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BACKGROUND@#Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.@*METHODS@#A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed.@*RESULTS@#In 6204 participants, there are 1002 women (1002/6204,16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02-1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01-1.61], P = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further.@*CONCLUSIONS@#The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.
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Adult , Female , Humans , Male , Pregnancy , Blood Glucose/metabolism , China/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Diabetes, Gestational , Fetal Macrosomia , Glucose Intolerance , Retrospective StudiesABSTRACT
Objective:To compare and study the clinical efficacy of three different phacoemulsification incisions for cataract patients with type 2 diabetes mellitus.Methods:A retrospective analysis was performed in 120 patients (198 eyes) with type 2 diabetes cataract who underwent cataract extraction and intraocular lens implantation from January 2018 to June 2019 in the First hospital of Hebei Medical University. According to the surgical incision, the patients were divided into three groups: A group (the cornea scleral marginal incision, 40 cases, 72 eyes), B group (the clear corneal incision at the top , 40 cases, 66 eyes), C group (underwent temporal clear corneal incision, 40 cases, 60 eyes). The corneal perception, dry eye symptoms, basic tear secretion test (SIt), tear film rupture time (BUT), corneal fluorescein staining (FL) and complications were compared among the three groups before and after treatment.Results:The corneal perception of B group and C group was lower than that of A group on 1 d, 7 d and 30 d after operation ( P<0.05); The scores of dry eye symptoms in C group were higher than those in A group and B group on 1 d, 7 d and 30 d after operation ( P<0.05), and the scores of dry eye symptoms in B group were higher than those in A group on 1 d and 7 d after operation ( P<0.05); The SIt value of C group was lower than that of A group on 1 d, 7 d and 30 d after operation ( P<0.05), and that of B group was lower than that of A group and group C on 1 d, 7 d and 30 d after operation ( P<0.05); The BUT value of C group was lower than that of A group at 1 d and 7 d after operation ( P<0.05), and the BUT value of B group was lower than that of A group and C group at 1 d, 7 d and 30 d after operation ( P<0.05); The FL value between A group and C group at 1 d, 7 d, 30 d and 90 d after treatment was not significant ( P>0.05). The FL value of B group returned to the level before treatment at 30 d after operation, and the FL value of B group was higher than that of A group and C group at 1 d and 7 d after operation ( P<0.05); There was little difference in the incidence of complications among the three groups ( P>0.05). Conclusions:The cornea scleral marginal incision can reduce the tear secretion, maintain the stability of tear film, and is more suitable for cataract patients with type 2 diabetes mellitus. It is worthy of further promotion in clinic.
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Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.
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Objective:To explore the effect of phacoemulsification through corneoscleral incision on cataract patients with type 2 diabetes mellitus.Methods:A prospective case-control study was conducted to collect cataract patients with type 2 diabetes who were admitted to the First Hospital of Hebei Medical University from January 2018 to June 2019. All patients were treated with phacoemulsification. They were randomly divided into three groups: 40 cases (68 eyes) of corneoscleral incision, 40 cases (66 eyes) of upper transparent corneal incision and 40 cases (70 eyes) of temporal transparent corneal incision. The dry eye symptom scale score, corneal fluorescein staining (FL) score, tear rupture time (BUT) and Schirmer I test (SIt) were compared in three groups; The levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in aqueous humor were compared among the three groups before and 7 days after operation.Results:⑴ The levels of IL-6 and IL-8 in aqueous humor of the three groups were significantly lower than those before operation, especially in group A ( P<0.05), but there was no significant difference in the levels of IL-6 and IL-8 in aqueous humor of group B and C ( P>0.05); ⑵ The scores of dry eye symptoms in group B were significantly higher than those in group A at 1 and 7 days after operation ( P<0.05); The scores of dry eye symptoms in group C were significantly higher than those in group A and B at 1, 7 and 30 days after operation ( P<0.05); The dry eye symptom score in group A and B decreased to the preoperative level 30 days after operation ( P>0.05), and that in group C decreased to the preoperative level 90 days after operation ( P>0.05); ⑶ The postoperative 1, 7 and 30 d BUT in group A and C were significantly higher than those in group B ( P<0.05), and the level of SIt was significantly lower than that in group B ( P<0.05); At 1 and 7 days after operation, SIt in group A was significantly lower than that in group C ( P<0.05); the FLS score in group A and C was significantly lower than that in group B at 1 and 7 days after operation ( P<0.05). Conclusions:The incision of corneoscleral margin has little effect on tear film stability and ocular surface function of cataract patients with type 2 diabetes mellitus treated by phacoemulsification, which is worthy of clinical recommendation.
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Objective To explore the characteristics of neonatal birth weight (BW) in two consecutive term singleton pregnant women and to investigate the influencing factors of macrosomia in the second birth.Methods In this case-control study,medical records of 1 920 singleton full-term pregnant women who gave birth twice in Peking University First Hospital from January 2005 to December 2017 were reviewed.All subjects were divided into two groups according to neonatal BW at the second birth regardless of the first one:macrosomia group (n=122) and non-macrosomia group (n=l 798).Then,those two groups were further divided into four sub-groups based on the neonatal BW in the first birth:macrosomia at both deliveries (n=27),macrosomia at the second time and non-macrosomia at the first time (n=95),non-macrosomia at the second time and macrosomia at the first time (n=90) and non-macrosomia at both deliveries (n=l 708).The differences of delivery interval,and the maternal age,pre-pregnancy body mass index (BMI),weight gain during pregnancy,area under the curve of oral glucose tolerance test results,weight retention,the incidence of diabetes in pregnancy (including gestational diabetes mellitus and diabetes mellitus complicated with pregnancy),incidence of hypertensive disorders during pregnancy and cesarean section rate at the second pregnancy between the groups and sub-groups were compared with t-test,Chi-square test and logistic regression analysis.Results (1) The total average neonatal BW in the second pregnancy was higher than that in the first [(3 443 ± 378) vs (3 403 ± 396) g,t=-4.119,P＜0.001].However,the proportion of macrosomia in each group was similar [6.4％ (122/ 1 920) vs 6.1％ (117/1 920),x2=3.237,P=0.198].The pre-pregnancy BMI,weight gain during pregnancy and proportion of previous macrosomia in the macrosomia group were significantly higher than those in non-macrosomia group [(23.6±3.4) vs (22.7±3.1) kg/m2,t=-2.882,P=0.004;(13.4±5.0) vs (12.4± 4.1) kg,t=-2.522,P=0.037;22.1％ (27/122) vs 5.0％ (90/1 798),x2=58.554,P＜0.001].Logistic regression analysis showed that previous macrosomia (OR=4.979,95％CI:3.052-8.122,P＜0.001),pre-pregnancy BMI (OR=1.084,95％CI:1.023-1.149,P=0.001) and weight gain during pregnancy (OR=1.077,95％CI:1.031-1.125,P=0.007) were influencing factors for macrosomia in the index delivery.(2) The pre-pregnancy BMI in the subgroup of macrosomia at both deliveries was significantly higher comparing to the subgroup of non-macrosomia at the second time and macrosomia at the first time [(25.8±4.3) vs (23.9±2.9) kg/m2,t=-2.600,P=0.011].Women in the subgroup of macrosomia at the second time and non-macrosomia at the first time had higher weight gain during second pregnancy than the subgroup of non-macrosomia at both deliveries [(13.5 ± 4.2) vs (12.5 ±4.1) kg,t=-2.404,P=0.016].Conclusions For two consecutive term singleton pregnancies,the average neonatal BW in the second time is slightly higher than that in the first,but the incidence of macrosomia is similar.Pre-pregnancy BMI,weight gain during pregnancy and macrosomia in the first birth are influencing factors for macrosomia in the second pregnancy.More attention should be paid to pre-pregnancy BMI reduction in women with history of macrosomia.For women without a history of macrosomia,weight management should be emphasized during the second pregnancy.
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BACKGROUND: Studies have found that chondroitin sulfate proteoglycans degradation with chondroitinase canpromote the migration of Müller cells on the retina, but whether it could promote the migration of adipose-derivedmesenchymal stem cells in retinal degeneration rats is unclear.OBJECTIVE: To investigate the effect of chondroitin sulfate proteoglycans degradation with chondroitinase on adipose-derived mesenchymal stem cell treatment for retinal degeneration in rats.METHODS: Human adipose-derived mesenchymal stem cells were isolated and cultured. A retinal degeneration ratmodel was established followed by administration of adipose-derived mesenchymal stem cells+chondroitinase into thesubretinal space. The migration of adipose-derived mesenchymal stem cells and retinal cell apoptosis in rats aftertransplantation were observed.RESULTS AND CONCLUSION: The human adipose-derived mesenchymal stem cells could be successfully cultured.The labeling rate of BrdU to the human adipose-derived mesenchymal stem cells was more than 90.0%. At 7 days aftermodeling, the outer nuclear layer of the retina was collapsed, and a large amount of photoreceptor cells were dissected.The outer nuclear layer was attached to the Bruch''s membrane, and the retina was arched. The central retina andperipheral retina were damaged. In normal rats, the retinal layers were clear, and the photoreceptor cells arrangedregularly; and the retinal pigment epithelium was complete. The migration rate of adipose-derived mesenchymal stemcells in adipose-derived mesenchymal stem cells+chondroitinase group was higher than that in adipose-derivedmesenchymal stem cells group (P 0.05). These experimental findings show that chondroitin sulfate proteoglycans degradationwith chondroitinase can enhance the migration ability of human adipose-derived mesenchymal stem cells on the retina.
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<p><b>BACKGROUND</b>The cesarean section rate (CSR) has been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related factors of CS delivery.</p><p><b>METHODS</b>An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling method. In total, 15,194 pregnancies were enrolled in the study between June 20, 2013 and November 30, 2013. Independent t-tests and Pearson's Chi-square test were used to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression.</p><p><b>RESULTS</b>The CSR was 41.9% (4471/10,671) in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women <25 years old (odd ratio [OR] = 7.388, 95% confidence interval [CI] = 5.561-9.816, P < 0.001). Prepregnancy obese women had a 2-fold increased risk of CS delivery compared with prepregnancy normal weight women (OR = 2.058, 95% CI = 1.640-2.584, P < 0.001). The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group (OR = 1.422, 95% CI = 1.289-1.568, P < 0.001). Gestational diabetes mellitus (GDM) women and DM women had an increased risk of CS delivery (1.2- and 1.7-fold, respectively) compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas (OR = 0.696, 95% CI = 0.625-0.775, P < 0.001). The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR (36.2%). Neonates weighing <2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g (OR = 2.020, 95% CI = 1.537-2.656, P < 0.001). Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g (OR = 8.313, 95% CI = 4.436-15.579, P < 0.001).</p><p><b>CONCLUSIONS</b>Maternal age, prepregnancy body mass index, gestational weight gain, blood glucose levels, residence, education level, and singleton fetal birth weight are all factors that might significantly affect the CSR.</p>
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Objective To explore the long term effects of gestational diabetes mellitus (GDM)on offsprings of affected women.Methods One hundred and twenty-four singleton pregnant women with GDM,who delivered in Department of Obstetrics and Gynecology,Peking University First Hospital from June 14,2006 to December 31,2007,were enrolled as the study group.Ninety-eight singleton pregnant women with normal glucose metabolism who delivered at the corresponding period were enrolled as the control group.The follow-up study was performed from November 6,2010 to January 31,2011 on their offsprings.Anthropometry indexes,including height,weight,waist circumference,systolic and diastolic blood pressure (DBP),triceps skin fold (TSF) and sub-scapular skin fold (SSF) were measured.According to the development standard of children less than five years old issued by World Health Organization in 2006,there were six detailed evaluation indicators including length/height for age z-score (HAZ),weight for age z-score (WAZ),weight for length/ height z score (WHZ),body mass index (BMI) for age z-score (BAZ),triceps skin folds for agez-score (TSFZ) and sub-scapular skin folds for age z-score (SSFZ).Chi-square,t-test or variance analysis were applied.Results (1) No statistical difference on age,birth weight,sex,height,weight,BMI,waist circumference,blood pressure,TSF and SSF was found between offsprings of study and control group (P＞0.05).(2) Offsprings in both groups were further divided into macrosomia and non-microsomia subgroups,i.e.GDM macrosomic subgroup (n =15),GDM nonmacrosomic subgroup (n=109),control macrosomia subgroup (n=6) and control non-macrosomia subgroup (n=92).Significant difference was shown amont the four subgroups in weight [(19.8±3.9),(17.0±1.9),(17.7±1.7)and (17.2±1.7) kg,F=6.238,P＜0.001],BMI (17.6±2.6,16.0±1.2,16.6±1.1 and 16.2±1.1,F=5.901,P＜0.001),waist circumference [(53.6±5.3),(49.9±2.7),(50.9±3.3) and (50.4±0.9) cm,F=5.307,P＜0.001],WHZ (1.40±1.44,0.45±0.81,0.88±0.75 and 0,60±0.87,F=5.269,P=0.002),HAZ (1.22±0.78,0.47±0.82,0.98±0.74 and 0.50±1.00,F=3.668,P=0.013),WAZ (1.68±1.23,0.58±0.79,1.15±0.85and 0.71±0.93,F=7.361,P＜0.001) and BAZ (1.41±1.52,0.42±0.84,0.81±0.76 and 0.60±0.90,F=5.210,P =0.002).While comparing between each two subgroups,there was statistical difference between GDM macrosomia subgroup and GDM non macrosomia subgroup,and between GDM marosomia subgroup and control non-macrosomia group.(3) While comparing GDM macrosomia and GDM non-macrosomia subgroup with control group [weight (17.2±2.5) kg,BMI (16.2± 1.4),waist circumference (50.5 ± 3.6) cm,DBP (55.2 ± 6.9)mm Hg,SSF(6.1 ± 1.8) mm,WHZ (0.62±0.87),HAZ (0.53±0.99),WAZ (0.73±0.92),BAZ(0.61±0.89)],the weight (F=9.283,P＜0.001),BMI (F=8.707,P＜0.001),waist circumference (F=7.934,P＜0.001),DBP(F=3.123,P=0.046),SSF (F=3.499,P=0.032),WHZ (F=7.639,P＜0.001),HAZ(F=4.709,P=0.010),WAZ (F=10.302,P＜0.001) and BAZ (F=7.689,P＜0.001) was higher in GDM group than the control group.(4) The proportions of overweight and obesity were higher in GDM macrosomia subgroup than in GDM non-macrosomia and control groups [overweight:9/15 vs24.8％ (27/109) and 24.5％ (24/98),x2 =8.870,P=0.012; obesity:5/15 vs 7.3％(8/109) and 9.2％(9/98),x2=10.083,P=0.006].If all subjects were divided into macrosomia and non-macrosomia group,then the proportion of overweight and obesity was higher in the former group [overweight:52.4％ (11/21) vs24.4％(49/201),x2=7.560,P=0.006; obesity:28.6％ (6/21)vs 7.9％(16/201),x2 =9.047,P=0.003].Conclusions GDM may have long term adverse effect on the development of offsprings at three-four-year-old with higher incidence of obesity or high diastolic blood pressure in macrosomic babies of GDM mothers than in non macrosomic babies of GDM mothers or babies of non GDM mothers.