to support these findings.

Macrosomia in non-gestational diabetes pregnancy:glucose tolerance test characteristics and feto-maternal complications in tropical Asia Pacific Australia

Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.

Changes of ghrelin following oral glucose tolerance test in obese children with insulin resistance

AIM： To characterize changes in ghrelin levels in response to oral glucose tolerance test （OGTT） and to correlate changes in ghrelin levels with changes in insulin and glucose following OGTT in Chinese obese children of Tanner Ⅰ and Ⅱ stage with insulin resistance. METHODS： 22 obese children with insulin resistance state were divided into four groups according to their Tanner stage and gender： boys of Tanner Ⅰ （fir- Ⅰ ）, boys of Tanner Ⅱ（BT-Ⅱ ）, girls of Tanner Ⅰ （GT- Ⅰ ）, girls of Tanner Ⅱ （GT-Ⅱ）. Ghrelin, insulin and glucose were measured at 0, 30, 60 and 120 rain following OGTT. The control children with normal BMI were divided into control boys of Tanner Ⅰ （CBT- Ⅰ, n = 6）, control boys of Tanner Ⅱ （CBT-Ⅱ, n = 5）, control girls of Tanner Ⅰ （CGT- Ⅰ, n = 6）, control girls of Tanner Ⅱ （CGT-Ⅱ, n = 5）. Fasting serum ghrelin levels were analyzed. RESULTS： Ghrelin levels were lower in obese groups. Ghrelin levels of control group decreased in Tanner Ⅱ stage （CGT- Ⅰ vs CGT-Ⅱ t = -4.703, P = 0.001; CBT- Ⅰ vs CBT- Ⅱ t = -4.794, P = 0.001）. Basal ghrelin levels in fir-Ⅱ decreased more significantly than that in BT- Ⅰ group （t = 2.547, P = 0.029）. Ghrelin levels expressed a downward trend after OGTT among obese children. The decrease in ghrelin levels at 60 min with respect to basal values was 56.9% in BT- Ⅰ. Ghrelin concentrations at 0 min correlated directly with glucose level at 0 min in fir- Ⅰ （r = 0.898, P = 0.015）. There wasn＇t a significant correlation of ghrelin changes with glucose changes and insulin changes during OGTT in obese children with insulin resistance. CONCLUSION： In conclusion, in obese children with insulin resistance, ghrelin levels decreased with advancing pubertal stage. Ghrelin secretion suppression following OGTT was influenced by gender and pubertal stage. Baseline ghrelin levels and ghrelin suppression after OGTT did not significantly correlate with the degree of insulin resistance and insulin sensitivity.

Oral glucose tolerance test in diabetes,the old method revisited

The oral glucose tolerance test(OGTT)has been widely used both in clinics and in basic research for a long time.It is applied to diagnose impaired glucose tolerance and/or type 2 diabetes mellitus in individuals.Additionally,it has been employed in research to investigate glucose utilization and insulin sensitivity in animals.The main aim of each was quite different,and the details are also somewhat varied.However,the time or duration of the OGTT was the same,using the 2-h post-glucose load glycemia in both,following the suggestions of the American Diabetes Association.Recently,the use of 30-min or 1-h post-glucose load glycemia in clinical practice has been recommended by several studies.In this review article,we describe this new view and suggest perspectives for the OGTT.Additionally,quantification of the glucose curve in basic research is also discussed.Unlike in clinical practice,the incremental area under the curve is not suitable for use in the studies involving animals receiving repeated treatments or chronic treatment.We discuss the potential mechanisms in detail.Moreover,variations between bench and bedside in the application of the OGTT are introduced.Finally,the newly identified method for the OGTT must achieve a recommendation from the American Diabetes Association or another official unit soon.In conclusion,we summarize the recent reports regarding the OGTT and add some of our own perspectives,including machine learning and others.

Utility of oral glucose tolerance test in predicting type 2 diabetes following gestational diabetes:Towards personalized care

BACKGROUND Women with gestational diabetes mellitus(GDM)are at a seven-fold higher risk of developing type 2 diabetes(T2D)within 7-10 years after childbirth,compared with those with normoglycemic pregnancy.Although raised fasting blood glucose(FBG)levels has been said to be the main significant predictor of postpartum progression to T2D,it is difficult to predict who among the women with GDM would develop T2D.Therefore,we conducted a cross-sectional retrospective study to examine the glycemic indices that can predict postnatal T2D in Emirati Arab women with a history of GDM.AIM To assess how oral glucose tolerance test(OGTT)can identify the distinct GDM pathophysiology and predict possible distinct postnatal T2D subtypes.METHODS The glycemic status of a cohort of 4603 pregnant Emirati Arab women,who delivered in 2007 at both Latifa Women and Children Hospital and at Dubai Hospital,United Arab Emirates,was assessed retrospectively,using the International Association of Diabetes and Pregnancy Study Groups(IADPSG)criteria.Of the total,1231 women were followed up and assessed in 2016.The FBG and/or the 2-h blood glucose(2hrBG)levels after a 75-g glucose load were measured to assess the prevalence of GDM and T2D,according to the IADPSG and American Diabetes Association(ADA)criteria,respectively.The receiver operating characteristic curve for the OGTT was plotted and sensitivity,specificity,and predictive values of FBG and 2hrBG for T2D were determined.RESULTS Considering both FBG and 2hrBG levels,according to the IADPSG criteria,the prevalence of GDM in pregnant Emirati women in 2007 was 1057/4603(23%),while the prevalence of pre-pregnancy T2D among them,based on ADA criteria,was 230/4603(5%).In the subset of women(n=1231)followed up in 2016,the prevalence of GDM in 2007 was 362/1231(29.6%),while the prevalence of prepregnancy T2D was 36/1231(2.9%).Of the 362 pregnant women with GDM in 2007,96/362(26.5%)developed T2D;142/362(39.2%)developed impaired fasting glucose;29/362(8.0%)developed impaired glucose tolerance,and the remaining 95/362(26.2%)had normal glycemia in 2016.The prevalence of T2D,based on ADA criteria,stemmed from the prevalence of 36/1231(2.9%)in 2007 to 141/1231(11.5%),in 2016.The positive predictive value(PPV)for FBG suggests that if a woman tested positive for GDM in 2007,the probability of developing T2D in 2016 was approximately 24%.The opposite was observed when 2hrBG was used for diagnosis.The PPV value for 2hrBG suggests that if a woman was positive for GDM in 2007 then the probability of developing T2D in 2016 was only 3%.CONCLUSION FBG and 2hrBG could predict postpartum T2D,following antenatal GDM.However,each test reflects different pathophysiology and possible T2D subtype and could be matched with a relevant T2D prevention program.

Repetitiveness of the oral glucose tolerance test in children and adolescents

BACKGROUND Data regarding the most suitable diagnostic method for the diagnosis of glucose impairment in asymptomatic children and adolescents are inconclusive.Furthermore,limited data are available on the reproducibility of the oral glucose tolerance test(OGTT)in children and adolescents who are obese(OB).AIM To investigate the usefulness of the OGTT as a screening method for glucose dysregulation in children and adolescents.METHODS Eighty-one children and adolescents,41 females,either overweight(OW),OB or normal weight(NW)but with a strong positive family history of type 2 diabetes mellitus(T2DM),were enrolled in the present observational study from the Outpatient Clinic of Paediatric Endocrinology of the University Hospital of Patras in Greece.One or two 3-h OGTTs were performed and glucose,insulin and Cpeptide concentrations were measured at several time points(t=0 min,t=15 min,t=30 min,t=60 min,t=90 min,t=120 min,t=180 min).RESULTS Good repetitiveness was observed in the OGTT response with regard to T2DM,while low repetitiveness was noted in the OGTT response with regard to impaired glucose tolerance(IGT)and no repetitiveness with regard to impaired fasting glucose(IFG).In addition,no concordance was observed between IFG and IGT.During the 1st and 2nd OGTTs,no significant difference was found in the glucose concentrations between NW,OW and OB patients,whereas insulin and C-peptide concentrations were higher in OW and OB compared to NW patients at several time points during the OGTTs.Also,OW and OB patients showed a worsening insulin and C-peptide response during the 2nd OGTT as compared to the 1st OGTT.CONCLUSION In mild or moderate disorders of glucose metabolism,such as IFG and IGT,a diagnosis may not be reached using only one OGTT,and a second test or additional investigations may be needed.When glucose metabolism is profoundly impaired,as in T2DM,one OGTT is probably more reliable and adequate for establishing the diagnosis.Excessive weight and/or a positive family history of T2DM possibly affect the insulin and C-peptide response in the OGTT from a young age.

Subclinical abnormal glucose tolerance is a predictor of death in liver cirrhosis

AIM: To determine if subclinical abnormal glucose tolerance (SAGT) has influence on survival of non-diabetic patients with liver cirrhosis.

Responses to oral glucose challenge differ by physical activity volume and intensity: A pilot study

Background:One-hour postprandial hyperglycemia is associated with increased risk of type 2 diabetes and cardiovascular disease.Physical activity(PA)has short-term beneficial effects on post-meal glucose response.This study compared the oral glucose tolerance test results of 3 groups of people with habitually different levels of PA.Methods:Thirty-one adults without diabetes(age 25.9±6.6 years;body mass index 23.8±3.8 kg/m^2;mean±SD)were recruited and divided into 3 groups based on self-reported PA volume and intensity:low activity<30 min/day of moderate-intensity activity(n=11),moderately active≥30 min/day of moderate-intensity PA(n=10),and very active≥60 min/day of PA at high intensity(n=10).Participants completed an oral glucose tolerance test(50 g glucose)with capillary blood samples obtained at baseline,15 min,30 min,45 min,60 min,90 min,and 120 min post-ingestion.Results:There were no significant differences between groups for age or body fat percentage or glycated hemoglobin(p>0.05).The groups were significantly different in terms of baseline glucose level(p=0.003)and,marginally,for gender(p=0.053)and BMI(p=0.050).There was a statistically significant effect of PA on the 1-h postprandial glucose results(p=0.029),with differences between very active and low activity groups(p=0.008)but not between the moderately active and low activity groups(p=0.360),even when baseline glucose level and gender differences were accounted for.For incremental area under the curve there was no significant effect of activity group once gender and body fat percentage had been accounted for(p=0.401).Those in the low activity group took 15 min longer to reach peak glucose level than those in the very active group(p=0.012).Conclusion:The results suggest that high levels of PA have a beneficial effect on postprandial blood glucose profiles when compared to low and moderate levels of activity.

Data Analytics on Unpredictable Pregnancy Data Records Using Ensemble Neuro-Fuzzy Techniques

The immune system goes through a profound transformation during pregnancy,and certain unexpected maternal complications have been correlated to this transition.The ability to correctly examine,diagnoses,and predict pregnancy-hastened diseases via the available big data is a delicate problem since the range of information continuously increases and is scalable.Many approaches for disease diagnosis/classification have been established with the use of data mining concepts.However,such methods do not provide an appropriate classification/diagnosis model.Furthermore,single learning approaches are used to create the bulk of these systems.Classification issues may be made more accurate by combining predictions from many different techniques.As a result,we used the Ensembling of Neuro-Fuzzy(E-NF)method to perform a high-level classification of medical diseases.E-NF is a layered computational model with self-learning and self-adaptive capabilities to deal with specific problems,such as the handling of imprecise and ambiguous data that may lead to uncertainty concerns that specifically emerge during the classification stage.Preprocessing data,Training phase,Ensemble phase,and Testing phase make up the complete procedure for the suggested task.Data preprocessing includes feature extraction and dimensionality reduction.Besides such processes,the training phase includes the fuzzification process of medical data.Moreover,training of input data was done using four types of NF techniques:Fuzzy Adaptive Learning Control Network(FALCON),Adaptive Network-based Fuzzy Inference System(ANFIS),Self Constructing Neural Fuzzy Inference Network(SONFIN)and/Evolving Fuzzy Neural Network(EFuNN).Later,in the ensemble phase,all the NF methods’predicted outcomes are integrated,and finally,the test results are evaluated in the testing phase.The outcomes indicate that the method could predict impaired glucose tolerance,preeclampsia,gestational hypertensive abnormalities,bacteriuria,and iron deficiency anaemia better than the others.In addition,the model exposed the capability to be utilized as an autonomous learning strategy,specifically in the early stages of pregnancy,examinations,and clinical guidelines for disease interventions.

口服葡萄糖耐量试验1h血糖对糖尿病前期的诊断和鉴别价值

目的:探讨口服葡萄糖耐量试验(OGTT)1 h血糖对糖尿病前期的诊断和鉴别价值。方法:收集2019年6月至2022年6月于北京中医药大学东直门医院门诊及住院行OGTT的受试者1 206例,其中血糖正常412例,糖尿病前期358例,糖尿病436例。比较3组OGTT不同时点血糖与空腹血糖(FPG)、空腹胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛β细胞分泌功能指数(HOMA-β)水平;采用ROC曲线分析OGTT 1 h血糖对糖尿病前期的诊断和鉴别价值。结果:3组OGTT各时点血糖均为糖尿病组>糖尿病前期组>血糖正常组(P<0.05)。FPG、HOMA-IR糖尿病组>糖尿病前期组>血糖正常组,FINS、HOMA-β糖尿病组<糖尿病前期组<血糖正常组(P<0.05)。ROC曲线分析结果显示,OGTT 1 h血糖诊断糖尿病前期的AUC(95%CI)为0.758(0.724~0.792),以敏感度最大选取最佳切点值,该值为9.35 mmol/L,此时敏感度为0.701,特异度为0.709;OGTT 1 h血糖对糖尿病和糖尿病前期鉴别的AUC(95%CI)为0.956(0.942~0.969),以敏感度最大选取最佳切点值,该值为12.55 mmol/L,此时敏感度为0.901,特异度为0.908。结论:OGTT 1 h血糖对糖尿病前期具有一定的诊断和鉴别价值。

Relationship between Oral Glucose Tolerance Test Characteristics and Adverse Pregnancy Outcomes among Women with Gestational Diabetes Mellitus

Background： Hyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test （OGTT） results on adverse perinatal outcomes. Methods： This retrospective cohort study included data from 15 hospitals in Beijing from June 20, 2013 to November 30, 2013. Women with gestational diabetes mellitus （GDM） were categorized according to the number and distribution of abnormal OGTT values, and the characteristics of adverse pregnancy outcomes were evaluated. Chi-square test and logistic regression analysis were used to determine the associations. Results： in total, 14,741 pregnant women were included in the study population, 2927 （19.86%） of whom had G DM. As the number of hyperglycemic values in the OGTT increased, the risk of cesarean delivery, preterm births, large-for-gestational age （LGA）, macrosomia, and neonatal complications significantly increased. Fasting hyperglycemia bad clear associations with macrosomia （odds ratios [ORs]：1.84, 95% confidence intervals [CIs]： 1.39-2.42, P 〈 0.001）, L（SA （OR： 1.70, 95% CI： 1.29-2.25. P 〈 0.001）, and cesarean delivery （OR： 1.33, 95% CI： 1.15-1.55, P 〈 0.001）. The associations were stronger as tasting glucose increased. GDM diagnosed by hyperglycemia at OGTT-2 h was more likely to lead to preterm birth （OR： 1.50, 95% Cl： 1. 11-2.03, P 〈 0.01）. Conclusions： Various characteristics of OGTTs are associated with different adverse outcomes. A careful reconsideration ofGDM wiih hierarchical and individualized management according to OGTT characteristics is needed.

Analysis of oral glucose tolerance test in pregnant women with abnormal glucose metabolism

Background Due to the controversy of the oral glucose tolerance test (OGTT), diagnostic criteria for gestational diabetes mellitus (GDM) in the world and researches on GDM remain undeveloped in China. American Diabetes Association recently recommended the clinicians to diagnose GDM by OGTT results without the third-hour glucose value. This new criteria has not been used in China. Research on the value and sensitivity of the criteria in detecting GDM is rare. The aim of our study is to analyze the characteristics of OGTT in Chinese women with GDM or gestational impaired glucose tolerance (GIGT) and to evaluate the effect of omission of the third-hour plasma glucose (PG) level in OGTT on the sensitivity of diagnosing GDM and GIGT, and the relationship between PG values of 50 g GCT or OGTT and insulin therapy. Methods A retrospective analysis was performed on medical records of 647 cases with GDM from January 1, 1989 to December 31, 2002, and 233 with GIGT. Among 647 cases of GDM, 535 cases were diagnosed by 75 g OGTT. All OGTT results including 535 cases of GDM and 233 patients with GIGT were evaluated. Results There were 112 cases of GDM diagnosed by elevated fasting PG (FPG) without OGTT performed. Of 535 cases of GDM diagnosed by OGTT, 49.2% (263/535) women had FPG value ≥5.8 mmol/L; 90.1% (482/535) women with 1-hour PG values ≥10.6 mmol/L; 64.7% (359/535) with 2-hour PG levels ≥9.2 mmol/L. There were only 114 cases (21.3%) with abnormal 3-hour PG levels among 535 women with OGTT. Among those with abnormal 3-hour PG level, 49.1% (56/114) had abnormal glucose values in the other three points of OGTT, and 34.2% (39/114) with two other abnormal values of OGTT. Our study showed that omission of the 3-hour PG of OGTT only missed 19 cases of GDM and they would be diagnosed as GIGT. Among the 233 women with GIGT, only 4 cases had abnormal 3-hour PG. So, omission of the third-hour glucose value of OGTT only resulted in failure to diagnose 3.6% (19/535) women with GDM diagnosed by OGTT, which means 2.9% (19/647) of all the GDM and 1.7% (4/233) of GIGT in Chinese women. PG levels ≥11.2 mmol/L following 50 g GCT was highly associated with GDM necessitating insulin therapy (75.4%). An elevated FPG level was also associated with insulin therapy (59.7%). Conclusions Omission of the third-hour glucose tolerance test value still yield a higher sensitivity in diagnosing GDM and GIGT. In Chinese women, it is practicable to omit third-hour post-glucose ingestion value of the OGTT in Chinese women. PG levels ≥11.2 mmol/L following 50 g GCT mostly indicates that the requirement of insulin therapy.

孕中期GDM患者血清Afamin和SFRP5水平及临床价值分析

目的分析孕中期妊娠期糖尿病(GDM)患者血清α清蛋白(Afamin)和分泌型卷曲相关蛋白5(SFRP5)水平及临床价值。方法选取2019年8月至2021年8月河北省秦皇岛市海港医院120例定期产检并分娩的孕妇为研究对象,其中GDM孕妇50例为GDM组,非GDM孕妇70例为对照组。采用酶联免疫吸附试验(ELISA)检测两组血清Afamin和SFRP5水平;采用口服葡萄糖耐量试验(OGTT)检测OGTT 1 h血糖(1 h PG)、OGTT 2 h血糖(2 h PG);检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)及空腹胰岛素(FINS)水平;分析Afamin、SFRP5与糖代谢指标之间的相关性;采用受试者工作特征(ROC)曲线评估Afamin、SFRP5单独及联合检测对GDM的诊断价值;分析不同Afamin、SFRP5水平孕妇不良妊娠结局发生情况。结果GDM组FPG、1 h PG、2 h PG、HbA1c和FINS水平明显高于对照组,差异有统计学意义(P<0.05);GDM组Afamin水平明显高于对照组,SFRP5水平明显低于对照组,差异有统计学意义(P<0.05);Afamin水平与FPG、1 h PG、2 h PG、HbA1c和FINS水平呈正相关(P<0.05);SFRP5水平与FPG、1 h PG、2 h PG、HbA1c和FINS水平呈负相关(P<0.05);ROC曲线分析结果显示,血清Afamin和SFRP5单独及联合检测诊断GDM的曲线下面积(AUC)分别为0.747、0.642、0.872,且联合检测的灵敏度为89.3%,特异度为77.9%,联合检测的AUC明显大于单独检测的AUC,差异有统计学意义(P<0.05)。以所有孕妇的Afamin、SFRP5水平均值为界,分为高Afamin组、低Afamin组,以及高SFRP5组、低SFRP5组,高Afamin组母婴不良妊娠结局发生率高于低Af amin组,低SFRP5组母婴不良妊娠结局发生率高于高SFRP5组,差异有统计学意义(P<0.05)。结论Afamin和SFRP5作为诊断GDM的生物标志物具有良好的效能,在临床上可以预测GDM的发展趋势和不良妊娠结局的风险。

孕妇血糖异常项数、孕期增重及其交互作用对妊娠不良结局的影响

目的探讨妊娠期糖尿病(GDM)患者在24~28周口服75g葡萄糖耐量试验(OGTT)的血糖异常项数、孕期增重(GWG)及其交互作用对妊娠不良结局的影响。方法选择2020年4月至2023年3月于中国人民解放军北部战区总医院定期产检并分娩的404例GDM孕妇为研究对象。按照OGTT血糖异常数量分1项、2项和3项异常,分别标记为Ⅰ组、Ⅱ组和Ⅲ组。根据美国医学研究所(IOM)的建议将GWG分为增重适宜、增重不足、增重过多组。比较不同组间孕妇临床资料的差异,采用Logistic回归及相乘相加模型,研究血糖异常项数和孕期增重对妊娠不良结局的影响是否存在交互作用。结果多因素Logistic回归分析显示,2项或3项血糖异常均是发生妊娠期高血压疾病(HDP)、妊娠期甲减、剖宫产、早产和大于胎龄儿(LGA)的危险因素(aOR值介于3.417~8.444之间,P<0.05);3项血糖异常是导致巨大儿发生的危险因素(aOR=6.199,P<0.05);孕期增重不足是引起孕妇妊娠期甲减的危险因素(aOR=10.537,P<0.05);增重过多是孕妇发生HDP、剖宫产、早产、巨大儿、LGA的危险因素(aOR值介于2.587~6.948之间,P<0.05)。亚组分析显示,Ⅰ组孕妇中孕期增重不足是引起妊娠期甲减、早产的危险因素,孕期增重过多是发生HDP、剖宫产的危险因素(aOR值介于4.609~41.366之间,P<0.05);Ⅱ组孕妇中孕期增重不足是发生剖宫产的危险因素,孕期增重过多是发生早产的危险因素(aOR值分别为8.878、12.722,P<0.05);Ⅲ组孕妇中孕期增重过多是孕妇发生剖宫产的危险因素(aOR=38.666,P<0.05);相乘、相加交互模型的结果提示,血糖异常项数≥2项和孕期不合理增重对妊娠不良结局无交互作用。结论孕妇OGTT血糖异常项数的增多及孕期不合理增重均会增加不良妊娠结局的发生风险,且随着OGTT异常项数的增多,孕期不合理增重对不良妊娠结局的影响作用逐渐减弱。血糖异常项数2项及以上、孕期不合理增重对妊娠不良结局的发生无相乘相加交互作用。

甲状腺功能亢进症患者治疗前后血糖波动及胰岛素分泌特征的临床研究

目的采用动态监测系统评估甲状腺功能亢进症(以下简称甲亢)患者治疗前后血糖波动并观察胰岛素分泌的改变。方法选取江苏省南通市海门区人民医院确诊的30例甲亢患者,葡萄糖耐量试验、胰岛素释放试验及动态血糖监测,比较治疗前后患者血糖波动及评估胰岛素水平及胰岛素抵抗指数。结果甲亢治疗前,女性患者日间血糖波动幅度、最大血糖波动幅度、日间血糖平均绝对差、血糖标准差水平明显低于男性患者(P<0.05)。甲亢治疗后患者餐后1 h葡萄糖、餐后1 h胰岛素、餐后2 h胰岛素和胰岛素抵抗指数、血糖波动幅度(日间平均血糖度、最大血糖度、日间血糖平均绝对差、餐后血糖曲线下面积)低于治疗前(P<0.05)。结论甲亢患者的血糖波动较大,以餐后血糖升高为主,并发生胰岛素抵抗,且男性甲亢患者血糖波动更为显著。甲亢患者在经治疗后胰岛素抵抗程度、餐后血糖和血糖变异性等随着甲状腺功能的恢复而改善。

医学营养治疗联合运动疗法干预对妊娠期糖尿病产妇分娩结局的影响分析

目的观察医学营养治疗(MNT)联合运动疗法干预对妊娠期糖尿病(GDM)产妇分娩结局的影响。方法200例确诊为GDM的产妇作为研究对象,根据产妇接受的干预方法不同分成研究组(予以医学营养治疗联合运动疗法干预)、对照组(予以常规饮食及运动指导干预),各100例。对比两组干预前、产后42 d时的口服葡萄糖耐量(OGTT)试验结果与血脂指标,分娩情况,新生儿不良结局发生情况。结果干预前,两组口服葡萄糖耐量试验结果与总胆固醇(TC)、甘油三酯(TG)相比,无显著差异性(P>0.05)。产后42 d时,两组产妇的口服葡萄糖耐量试验结果与TC、TG均较干预前下降,且研究组产妇的口服葡萄糖耐量试验空腹血糖(4.59±0.52)mmol/L、1 h血糖(9.17±0.61)mmol/L、2 h血糖(7.12±0.69)mmol/L与TC(2.92±0.17)mmol/L、TG(1.21±0.34)mmol/L均低于对照组的(6.06±1.03)、(10.87±0.85)、(8.05±0.74)、(4.34±0.18)、(2.05±0.35)mmol/L,差异具有统计学意义(P<0.05)。研究组胎膜早破、早产、产后出血、胎儿宫内窘迫及巨大儿的发生率分别为5.00%、2.00%、1.00%、7.00%、2.00%,均低于对照组的14.00%、9.00%、8.00%、16.00%、11.00%,差异具有统计学意义(P<0.05)。而两组剖宫产发生率相比,研究组稍低于对照组,但相比无显著差异性(P>0.05)。研究组新生儿低血糖、肺炎、高胆红素血症的发生率分别为2.00%、2.00%、7.00%,均低于对照组的11.00%、9.00%、16.00%,差异具有统计学意义(P<0.05)。结论GDM产妇以医学营养治疗联合运动疗法进行干预,可控制产妇产后42 d口服葡萄糖耐量试验结果及血脂指标水平,改善产妇分娩情况与新生儿不良结局,效果理想。

妊娠期糖尿病临床预测标志物研究进展

妊娠期糖尿病(GDM)作为妊娠期高血糖的主要类型,是引起不良妊娠结局和女性产后糖尿病的主要原因。口服葡萄糖耐量试验(OGTT)作为常规方法,目前仍然是诊断GDM的主要手段。但OGTT一般在孕中期、孕晚期才实施,可能错过GDM最佳的干预时机。因此,如何在孕早期及时、准确地筛选出GDM高危孕妇并给予适时干预成为预防GDM的关键。该文基于已有文献报道,概括总结了孕早期孕妇血清14种炎症因子和脂肪因子与GDM的关系,探讨这些指标预测GDM的能力,同时评估14种指标作为危险因素加入GDM早期预测模型的可能性,以期认识到孕早期血清中相关指标非正常变化可能带来的后果,为临床医生在孕早期及时、准确筛选出GDM高危人群提供支持。

The Use of Glycated Albumin in the Diagnosis of Gestational Diabetes Mellitus

Gestational diabetes mellitus is the most common endocrine disorder in pregnancy and a cause of maternal and fetal morbidities and mortalities. The oral glucose tolerance test is the gold standard for diagnosing gestational diabetes mellitus. Nevertheless, the oral glucose tolerance test is time-consuming and requires patient preparation. On the contrary, Glycated albumin does not require patient preparation or administration of any substance. Most studies on glycated albumin in pregnancy were among the non-African population, and black Americans have higher glycated albumin levels than Caucasians. This study determined the use of glycated albumin in diagnosing gestational diabetes mellitus among pregnant women. The study was a prospective study of 160 pregnant women between 24 and 28 weeks of gestation at the University of Port Harcourt Teaching Hospital. The diagnosis of gestational diabetes mellitus was based on the World Health Organization 2013 criteria. The diagnostic value of glycated albumin was determined using the area under the receiver operator characteristic curve. The prevalence of gestational diabetes mellitus was 9.4% and the mean glycated albumin was 16.91% (±2.77). The area under the receiver operator characteristic curve for glycated albumin was 0.845 (95% CI 0.733 - 0.956;p = 0.0001). The optimal cut-off value of glycated albumin in the diagnosis of gestational diabetes mellitus was 18.9%. Glycated albumin was useful in the diagnosis of gestational diabetes mellitus at 24 to 28 weeks of gestation.

妊娠期糖尿病孕妇产后血糖异常的影响因素分析

目的分析影响妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇产后血糖异常的相关因素。方法选取2021年2月—2024年2月莆田市第一医院完成分娩的146例GDM产妇作为研究对象,均在产后接受口服葡萄糖耐量试验,结果显示血糖异常的产妇纳入观察组、血糖正常的产妇纳入对照组。发放本院自制的调查问卷,分析影响产后血糖异常的相关因素。结果口服葡萄糖耐量试验结果显示,90例(61.64%)存在血糖异常,56例(38.36%)为血糖正常。Logistic回归分析结果显示,诱发GDM产妇产后血糖异常的独立危险因素包括年龄、孕前及产前体重指数(P均<0.05)。结论GDM产妇产后血糖异常与年龄较大、孕前及产前体重指数高之间存在密切关系,临床工作人员应重点关注上述影响因素,以防止发生产后血糖异常。