Circulating glycated albumin levels and gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)is characterized by glucose intolerance that is first diagnosed during pregnancy,making it the most common complication associated with this period.Early detection and targeted treatment of GDM can minimize foetal exposure to maternal hyperglycaemia and subsequently reduce the associated adverse pregnancy outcomes.Previous studies have inconsistently suggested that the level of glycated albumin(GA)might predict GDM.AIM To review and synthesize existing evidence to evaluate the relationship between GA levels and the development of GDM.METHODS We sought to compare GA levels between GDM and control groups in this metaanalysis by systematically searching the Web of Science,PubMed,Cochrane Library,and Embase databases for articles published up to June 2023.The analysis utilized the weighted mean difference(WMD)as the primary metric.The data were meticulously extracted,and the quality of the included studies was assessed.Additionally,we conducted a subgroup analysis based on study region and sample size.We assessed heterogeneity using I2 statistics and evaluated publication bias through funnel plots.Additionally,trim-and-fill analysis was employed to detect and address any potential publication bias.RESULTS The meta-analysis included a total of 11 studies involving 5477 participants,comprising 1900 patients with GDM and 3577 control individuals.The synthesized results revealed a notable correlation between elevated GA levels and increased susceptibility to GDM.The calculated WMD was 0.42,with a 95%confidence interval(95%CI)ranging from 0.11 to 0.74,yielding a P value less than 0.001.Concerning specific GA levels,the mean GA level in the GDM group was 12.6,while for the control group,it was lower,at 11.6.This discrepancy underscores the potential of GA as a biomarker for assessing GDM risk.Moreover,we explored the levels of glycated haemoglobin(HbA1c)in both cohorts.The WMD for HbA1c was 0.19,with a 95%CI ranging from 0.15 to 0.22 and a P value less than 0.001.This observation suggested that both GA and HbA1c levels were elevated in individuals in the GDM group compared to those in the control group.CONCLUSION Our meta-analysis revealed a substantial correlation between elevated GA levels and increased GDM risk.Furthermore,our findings revealed elevated levels of HbA1c in GDM patients,emphasizing the significance of monitoring both GA and HbA1c levels for early GDM detection and effective management.

Unique Ultrastructural Alterations in the Placenta Associated With Macrosomia Induced by Gestational Diabetes Mellitus

Objective:To investigate the morphological and ultrastructural alterations in placentas from pregnancies with gestational diabetes mellitus(GDM)–induced macrosomia,term nondiabetic macrosomia,and normal pregnancies.Methods:Sixty full-term placentaswere collected,and clinical data alongwith informed consent were obtained from pregnant womenwho underwent regular visit checks and delivered their newborns in Northwest Women’s and Children’s Hospital between May and December 2022.Placentas were divided into three equal groups:normal pregnancy(control group),nondiabetic macrosomia group,and macrosomia complicated with GDM(diabetic macrosomia)group.Gross morphological data of placentas were recorded,and placental samples were processed for examination of ultrastructural and stereological changes using transmission electron microscopy.Analysis of variance and chi-squared test were used to examine the differences among the three groups for continuous and categorical variables,respectively.Results:The baseline characteristics of mothers and neonates did not differ across the three groups,except for a significantly higher birth weight in the diabetic macrosomia group(4172.00±151.20 g vs.3192.00±328.70 g,P<0.001)and nondiabetic macrosomia group(4138.00±115.20 g vs.3192.00±328.70 g,P<0.001)comparedwith control group.Examination of the placentas revealed that placental weight was also highest in the diabeticmacrosomia group comparedwith control group(810.00±15.81 g vs.490.00±51.48 g,P<0.001)and nondiabetic macrosomia group(810.00±15.81 g vs.684.00±62.69 g,P<0.001),but the ratio of neonatal birth weight to placental weight(BW/PW)was significantly lower in the diabetic macrosomia group compared with that in the control group(5.15±0.19 vs.6.54±0.63,P<0.001)and nondiabetic macrosomia group(5.15±0.19 vs.6.09±0.52,P<0.001)group.In contrast,the BW/PW ratio in nondiabetic macrosomia did not differ significantly from that in the control group.Distinct ultrastructural changes in terminal villi and stereological alterations in microvilli were observed in the diabetic macrosomia group,including changes in the appearance of cytoplasmic organelles and the fetal capillary endothelium and thickness of the vasculo-syncytial membrane and basal membrane.Conclusion:Significant ultrastructural and stereological alterations were discovered in the placentas from pregnant women with macrosomia induced by GDM.These alterationsmay be the response of the placenta to the hyperglycemia condition encountered during pregnancies complicated with GDM.

Effect of individualized nutrition interventions on clinical outcomes of pregnant women with gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)can lead to excessive pregnancy weight gain(PWG),abnormal glucolipid metabolism,and delayed lactation.Therefore,it is necessary to provide appropriate and effective interventions for pregnant women with GDM.AIM To clarify the effects of individualized nutrition interventions on PWG,glucolipid metabolism,and lactation in pregnant women with GDM.METHODS The study population consisted of 410 pregnant women with GDM who received treatment at the Northern Jiangsu People's Hospital of Jiangsu Provinceand Yangzhou Maternal and Child Health Hospital between December 2020 and December 2022,including 200 who received routine in-terventions[control(Con)group]and 210 who received individualized nutrition interventions[research(Res)group].Data on PWG,glucolipid metabolism[total cholesterol,(TC);triglycerides(TGs);fasting blood glucose(FPG);glycosylated hemoglobin(HbA1c)],lactation time,perinatal complications(cesarean section,premature rupture of membranes,postpartum hemorrhage,and pregnancy-induced hypertension),and neonatal adverse events(premature infants,fetal macrosomia,hypo-glycemia,and respiratory distress syndrome)were collected for comparative analysis.RESULTS The data revealed markedly lower PWG in the Res group vs the Con group,as well as markedly reduced TG,TC,FPG and HbA1c levels after the intervention that were lower than those in the Con group.In addition,obviously earlier lactation and statistically lower incidences of perinatal complications and neonatal adverse events were observed in the Res group.CONCLUSION Individualized nutrition interventions can reduce PWG in pregnant women with GDM,improve their glucolipid metabolism,and promote early lactation,which deserves clinical promotion.

Associations of Gestational Diabetes Mellitus and Excessive Gestational Weight Gain with Offspring Obesity Risk

Objective Gestational diabetes mellitus(GDM)and gestational weight gain(GWG)are important risk factors that are known to affect offspring growth,but these outcomes are inconsistent and it remains unknown if both risk factors have a synergetic effect on early childhood growth.The present study aimed to conduct offspring body mass index-for-age Z-scores(BMIZ)trajectories and to evaluate the independent and interactive effect of the status of GDM and excessive GWG on the risks of overweight/obesity from birth to 24 months of age.Methods A total of 7949 mother-child pairs were enrolled in this study.The weight and length of children were measured at birth,6,12,and 24 months of age to calculate BMIZ.Results The status of GDM was positively associated with offspring BMIZ and risk of macrosomia at birth but was not associated with offspring BMIZ or the risks of overweight/obesity at 6,12,and 24 months of age.In contrast,excessive GWG was positively linked to offspring BMIZ,the stable high BMIZ trajectory pattern,and risks of overweight/obesity in the first 24 months of age.These two risk factors also had a significant synergistic effect on macrosomia at birth,but the interactive effect was only significant in boys during the follow-up years in the sex-stratified analyses.Conclusion The maternal GWG was a more pronounced predictor than GDM with relation to BMIZ and risk of overweight/obesity in early childhood.The interactive effect between these risk factors on offspring overweight/obesity may vary by sex.

High Prevalence of Gestational Diabetes Mellitus in Beijing： Effect of Maternal Birth Weight and Other Risk Factors

Background： Gestational diabetes mellitus （GDM） is associated with both short- and long-term adverse health consequences for both the mother and her offspring. The aim was to study the prevalence and risk factors for GDM in Beijing. Methods： The study population consisted of 15,194 pregnant women attending prenatal care in 15 hospitals in Beijing, who delivered between June 20, 2013, and November 30, 2013, after 28 weeks of gestation. The participants were selected by cluster sampling from the 15 hospitals identified through random systematic sampling based on the number of deliveries in 2012. A questionnaire was designed to collect information. Results： A total of 2987 （19.7%） women were diagnosed with GDM and 208 （1.4%） had diabetes in pregnancy （DIP）, Age （OR： 1.053, 95% CI： 1.033-1.074, P 〈 0.01）, family history of diabetes mellitus （OR： 1.481, 95% CI：1.254 1.748, P 〈 0.01）, prepregnancy body mass index （BMI） （OR： 1.481, 95% CI：1.254 1.748, P 〈 0.01）, BMI gain before 24 weeks （OR： 1.126, 95% CI： 1.075-1.800, P 〈 0.01 ）, maternal birth weight （P 〈 0.01）, and fasting plasma glucose at the first prenatal visit （P 〈 0.01） were identified as risk factors for GDM. In women with birth weight 〈3000 g, GDM rate was significantly higher. Conclusions： One out of every five pregnant women in Beijing either had GDM or DIP and this constitutes a huge health burden for health services. Prepregnancy BMI and weight gain before 24^th week are important modifiable risk factors for GDM. Ensuring birth weight above 3000 g may help reduce risk for future GDM among female offsprings.

Analysis on Family History of Diabetes, Weight Gain during Pregnancy and Pre-pregnancy Body Mass Index on 82 Pregnant Women with Gestational Diabetes Mellitus

Objective:To investigate the effects of family history of diabetes mellitus,Gestational Weight Gain(GWG)and Body Mass Index(BMI)before pregnancy on Gestational Diabetes Mellitus(GDM).Method:82 pregnant women with GDM who were hospitalized and delivered in the obstetrics department of our hospital from September 2017 to September 2019 were selected as the observation group,and 60 pregnant women with normal glucose tolerance test in the same period were selected as the control group;The relationship between family history of diabetes,weight gain during pregnancy and pre-pregnancy Body Mass Index and GDM were analyzed.Results:The age,pre-pregnancy weight and weight gain during pregnancy were significantly higher in the observation group than in the control group(P<0.05),and the family history of diabetes and pre-pregnancy Body Mass Index were higher in the observation group than in the control group(P<0.05),and the differences were statistically significant.Conclusion:It is suggested that family history of diabetes is related to gestational diabetes mellitus.Excessive GWG growth during pregnancy and high Body Mass Index before pregnancy may increase the risk of gestational diabetes mellitus in pregnant women.

Consequences of gestational and pregestational diabetes on placental function and birth weight

Maternal diabetes constitutes an unfavorable environment for embryonic and fetoplacental development. Despite current treatments, pregnant women with pregestational diabetes are at increased risk for congenital malformations, materno-fetal complications, placental abnormalities and intrauterine malprogramming. The complications during pregnancy concern the mother (gravidic hypertension and/or preeclampsia, cesarean section) and the fetus (macrosomia or intrauterine growth restriction, shoulder dystocia, hypoglycemia and respiratory distress). The fetoplacental impairment and intrauterine programming of diseases in the offspring's later life induced by gestational diabetes are similar to those induced by type 1 and type 2 diabetes mellitus. Despite the existence of several developmental and morphological differences in the placenta from rodents and women, there are similarities in the alterations induced by maternal diabetes in the placenta from diabetic patients and diabetic experimental models. From both human and rodent diabetic experimentalmodels, it has been suggested that the placenta is a compromised target that largely suffers the impact of maternal diabetes. Depending on the maternal metabolic and proin ammatory derangements, macrosomia is explained by an excessive availability of nutrients and an increase in fetal insulin release, a phenotype related to the programming of glucose intolerance. The degree of fetal damage and placental dysfunction and the availability and utilisation of fetal substrates can lead to the induction of macrosomia or intrauterine growth restriction. In maternal diabetes, both the maternal environment and the genetic background are important in the complex and multifactorial processes that induce damage to the embryo, the placenta, the fetus and the offspring. Nevertheless, further research is needed to better understand the mechanisms that govern the early embryo development, the induction of congenital anomalies and fetal overgrowth in maternal diabetes.

A Review on the Management of Gestational Diabetes Mellitus(GDM):Pharmacological and Non-Pharmacological Interventions

Gestational diabetes mellitus(GDM)is defined as any degree of glucose or carbohydrate intolerance mainly during pregnancy.About 10%to 15%of pregnancies are affected and complicated by gestational diabetes.Due to hormonal changes during pregnancy,the requirement for insulin increases,and thus the usual concentration of insulin previously catered for glycemic control is ineffective.In order to meet the body’s demand,the islet cells secrete a higher amount of insulin.GDM occurs when this higher concentration is also unable to control blood glucose.This increased resistance toward insulin is most noticeable during the third trimester of pregnancy,which gradually normalizes after the termination of pregnancy.Various complications do arise,which affect both the mother and her developing fetus.In the mother,miscarriages,delivery of baby via caesarian section,and other complications may result,whereas the fetus may be affected with congenital abnormalities,neonatal hypoglycemia,and even death.Treatment of GDM includes both non-pharmacological and pharmacological interventions.Pharmacological agents are employed when non-pharmacological interventions fail to achieve the desired target.Glyburide,insulin,and metformin are the commonly used pharmacological agents.

Outcomes of Fetal Macrosomia and Associated Factors: A Case-Control Facility Based Study

Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.

Maternal Obesity,Gestational Diabetes,and Fetal Macrosomia:An Incidental or a Mechanistic Relationship?

Gestational diabetes mellitus(GDM)is a well-established risk factor for fetal macrosomia.A significant number of patients with GDM also suffer from obesity,a factor associated with fetal macrosomia.An important question is whether GDM is independently associated with fetal macrosomia,or whether this relationship is merely the result of maternal obesity acting as a confounder.In this review of the literature,we attempt to further elucidate the relationship between GDM,maternal obesity,and fetal macrosomia.

Gestational weight gain and risk of gestational diabetes mellitus among Chinese women

Background Gestational diabetes mellitus （GDM） is a common complication during pregnancy,and gestational weight gain is one of the major and modifiable risk factors.This study aims to estimate the relationship between the rate of gestational weight gain before diagnosis of GDM and the subsequent risk of GDM.Methods A case-control study was conducted with 90 GDM cases and 165 women in the control group from May 2012 to August 2012 at Peking University First Affiliated Hospital.GDM was diagnosed according to the standards issued by the Ministry of Health of China in 2011.The plasma glucose levels,weights,and covariate data of the women were obtained based on medical records.Univariate analysis and unconditional Logistic regression model were used to estimate the associations.Results After adjusting for age at delivery,parity,and pre-pregnancy body mass index,the risk of GDM increased with increasing rates of gestational weight gain.Compared with the lower rate of gestational weight gain （less than 0.28 kg per week）,a rate of weight gain of 0.28 kg per week or more was associated with increased risk of GDM （odds ratio：2.03; 95％ confidence interval：1.15 to 3.59）.The association between the rate of gestational weight gain and GDM was primarily attributed to the increased weight gain in the first trimester.Conclusion High rates of gestational weight gain,particular during early pregnancy,may increase a woman＇s risk of GDM.

Excessive gestational weight gain in early pregnancy and insufficient gestational weight gain in middle pregnancy increased risk of gestational diabetes mellitus

Background:Gestational weight gain(GWG)is associated with the risk of gestational diabetes mellitus(GDM).However,the effect of weight gain in different trimesters on the risk of GDM is unclear.This study aimed to evaluate the effect of GWG on GDM during different trimesters.Methods:A birth cohort study was conducted from 2017 to 2020 in Shenzhen,China.In total,51,205 participants were included comprising two models(early pregnancy model and middle pregnancy model).Gestational weight(kg)was measured at each prenatal clinical visit using a standardized weight scale.Logistic regression analysis was used to assess the risk of GDM.Interaction analysis and mediation effect analysis were performed in the middle pregnancy model.Results:In the early pregnancy model,the risk of GDM was 0.858 times lower(95%confidence interval[CI]:0.786,0.937)with insufficient GWG(iGWG)and 1.201 times higher(95%CI:1.097,1.316)with excessive GWG after adjustment.In the middle pregnancy model,the risk of GDM associated with iGWG increased 1.595 times(95%CI:1.418,1.794)after adjustment;for excessive GWG,no significant difference was found(P=0.223).Interaction analysis showed no interaction between GWG in early pregnancy(GWG-E)and GWG in middle pregnancy(GWG-M)(F=1.268;P=0.280).The mediation effect analysis indicated that GWG-M plays a partial mediating role,with an effect proportion of 14.9%.Conclusions:eGWG-E and iGWG-M are associated with an increased risk of GDM.Strict control of weight gain in early pregnancy is needed,and sufficient nutrition should be provided in middle pregnancy.

International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis： further evidence from China

Background The International Association of Diabetes and Pregnancy Study Group （IADPSG） recommended new diagnostic criteria for gestational diabetes mellitus （GDM） after extensive analyses of the Hyperglycemia and Adverse Pregnancy Outcomes （HAPO） study. Unfortunately, there was no data from mainland of China in this study. We evaluated the feasibility of IADPSG criteria for GDM diagnosis in China. Methods A large prospective study was conducted. We reviewed medical records of a total of 25 674 pregnant women who underwent GDM screening and diagnosis between January 1, 2005 and December 31, 2012 in the Peking University First Hospital. The prevalence of gestational glucose metabolism abnormalities was calculated according to different cut off values defined by the National Diabetes Data Group （NDDG） or the IADPSG, and the incidence of adverse pregnancy outcomes related to GDM was analyzed. Results According to the cut off values of NDDG and IADPSG criteria, the prevalence of gestational glucose metabolism abnormalities was 8.4% and 18.9% （P 〈0.01） respectively, and the prevalence of cesarean section （52.5% vs. 46.0%, P 〈0.01）, macrosomia （7.5% vs. 6.3%, P 〈0.05）, neonatal hypoglycemia （1.6% vs. 1.0%, P 〈0.01）, and perinatal death （0.5% vs. 0.2%, P 〈0.01）; the prevalence was significantly lower when IADPSG criteria were applied. The prevalence of macrosomia, cesarean section, neonatal hypoglycemia, pregnancy induced hypertension, etc. was also higher in the GDM group than in the normal group. The prevalence of cesarean section （62.3%） and macrosomia （14.8%） was the highest in untreated mild GDM patients. Conclusions Our results indicated that treatment/intervention of women with GDM identified by IADPSG criteria was related to significantly lower risk of multiple adverse pregnancy outcomes. Such findings provide support for applying IADPSG criteria in China.

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.

妊娠期糖尿病产妇与非妊娠期糖尿病产妇分娩巨大儿的影响因素

目的探讨妊娠期糖尿病(GDM)产妇与非GDM产妇分娩巨大儿的影响因素。方法纳入分娩巨大儿的143例产妇和分娩正常体重新生儿的157例产妇作为研究对象,根据孕期是否患GDM,将前者分为GDM巨大儿组、非GDM巨大儿组,将后者分为GDM对照组及非GDM对照组。使用多因素二元Logistic回归模型分析GDM产妇和非GDM产妇分娩巨大儿的影响因素。结果无论是否患GDM,孕前体质指数、孕晚期载脂蛋白A水平和孕期胆固醇差值增加是产妇分娩巨大儿的危险因素(P<0.05),而孕晚期胆固醇水平较高则是产妇分娩巨大儿的保护因素(P<0.05)。在GDM产妇中,孕早期LDL水平、孕中期OGTT前血糖水平较高是其分娩巨大儿的危险因素(P<0.05),孕期HDL差值较高则是其分娩巨大儿的保护因素(P<0.05)。在非GDM产妇中,胎儿为男性、孕期总增重较高、分娩孕周较大、孕晚期LDL水平较高是其分娩巨大儿的危险因素,而孕晚期HDL水平较高、孕期LDL差值较大则是其分娩巨大儿的保护因素(P<0.05)。结论GDM产妇与非GDM产妇分娩巨大儿的影响因素不完全相同。对于GDM产妇,尤其空腹血糖高者,应合理控制血糖并密切监测,关注血脂变化;对于非GDM产妇,应在孕期注意体重管理,避免增重过度,并监测血脂,以降低巨大儿的发生率。

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。

GDM患者分娩前血糖变异性参数对巨大儿的预测价值

目的探讨妊娠糖尿病(GDM)患者分娩前血糖变异性参数与子代出生体重的相关性。方法选取2019年3月—2021年2月连云港市东方医院GDM患者100例,以各项指标均正常的孕妇261例作为对照。根据GDM患者和正常孕妇分娩的新生儿是否为巨大儿(体重≥4000 g)分为GDM巨大儿组、GDM健康儿组、巨大儿对照组、健康儿对照组。收集所有孕妇一般资料和实验室检测结果[血脂、血糖、糖化血红蛋白(HbA_(1c))等],并检测血糖变异性参数[平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、餐后血糖波动幅度(PPGE)]。采用Logistic回归分析评估GDM患者子代巨大儿的危险因素。构建列线图预测模型,并进行评价。采用Pearson相关分析评估新生儿体重与产妇血糖变异性参数之间的相关性。通过曲线拟合和阈值效应分析确定MAGE、MODD和PPGE的阈值效应。结果GDM巨大儿组新生儿出生30 min的血糖水平显著低于巨大儿对照组(P<0.05)。GDM巨大儿组孕妇空腹血糖(FBG)、餐后2 h血糖(2 h PG)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、HbA_(1c)、MAGE、PPGE、MODD、载脂蛋白B(apo B)显著高于其他3组孕妇(P<0.05),高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(apo A)显著低于其他3组孕妇(P<0.05)。多因素Logistic回归分析结果显示,MAGE、PPGE、MODD和HbA_(1c)均是GDM患者子代巨大儿的危险因素[比值比(OR)值分别为1.116、1.169、1.072、1.061,95%可信区间(CI)分别为1.021~1.246、1.051~1.301、1.012~1.134、1.004~1.121,P<0.05]。Pearson相关分析结果显示,新生儿体重与MAGE、PPGE、MODD和HbA_(1c)均呈正相关(r值分别为0.77、0.68、0.72、0.75,P<0.05)。曲线拟合和阈值效应分析结果显示,当MAGE、PPGE、MODD分别高于2.75、2.06、3.27 mmol·L^(-1)时,GDM患者子代巨大儿的发生率随3项指标的升高而呈上升趋势。列线图预测模型的受试者工作特征(ROC)曲线下面积为0.887,一致性指数(C-index)为0.887,校正曲线与理想曲线拟合度良好。结论血糖变异性参数可作为GDM患者分娩巨大儿的预测指标,具有较高的临床应用价值。

生物钟基因调控妊娠并发症及其对子代发育的影响

母体的昼夜节律信号与生物钟基因相互作用可以影响胎盘及胎儿的发育,引发妊娠期糖尿病、子痫前期、流产、早产、子代发育异常等结局。该文综述了生物钟基因与母体、胎盘及胎儿之间的联系,以及如何诱导母胎界面不良妊娠结局的发生,从而预测相关风险对子代的影响,提高临床妊娠并发症的风险管理和疾病控制及预防方案的准确性,为人类生殖健康提供重要指引。

叶酸补充持续时间与妊娠期糖尿病及不良围产结局的关系

目的:利用广义线性混合模型探讨叶酸补充持续时间、妊娠期糖尿病(GDM)与不良围产结局的关系。方法:收集2021年1月到2022年12月在河北北方学院附属第一医院进行分娩的759对母子临床资料。其中研究的不良围产结局包括剖宫产、早产儿、巨大儿、低出生体质量儿(LBW)、大于胎龄儿(LGA)和小于胎龄儿(SGA)。使用广义线性混合模型分析GDM、叶酸补充持续时间≥3个月对不良围产结局风险影响。对叶酸补充的持续时间进行分层分析,以确定其是GDM与不良围产结局的混杂因素还是影响因素。结果:共有748例(98.55%)研究对象在妊娠前、妊娠期进行了叶酸补充,其中妊娠期补充叶酸累计743例(97.89%)、妊娠前补充496例(65.35%)。77例孕妇发生GDM,发生率为10.14%。与妊娠前叶酸补充持续时间<3个月者相比,妊娠前叶酸补充持续时间≥3个月与GDM发生风险增加相关,调整后RR(aRR)为1.72(95%CI 1.17~2.53);GDM患者妊娠前叶酸补充持续时间≥3个月与SGA发生风险降低相关,aRR为0.40(95%CI 0.18~0.89)。在妊娠期叶酸补充持续时间≥3个月亚组中,GDM与剖宫产(aRR 1.36,95%CI 1.06~1.75)和巨大儿(aRR 2.11,95%CI 1.06~4.20)风险增加有关,但aRR均低于固定效应RR,分别为1.53(95%CI 1.01~2.34)和2.43(95%CI 12.7~4.66),以上差异均有统计学意义(P<0.01)。结论:妊娠前叶酸补充持续时间≥3个月可能增加GDM的风险,但降低GDM患者SGA出生的风险。妊娠期叶酸补充持续时间≥3个月对GDM妇女的剖宫产和巨大儿不良围产结局风险具有降低作用。

人体成分与脂肪细胞因子在妊娠期糖尿病患者中的关系研究

目的:探讨妊娠期女性的人体成分与脂肪细胞因子在妊娠期糖尿病(GDM)风险之间的关系。方法:选择本院常规产前检查单胎自然受孕GDM孕妇90例为GDM组,另选择同期单胎正常妊娠孕妇219例为对照组(NGT组)。在妊娠24~28周时,用生物阻抗法测定其人体成分。分析孕前体质量指数(BMI)、体脂百分比(FMP)、去脂体质量百分比(FFMP)、细胞外液/细胞内液(ECW/ICW)、体脂指数(FMI)等人体成分与GDM的关系。所有入组孕妇同期采用酶联免疫吸附法(ELISA)检测循环脂联素、脂肪酸结合蛋白4(FABP4)、瘦素以及空腹胰岛素(FINS)水平,并分析其与人体成分各指标的关系。结果:①GDM组脂联素低于NGT组,而瘦素高于NGT组(P<0.05)。②GDM组FMP、ECW/ICW、FMI显著高于NGT组(P<0.05),单因素回归分析显示孕前BMI、FMP、FMI、ECW/ICW是GDM的危险因素(OR>1,P<0.05)。而多因素分析显示仅FMP升高与GDM发病风险显著相关,是其发病的独立危险因素(OR>1,P<0.05),FFMP、MP、PP、M/F是GDM的保护因素(OR<1,P<0.05)。③GDM组,胰岛素抵抗指数(HOMA-IR)与FMI呈正相关(r>1,P<0.05),与PP呈负相关(r<1,P<0.05)。④ROC曲线显示,孕前BMI、FMP、ECW/ICW、FMI对GDM的诊断价值相似,孕前BMI、FMP和FMI相比差异无统计学意义(P>0.05),但略优于ECW/ICW(P<0.001)。结论:妊娠期的人体成分与患GDM的风险有关。FMP升高与发展为GDM的风险增加有关,FMP越高,GDM的风险越高。孕前BMI、FMP、FMI对GDM的诊断效能相似。