Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers

BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients.AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion(CSII).METHODS Based on the treatment modality received,the patients were allocated into two cohorts:The CSII group and the multiple daily injections(MDI)group,with each cohort comprising 210 patients.Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5,homocysteine,and C1q/TNF-related protein 9.Furthermore,outcomes such as fasting plasma glucose,2-hour postprandial glucose levels,pain assessment scores,and the incidence of complications were evaluated post-treatment.RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group(P<0.05).Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group(60.00%)in contrast to the MDI group(36.19%)(P<0.05).Additionally,the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group(P<0.05).However,there were no significant variances observed in other pregnancy outcomes between the two groups(P>0.05).A statistical analysis revealed a significant difference in the incidence of complications between the groups(χ^(2)=11.631,P=0.001).CONCLUSION The utilization of CSII via an insulin pump,as opposed to MDI,can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery.This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar,reducing the likelihood of adverse pregnancy outcomes and complications.The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.

Comparative Study on Clinical Characteristics and Outcomes of Overt Diabetes Mellitus and Gestational Diabetes Mellitus in Late Pregnancy

Background: With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes of maternal and child mortality and morbidity worldwide and has raised health concern. It is seriously detrimental to both the women and fetuses. However, there are limited evidences of two types of gestational diabetes mellitus on clinical characteristics and outcomes. Therefore, this study was aimed to explore the clinical characteristics and outcomes of patients with overt diabetes mellitus (ODM) and gestational diabetes mellitus (GDM) at the late pregnancy. Methods: From January 2015 to August 2016, totally 63 gestational diabetes mellitus from the Department of Clinical Nutrition in Beijing Anzhen Hospital were enrolled in the study. Patients were classified into two groups. 31 patients with gestational overt diabetes mellitus were grouped into ODM group and 32 patients with gestational diabetes mellitus were grouped into GDM group. Clinical characteristics and outcomes were compared between ODM and GDM. We collected records of the age, gestational week, family history, past history, pregnancy complications, insulin use, blood pressure, clinical nutrition indexes, blood pressure. Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total protein (TP), albumin (ALB), prealbumin (PALB), hemoglobin (HGB), urea nitrogen (BUN), serum creatinine (CREA), and dynamic blood glucose monitoring were measured. And we recorded the changes of blood glucose and the test data. We statistically analyzed the data of two groups. Results: In the ODM group, HbA1c, FBG, average blood glucose, two-hour postprandial blood glucose (2hPBG) after breakfast, 2hPBG after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than those of GDM and two groups compared with statistical significance (P < 0.05). The number of patients treated with insulin (10/31) in ODM is significantly more than that in GDM (1/32) (P < 0.05). 45% (14/31) of ODM have a family history of diabetes patients. The ratio is significantly higher than 13% (4/32) of GDM (P < 0.05). There was significant difference in urinary ketone positive rate between the two groups (P < 0.05), but there was no significant difference in urinary microalbumin abnormal rate between them (P > 0.05). The number of preeclampsia in ODM (8/31) is significantly higher than that of GDM (P < 0.05). The level of HGB in ODM is lower than that of GDM (P < 0.05). There was no difference in the pregnancy outcomes between the two groups. Conclusion: Late pregnancy women with ODM have obvious family history, higher HbA1c, higher FBG, higher glucose levels of two-hours after breakfast and dinner, higher average blood glucose, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients, higher risk of preeclampsia, lower HGB level than GDM, while GDM has higher positive rate of urine ketone than ODM.

Evaluation of Pregnancy Outcomes among Women with Pregnancies Complicated by Diabetes Mellitus in Abakaliki, South-East, Nigeria

Background: Pregnancies complicated by diabetes are associated with significant increase in maternal and perinatal morbidity and mortality. The management of diabetes in pregnancy is a great challenge in a low resource setting because of limited resources and facilities to care for these women. Aim: To determine the maternal and perinatal outcomes of diabetic pregnant women managed at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Southeast, Nigeria. Materials and methods: This was a 7-year retrospective case-control study that compared pregnancy outcomes among women with pregnancies complicated by diabetes and those without diabetes managed at Alex Ekwueme Federal University Teaching Hospital, Abakalikibetween January 1st, 2012 and December 31st, 2018. The statistical analysis was done using SPSS version 22. Results: The incidence of diabetes in pregnancy in this study was 6.6 per 1000 deliveries. Of 126 women in diabetic arm of the study, 81 were diagnosed during pregnancy and 45 were known diabetic prior to conception. Over two-thirds of 126 women with pregnancy complicated by diabetes achieved good blood glucose control during pregnancy. Both groups differ in their mean BMI and women with diabetes in pregnancy were more likely to be obese compared with control (diabetic;30.1 ± 2.5 versus control;23.4 ± 2.1, P < 0.0001). Pregnant women with diabetes were more likely to be delivered by cesarean section when compared with non-diabetic women (86 versus 23, OR = 9.6, 95% CI: 5.35 - 17.32, P < 0.0001). Similarly, the incidence of polyhydramnious was higher in paturients with diabetes when compared with the control groups (26 versus 13, OR = 2.2, 95%CI: 1.10 - 4.63, P = 0.02). There were no differences between both study groups with regards to other maternal outcomes. The incidence of fetal macrosomia, neonatal hypoglycemia and neonatal respiratory distress syndrome were significantly higher among women whose pregnancies were complicated by diabetes when compared with the control [Diabetics;fetal macrosomia (62.7%), neonatal hypoglycemia (44.4%) and neonatal respiratory distress syndrome (22.2%) versus Control;fetal macrosomia (34.1%), neonatal hypoglycemia (7.9%) and neonatal respiratory distress syndrome (5.6%) respectively]. Conclusion: Women with pregnancies complicated by diabetes had a higher incidence of adverse maternal and perinatal outcomes. Clinical recognition of diabetes in pregnancy is important because institution of therapy, and antepartum fetal surveillance can reduce the maternal and perinatal morbidity and mortality associated with the condition.

Gestational Diabetes Mellitus: New Diagnostic Criteria

Gestational mellitus diabetes (GDM) is a highly prevalent metabolic disorder among pregnant women nowadays. It is defined as any level of glucose intolerance, appearing or first being recognized during pregnancy. It is essential to diagnose and treat GDM early, in order to reduce or avoid complications for mother and fetus. Recently, new guidelines have changed the diagnosis criteria, and it is expected that the prevalence of GDM will increase by approximately 18%. A relevant goal of these new definitions is to provide a better care for pregnant women, in an attempt to reduce fetal and maternal complications. These new criteria will also increase the impact on costs of the health care system. Treatment must be individualized for best results, including a specific diet, physical activity and the use of medications. Metformin and Insulin use are analyzed in detail, in face of new evidences regarding their safety and efficacy during pregnancy.

Relationship between depression and diabetes in pregnancy: A systematic review

AIM To systematically review the literature on women with both diabetes in pregnancy(DIP) and depression during or after pregnancy. METHODS In this systematic literature review, PubM ed/MEDLINE and EMBASE were searched(13 November 2015) using terms for diabetes(type 1, type 2, or gestational), depression, and pregnancy(no language or date restrictions). Publications that reported on women who had both DIP(any type) and depression or depressive symptoms before, during, or within one year after pregnancy were considered for inclusion. All study types were eligible for inclusion; conference abstracts, narrative reviews, nonclinical letters, editorials, and commentaries were excluded, unless they provided treatment guidance.RESULTS Of 1189 articles identified, 48 articles describing women with both DIP and depression were included(sample sizes 36 to > 32 million). Overall study quality was poor; most studies were observational, and only 12 studies(mostly retrospective database studies) required clinical depression diagnosis. The prevalence of concurrent DIP(any type) and depression in general populations of pregnant women ranged from 0% to 1.6%(median 0.61%; 12 studies). The prevalence of depression among women with gestational diabetes ranged from 4.1% to 80%(median 14.7%; 16 studies). Many studies examined whether DIP was a risk factor for depression or depression was a risk factor for DIP. However, there was no clear consensus for either relationship. Importantly, we found limited guidance on the management of women with both DIP and depression. CONCLUSION Given the increasing prevalence of diabetes and depression, high-quality research and specific guidance for management of pregnant women with both conditions are warranted.

Pregnancy complications effect on the nickel content in maternal blood,placenta blood and umbilical cord blood during pregnancy

BACKGROUND Nickel(Ni)may accumulate in the human body and has biological toxicity and carcinogenicity.Ni has an extensive impact on the health of pregnant women and fetuses during gestation.AIM To evaluate Ni exposure in pregnant women in Kunming,Yunnan Province,China;to describe the distribution of Ni in the maternal-fetal system and placental barrier function;and to investigate the effect of Ni exposure on fetal health in mothers with pregnancy complications.METHODS Seventy-two pregnant women were selected using a case-control design.The women were divided into two groups:The control group(no disease;n=29)and the disease group[gestational diabetes(GDM),hypertensive disorder complicating pregnancy(HDCP),or both;n=43].The pregnant women in the disease group were further divided as follows:14 cases with GDM(GDM group),13 cases with HDCP(HDCP group)and 16 cases with both GDM and HDCP(disease combination group).Basic information on the pregnant women was collected by questionnaire survey.Maternal blood,placenta blood and cord blood were collected immediately after delivery.The Ni content in paired samples was determined using inductively coupled plasma mass spectrometry.RESULTS Compared to the control group,age was higher and body mass index was greater in pregnant women in the disease groups(28.14±2.54 vs 28.42±13.89,P<0.05;25.90±3.86 vs 31.49±5.30,P<0.05).The birth weights of newborns in the HDCP group and the control group were significantly different(2.52±0.74 vs 3.18±0.41,P<0.05).The content of Ni in umbilical cord blood in the entire disease group was higher than that in the control group(0.10±0.16 vs 0.05±0.07,P<0.05).CONCLUSION In the maternal-fetal system of women with pregnancy complications,the barrier effect of the placenta against Ni is weakened,thus affecting healthy growth of the fetus in the uterus.

Effect of Case Management for Patients with Gestational Diabetes

Objective:To explore the effect of allocating case managers for gestational diabetes patients.Methods:200 patients with gestational diabetes mellitus from December 2021 to December 2022 were included in this study,and the collection period.They were divided into groups according to the interventions received.Each patient in the observation group was managed by a case manager,while the control group were managed with conventional methods without the supervision of a case manager.There were 100 cases in each group,and the curative effects of the two groups were compared.Results:The fasting blood glucose and 2-hour postprandial blood glucose in the observation group were significantly lower than those of the control group(P<0.05).The re-admission rate of patients due to poor blood sugar control in the observation group was lower than that in the control group(P<0.05).The pregnancy outcome of the observation group was better than that of the control group(P<0.05).Conclusion:Case management of gestational diabetes can not only control the blood glucose of pregnant women,but also improve pregnancy outcomes.

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.

Unsatisfactory Glucose Management and Adverse Pregnancy Outcomes of Gestational Diabetes Mellitus in the Real World of Clinical Practice： A Retrospective Study

Background：Facing the increasing prevalence of gestational diabetes mellitus （GDM）,this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes.Methods：The data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected.Treatments during pregnancy and the last hospital admission before delivery were analyzed.Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age.The association between fasting plasma glucose （FPG） and adverse pregnancy outcomes was examined by logistic regression analyses.Results：The average prevalence of GDM over the 5 years was 4.4％ （1330/30,191）.Within the GDM patients,42.8％ （426/996） received dietary intervention,whereas 19.1％ （190/996） received insulin treatment.Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome （RDS,x2 =13.373,P ＜ 0.01）.Elevated FPG was identified as an independent risk factor for premature birth （odds ratio [OR] =1.460,P ＜ 0.001）,neonatal care unit admission （OR =1.284,P ＜ 0.001）,RDS （OR=1.322,P =0.001）,and stillbirth （OR =1.427,P ＜ 0.001）.Conclusions：Management of GDM in the real world of clinical practice was unsatisfactory,which might have contributed to adverse pregnancy outcomes.

Gestational diabetes: weight gain during pregnancy and its relationship to pregnancy outcomes

Background:Weight gain during pregnancy reflects the mother's nutritional status.However, it may be affected by nutritional therapy and exercise interventions used to control blood sugar in gestational diabetes mellitus (GDM).This study aimed to evaluate weight gain during gestation and pregnancy outcomes among women with GDM.Methods:A retrospective study involving 1523 women with GDM was conducted between July 2013 and July 2016.Demographic data, gestational weight gain (GWG), blood glucose, glycated-hemoglobin level, and maternal and fetal outcomes were extracted from medical records.Relationships between GWG and pregnancy outcomes were investigated using multivariate logistic regression.Results:In total, 451 (29.6%) women showed insufficient GWG and 484 (31.8%) showed excessive GWG.Excessive GWG was independently associated with macrosomia (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.50-3.52, P<0.001), large for gestational age (aOR 2.06, 95% CI 1.44-2.93, P<0.001), small for gestational age (aOR 0.49, 95% CI 0.25-0.97, P=0.040), neonatal hypoglycemia (aOR 3.80, 95% CI 1.20-12.00, P=0.023), preterm birth (aOR 0.45, 95% CI 0.21-0.96, P=0.040), and cesarean delivery (aOR 1.45, 95% CI 1.13-1.87, P=0.004).Insufficient GWG increased the incidence of preterm birth (aOR 3.53, 95% CI 1.96-6.37, P<0.001).Conclusions:Both excessive and insufficient weight gain require attention in women with GDM.Nutritional therapy and exercise interventions to control blood glucose should also be used to control reasonable weight gain during pregnancy to decrease adverse pregnancy outcomes.

Use of metformin during pregnancy for women with polycystic ovary syndrome

Objective: The purpose of this article is to review the literature assessing foetal and maternal pregnancy outcomes in women with PCOS who used metformin during pregnancy. Study Design: A literature search was conducted using MEDLINE, with analysis of 25 studies that recorded neonatal and maternal outcomes in women who used metformin during pregnancy. The outcomes assessed in this review include congenital deformities, miscarriages, preterm labour, gestational diabetes (GDM) and pregnancy induced hypertension (PIH). Results: We found that the use of metformin throughout pregnancy correlated with decreased rates of preterm labour, GDM and PIH. Conflicting evidence exists over whether metformin use during pregnancy reduced miscarriage rates. The use of metformin during pregnancy did not increase teratogenicity risks. Conclusion: The use of metformin throughout pregnancy is associated with decreased rates of preterm labour, GDM, and PIH. However, more randomised controls involving larger numbers of participants are required for more definitive results.

妊娠期糖尿病患者血清LncRNA DANCR和miR-33a-5p水平表达对妊娠结局预测价值研究

目的 探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清长链非编码核糖核酸分化拮抗非蛋白编码RNA (long noncoding RNA differentiation antagonizing nonprotein coding RNA,LncRNA DANCR)、微小RNA-33a-5p (miR-33a-5p)水平表达对妊娠结局的预测价值。方法 选取2021年8月~2023年2月于衡水市第四人民医院产检和分娩的154例GDM患者为GDM组,并根据妊娠结局分为良好结局组(n=115)和不良结局组(n=39);同期收集24周葡萄糖耐量试验正常的149例健康孕产妇作为对照组。采用实时荧光定量PCR(qRT-PCR)检测血清LncRNA DANCR和miR-33a-5p水平;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清LncRNA DANCR和miR-33a-5p预测GDM患者不良妊娠结局的价值;采用Pearson相关性分析GDM不良妊娠结局患者血清LncRNA DANCR,miR-33a-5p与空腹血糖(FBG)、空腹胰岛素(FINS)、稳态模式评估法计算胰岛素抵抗指数(HOMA-IR)的相关性;Logistic回归分析GDM患者不良妊娠结局的影响因素。结果 GDM组血清LncRNA DANCR水平(0.69±0.15)显著低于对照组(1.01±0.22),miR-33a-5p (1.59±0.40)及不良妊娠结局总发生率(25.34%)显著高于对照组(1.02±0.23,5.36%),差异具有统计学意义(t/χ^(2)=14.835,15.140,23.011,均P<0.05)。不良妊娠结局组血清LncRNADANCR水平(0.50±0.14)显著低于良好结局组(0.75±0.18),miR-33a-5p (2.00±0.58),FBG (8.97±0.66mmol/L),FINS (18.63±1.31pmol/ml)和HOMAIR (7.42±0.98)显著高于良好结局组(1.45±0.26,8.01±0.59mmol/L,14.32±1.29pmol/ml,5.10±0.86),差异具有统计学意义(t=7.895~17.961,均P<0.05)。LncRNA DANCR,miR-33a-5p单独及二者联合预测GDM患者不良妊娠结局的曲线下面积(area under curve,AUC)分别为0.820,0.819和0.897。GDM不良妊娠结局患者血清LncRNA DANCR与FBG,FINS,HOMA-IR呈负相关(r=-0.498,-0.513,-0.509,均P<0.05),miR-33a-5p与FBG,FINS,HOMA-IR呈正相关(r=0.517,0.494,0.507,均P<0.05)。LncRNA DANCR是影响GDM患者不良妊娠结局的保护因素(OR=0.804,95%CI:0.693~0.933,P=0.004),miR-33a-5p是影响GDM患者不良妊娠结局的危险因素(OR=2.747,95%CI:1.444~5.225,P=0.002)。结论 GDM不良妊娠结局患者LncRNADANCR降低,miR-33a-5p升高,二者均是不良妊娠结局的影响因素。

慢性高血压及其合并妊娠期糖尿病的患病率和妊娠结局

目的:随着中国生育政策全面放开、女性妊娠年龄逐步提高、育龄期超重和肥胖比例逐步增加,慢性高血压(chronic hypertension,CHTN)合并妊娠期糖尿病(gestational diabetes mellitus,GDM)的孕妇比例呈现增多趋势,发生不良妊娠结局风险显著增加。本研究拟分析CHTN及其合并GDM的患病率,并比较二者的不良妊娠结局,旨在为制订干预措施提供依据。方法:本研究为前瞻性研究。根据2016年1月1日至2020年12月31日期间共378366例大型孕妇队列,筛选出CHTN孕妇1418例,其中单纯CHTN 1027例,CHTN合并GDM 391例。应用SAS9.4统计分析孕妇的基本情况、临床资料和妊娠结局,并分析影响CHTN及其合并GDM患者妊娠结局的危险因素。结果:妊娠合并CHTN的患病率为3.8‰,CHTN合并GDM的患病率为1.0‰。CHTN合并GDM患者占所有CHTN孕妇总数的27.57%(391/1418)。母亲年龄,妊娠次数,产次,既往剖宫产次数,入队列时收缩压、舒张压和平均动脉压在CHTN合并GDM与单纯CHTN 2组间的差异均有统计学意义(均P<0.05)。在调整孕妇年龄、妊娠次数、产次等可能的混杂因素后,二元Logistic回归分析结果显示:CHTN合并GDM孕妇发生剖宫产的危险是CHTN孕妇的1.348倍(OR=1.348,95%CI 1.043~1.741),发生胎盘粘连的危险是CHTN孕妇的2.029倍(OR=2.029,95%CI 1.190~3.462),发生子痫前期的危险是CHTN孕妇的1.540倍(OR=1.540,95%CI 1.101~2.152),结局为巨大儿的危险是CHTN孕妇的2.670倍(OR=2.670,95%CI 1.398~5.100)。结论:CHTN孕妇合并GDM的风险较高,CHTN合并GDM患者的妊娠结局与仅患有CHTN的孕妇在剖宫产、胎盘粘连、子痫前期及巨大儿发生方面存在差异。CHTN合并GDM患者的孕期保健,特别是其血压及血糖的管理更需要重点关注。

综合营养管理对妊娠期糖尿病患者的血糖及妊娠结局的影响

目的 探讨综合营养管理对妊娠期糖尿病(GDM)患者糖脂代谢及妊娠结局的影响。方法 本研究纳入了2021年5月~2021年7月共121名在全国6个分中心医院产科建档的妊娠24~28周的GDM孕妇,随机分为干预组(n=74)和对照组(n=47)。干预组接受综合营养管理,包括至少6次门诊干预、个体化营养管理及妊娠期糖尿病半日规范化门诊宣教,并持续使用动态血糖监测仪和指血血糖监测仪监测血糖,每4周进行糖化白蛋白和尿常规检测,记录体质量、体成分、饮食运动实施、胎儿发育以及并发症发生情况。对照组接受常规营养指导。比较两组孕37周的血糖相关指标、分娩前的体质量增加和部分脂类代谢指标、妊娠结局以及产后42 d口服葡萄糖耐量试验(OGTT)结果的差异。结果 与对照组相比,干预组孕妇的产前空腹血糖(P=0.006)、餐后2 h静脉血浆葡萄糖(P=0.009)、血酮(P=0.044)水平显著降低。两组间体质量增加值与体质量达标率没有显著性差异。干预组孕妇的产后2h OGTT试验结果小于对照组(P=0.006),差异有统计学意义,子痫前期的发生率和产后出血量低于对照组,但两组之间没有统计学差异。对于新生儿来说,干预组的巨大儿(P=0.042)、剖宫产(P=0.048)的发生率略低于对照组,结果有统计学差异。其他不良妊娠结局在两组之间没有统计学差异。结论 强化综合营养管理能够更好地控制孕妇血糖水平,改善GDM妇女的孕产妇和新生儿结局。

外周血IL-10、IL-33及其受体sST2水平与妊娠期糖尿病患者不良妊娠结局的关系

目的 探究外周血白介素-10(IL-10)、白介素-33(IL-33)及其受体可溶性肿瘤抑制素2(sST2)水平与妊娠期糖尿病(GDM)患者不良妊娠结局的关系。方法 选取2022年7月至2023年7月在我院建档产检的GDM患者80例纳入研究组,同期在我院进行产检的健康孕产妇80例纳入对照组,比较两组产妇孕37周时的外周血IL-10、IL-33及其受体sST2水平。对研究组患者进行追踪随访,并根据不同妊娠结局将研究组分为良好结局组(获得良好妊娠结局,n=55)和不良结局组(发生不良妊娠结局,n=25),探究影响GDM患者妊娠结局的因素,以及外周血IL-10、IL-33及其受体sST2水平对不良妊娠结局的预测价值。结果 研究组和对照组患者的年龄、孕次、产次、总胆固醇、受教育年限、孕前体质量指数(BMI)比较均无显著性差异(P>0.05),但研究组分娩前BMI、胰岛素抵抗指数均显著高于对照组(P<0.05)。研究组患者的IL-10水平显著低于对照组,IL-33及sST2水平显著高于对照组(P均<0.05)。对照组发生1例产后出血,2例巨大儿,不良妊娠结局总发生率为3.75%;研究组发生3例产后出血,5例巨大儿,8例新生儿窒息,6例足月低体重儿,3例胎儿发育异常,不良妊娠结局总发生率为31.25%,显著高于对照组(P<0.05)。研究组中,不良结局组患者的IL-10水平显著低于良好结局组,IL-33及sST2水平显著高于良好结局组(P均<0.05)。经单因素及多因素分析,IL-10、IL-33、sST2、胰岛素抵抗指数均能影响GDM患者的妊娠结局(P<0.05)。经受试者工作特征(ROC)曲线分析,IL-10、IL-33、sST2对GDM患者不良妊娠结局具有一定预测价值,曲线下面积(AUC)分别为0.969、0.945、0.960(P<0.05)。结论 外周血IL-10、IL-33及其受体sST2水平在预测GDM患者的新生儿窒息、产后出血、巨大儿、足月低体重儿、胎儿发育异常等不良妊娠结局方面具有潜在的临床应用价值,有助于早期识别上述高风险患者,以采取积极有效的干预措施改善妊娠结局。

妊娠期糖尿病孕妇血清PPARγ、FABP4、CST与胰岛素抵抗的关系及对妊娠结局的影响

目的探讨妊娠期糖尿病(GDM)孕妇过氧化物酶体增殖物激活受体γ(PPARγ)、脂肪酸结合蛋白4(FABP4)及皮质抑素(CST)的表达与胰岛素抵抗的关系及对妊娠结局的影响,以期为GDM孕妇的临床干预提供参考。方法选取2021年9月—2023年9月陕西省人民医院收治的GDM孕妇83例作为观察组,另选取同期进行孕检且结果正常的健康孕妇67例作为对照组。统计GDM孕妇的妊娠结局,对比GDM孕妇和健康孕妇孕早期、孕中期及孕晚期血清PPARγ、FABP4、CST水平及胰岛素抵抗指数(HOMA-IR),采用Pearson相关分析PPARγ、FABP4、CST与HOMA-IR的关系,并分析影响GDM孕妇妊娠结局的相关因素。结果观察组孕妇孕早期、孕中期及孕晚期血清FABP4及HOMA-IR水平均高于对照组,血清PPARγ、CST水平均低于对照组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,GDM孕妇血清FABP4水平与HOMA-IR呈正相关(r=0.754,P<0.001),血清PPARγ和CST水平与HOMA-IR呈负相关(r=-0.679、-0.836,P<0.001)。观察组孕妇正常妊娠69例,不良妊娠14例;对照组孕妇正常妊娠66例,不良妊娠1例;观察组孕妇不良妊娠结局发生率为16.87%(14/83),高于对照组的1.49%(1/67),差异有统计学意义(χ^(2)=9.737,P=0.002)。不同妊娠结局GDM孕妇的年龄、孕周及高血压病史比例比较,差异均无统计学意义(P>0.05);不良妊娠GDM孕妇身体质量指数(BMI)>25 kg/m^(2)、糖尿病家族史比例及血清FABP4、HOMA-IR水平均高于正常妊娠GDM孕妇,血清PPARγ及CST水平均低于正常妊娠GDM孕妇,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,BMI、糖尿病家族史及血清PPARγ、CST、FABP4、HOMA-IR水平是GDM孕妇发生不良妊娠结局的影响因素(P<0.05)。结论GDM孕妇血清FABP4、PPARγ和CST表达异常,并与胰岛素抵抗、妊娠结局密切相关。临床应针对GDM孕妇给予饮食、药物等有效干预,以控制血糖变化,从而改善妊娠结局。

妊娠期糖尿病患者体重增长情况及与母婴不良结局的相关性研究

目的根据我国妊娠期体重增长(GWG)标准,分析妊娠期糖尿病(GDM)孕妇妊娠期体重增长情况及其和母婴不良结局的相关性。方法选取北京市朝阳区2019年2月至2022年8月建档分娩的单胎妊娠GDM孕妇10539例为研究对象,采用Logistic回归分析GDM孕妇GWG与妊娠期高血压、妊娠合并贫血、子痫前期/子痫、胎膜早破、剖宫产、低出生体重、巨大儿、小于胎龄儿(SGA)、大于胎龄儿(LGA)的相关性。结果10539例GDM孕妇中,35.53%GWG过多,20.56%GWG不足,43.90%GWG适宜;42.49%的超重人群和45.61%的肥胖人群GWG过多。在调整年龄、民族、文化程度、职业、孕次、孕前体质量指数、孕龄后,多因素Logistic回归分析结果显示,GWG过多是妊娠期高血压、子痫前期/子痫、剖宫产、巨大儿和LGA的危险因素(aOR值介于1.39~2.37之间,P<0.05),是低出生体重、SGA的保护性因素(aOR值分别为0.60、0.61,P<0.01);而GWG不足是低出生体重、SGA的危险因素(aOR值分别为1.81、1.38,P<0.01),是胎膜早破、剖宫产、LGA的保护性因素(aOR值分别为0.65、0.89、0.81,P<0.05);未观察到GWG与妊娠合并贫血的相关性(P>0.05)。结论在我国妊娠期体重增长标准下,GDM孕妇中约20%增重不足,约40%的肥胖和超重人群增重过多。GDM孕妇妊娠期体重增长过多和不足均会增加母婴不良结局的风险,为GDM人群制定针对性妊娠期增重标准,指导和监测GDM孕妇妊娠期增重具有一定的意义。

妊娠糖尿病发生的危险因素及其对不良妊娠结局的影响

目的探讨妊娠糖尿病(GDM)发生的危险因素及其对不良妊娠结局的影响。方法选取2022年6月至2023年3月在福建省妇幼保健院产科建档并住院分娩的548例GDM孕妇作为病例组,从同期就诊的非GDM孕妇中抽取2192例作为对照组,所有研究对象年龄介于20~44周岁、单胎、初产妇、分娩孕龄≥28周。收集其一般资料,采用条件logistic回归模型分析发生GDM的危险因素,并比较分析不同组别不良妊娠结局的差异。结果单因素分析结果显示,GDM孕妇的孕前体重指数(BMI)和妊娠年龄均高于非GDM孕妇,GDM孕妇的分娩孕龄低于非GDM孕妇,GDM孕妇的妊娠高血压发生比例高于非GDM孕妇,差异均有统计学意义(P<0.05)。进一步多因素条件logistic回归分析显示:孕前肥胖(β=1.147,OR=3.150,95%CI:2.180~4.551)和孕前超重(β=0.488,OR=1.629,95%CI:1.112~2.386)、妊娠年龄≥35周岁(β=0.870,OR=2.387,95%CI:1.381~4.123)、患有妊娠期高血压(β=1.230,OR=3.421,95%CI:1.850~6.326)是发生GDM的独立危险因素(P<0.05),而分娩孕龄(β=-0.097,OR=0.907,95%CI:0.868-0.948)是GDM的保护因素(P<0.05)。GDM孕妇剖宫产、胎膜早破、低出生体重儿和早产儿的发生率均高于非GDM孕妇,差异均有统计学意义(P<0.05)。结论GDM孕妇的妊娠结局较差,应加强对GDM的监测与管理,对有GDM危险因素的高危孕妇应进行早期筛查,及时干预和诊断,避免不良妊娠结局的发生。

双胎妊娠中GDM孕妇临床特征对新生儿早期不良结局的影响

目的:探讨双胎妊娠合并妊娠期糖尿病(GDM)孕妇临床特征及对新生儿早期不良结局的影响.方法:收集2017年1月-2022年1月于本院住院的719例单双胎GDM者母婴临床资料,同期正常双胎妊娠者母婴临床资料作为对照组,并行多因素logistic回归分析探讨GDM母婴早期不良结局的影响因素.结果:GDM产妇相较于单胎,双胎妊娠产妇胰岛素使用频率更低(P<0.05),妊娠晚期糖化血红蛋白水平及子痫前期发病率更高(P<0.05);双胎妊娠新生儿更易患新生儿疾病及胎龄更小(P<0.05),更易发生小于胎龄儿(SGA)、早产、高胆红素血症和气胸等早期不良结局(P<0.05).与正常双胎妊娠产妇相比,GDM双胎妊娠产妇体质指数(BMI)、孕期体重增长更低且更易剖宫产(P<0.05),但两组产妇早期不良结局无统计学差异(P>0.05).与正常双胎妊娠新生儿相比,GDM双胎妊娠新生儿SGA、大于胎龄儿(LGA)发生率更低(P<0.05),早期不良结局无统计学差异(P>0.05).多因素logistic显示,SGA(OR=7.357,95%CI2.136~25.341)、早产(OR=5.329,95%CI1.430~19.852)和应用辅助生殖技术(OR=6.838,95%CI1.715~27.263)为GDM双胎新生儿早期不良结局的危险因素.结论:GDM双胎妊娠中,早期积极预防与治疗SGA及早产,定期进行孕前检查及更优质辅助生殖技术均可有效降低新生儿早期不良结局的发生.

基于IMB模型的运动干预对妊娠期糖尿病孕妇血糖控制、自我管理能力及妊娠结局的影响

目的:探讨基于信息-动机-行为技巧模型(IMB模型)的运动干预对妊娠期糖尿病(GDM)孕妇血糖控制、自我管理能力及妊娠结局的影响。方法:将100例GDM患者根据干预方式的不同分为两组,予以常规运动干预的为对照组(n=50);予以基于IMB模型运动干预的为观察组(n=50)。两组均干预4周。比较两组干预前后GDM运动知、信、行水平[GDM运动知识-态度-行为问卷]、自我管理能力[孕妇自我保健管理评定问卷]、血糖水平[空腹血糖(FPG)、糖化血红蛋白(HbAlc)水平,餐后2 h血糖(2 hPG)],随访至患者分娩,比较两组患者血糖控制不佳入院率、孕期体重增长超标、分娩后口服葡萄糖耐量试验(OGTT)不达标率及妊娠结局。结果:相较于对照组,干预后,观察组GDM运动知识、态度及行为评分均更高(P<0.05);孕妇自我保健管理评定问卷总分及各维度评分均更高(P<0.05);观察组FBG、2 hPG及HbA1c均更低(P<0.05),血糖控制不佳入院、孕期体重增长超标及分娩后OGTT不达标总发生率均更低(P<0.05)。观察组患者妊娠不良结局总发生率均低于对照组(P<0.05)。结论:基于IMB模型的运动干预可提高GDM患者运动知、信、行水平及自我管理能力,有效控制患者血糖,改善母婴结局。