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The pathogenesis of gestational diabetes mellitus (GDM) remains unclear. Recent studies have found that a dysbiosis of gut flora could lead to metabolism and immune system disorders in human beings, resulting in GDM. The gut microbiome changes can be affected by various factors, of which diet and antibiotic exposure are the most dominant. From the perspective of the gut microbiome changes, individualized dietary guidance, evidence-based administration of antibiotics, appropriate intake of prebiotics, and probiotics supplement may help prevent and treat GDM.
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Autophagy is the process by which cells remove unnecessary or damaged cells or parts of cells, to allow for their orderly renewal. It occurs commonly in body cells, and is considered as a protection for cells and maintaining normal function and tissue structure in cells, such as human placental tissues. However, excessive autophagy can lead to cell death and pathological damage in tissue. An excessive autophagy response to hyperglycemia in women with gestational diabetes mellitus inhibits angiogenesis in the placenta, resulting in tissue ischemia and hypoxia, increased level of reactive oxygen species, and risk of adverse pregnancy outcomes.
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Objective To evaluate the effect of strengthening nutrition intervention in gravidas with gestational diabetes mellitus (GDM) with WeChat on blood glucose control and pregnant outcomes.Methods A total of 410 gravidas,diagnosed with GDM and treated in the Department of Clinical Nutrition of Shanghai General Hospital from October 2015 to April 2016,were enrolled and randomly divided into two groups (n=205).The control group received traditional nutrition clinic education only,while the intervention group was given strengthened nutrition education through WeChat in addition to traditional education.Blood glucose level and insulin dosage were followed up after one,two and four weeks of intervention.Pregnant outcomes and patient satisfaction were investigated on 42 d after delivery.T test,Chi-square test and non-parametric test were used for statistical analysis.Results (1) Two weeks after the intervention,the average 1-hour postprandial blood glucose in the intervention group was lower than in the control group [(7.46± 1.01) vs (7.68± 1.06) mmol/L,t=2.243,P=0.025].After 4 weeks,both 1-and 2-hour postprandial blood glucose levels of the intervention group were lower than those of the control group [(7.03±0.65) vs (7.33±0.63) mmol/L,t=4.629,P＜0.05;(6.00±0.65) vs (6.21 ±0.62) mmol/L,t=3.153,P＜0.05] and more gravidas achieved euglycemia [79.9％ (151/189) vs 60.8％ (113/186),x2=16.483,P＜0.001].(2) Compared with the control group,the intervention group had a higher vaginal delivery rate [38.7％ (72/186) vs 50.5％ (95/188),x2=5.288,P=0.021] and a lower rate of postpartum complications [9.1％ (17/186) vs 2.1％ (4/188),x2=7.394,P=0.007].All of the gravidas in the intervention group were satisfied with the WeChat intervention except one lost to follow up [99.5％ (203/204)].Conclusions Strengthening nutrition education through WeChat is much more effective than traditional nutritional outpatient education alone in order to achieve a better control of blood glucose and improve pregnant outcomes in GDM women.This intervention is highly acceptable to gravidas and can be further extensively applied in nutrition clinic.
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Objective To explore the glucose and liplid metabolism changes of pregnant rats and the birth weight of their offsprings due to pregnancy malnutrition,including overnutrition and undernutrition.Methods Thirty pregnant Wistar rats were randomly divided into three groups on the day of conception,the high-fat-diet group,normal control group and 50％ food-restricted diet group.Increase of body weight and serum level of triglycerides,high-density lipoprotein,low-density lipoprotein,oral glucose tolerance test (OGTT) and insulin release test(IRT) levels during pregnancy were measured.The birth weight of offsprings was recorded within 12 h after birth.One-way ANOVA,LSD or Dunnett T3,and Chi-square test were applied for statistical analysis.Results The body weight at late pregnancy and the level of triglycerides and low-density lipoprotein were significantly increased in the high-fat-diet rats compared to normal control ones [(1.68±0.13) mmol/L vs (0.78±0.08) mmol/L,(0.57±0.04) mmol/L vs (0.35±0.07) mmol/L; both P＜0.01].While the level of high-density lipoprotein of high-fat-diet rats was lower than that of the normal control rats [(0.56±0.06) mmol/L vs (1.09±0.08) mmol/L,P＜0.05].The level of triglycerides,low density lipoprotein and high density lipoprotein in 50％ food restricted group [(0.47±0.06) mmol/L,(0.21±0.06) mmol/L and (0.42±0.05) mmol/L] were lower than the control group (all P＜0.05).Impaired glucose tolerance,abnormal OGTT and IRT results were found in both high-fat-diet and 50％ foodrestricted diet rats.The fasting plasma glucose level in high-fat-diet group was significantly increased in late pregnancy compared to the control [(6.63±0.53) mmol/L vs (4.90±0.26) mmol/L,P＜0.05],while there was no significant difference between rats in 50％ food-restricted diet [(4.18±0.26) mmol/L]and control group (P＞0.05).There was no statistical difference in fasting serum insulin level among the three groups.The average birth weight was significantly increased in high-fat-diet rats than in the control group [(6.14±0.31) g vs (5.73±0.26) g,P＜0.05],and the incidence of macrosomic newborn rats in the high-fat-diet group was also higher than that of the control group [19.2 ％ (19/99)vs 7.84％(8/102),P＜0.05].The birth weight of offspring in 50％ food-restricted diet group was decreased with their average birth weight of (4.54±0.23) g,which was lower than that of the control group (P＜0.05).The incidence of macrosomic [13.40％ (11/76)] and low birth weight newborn rats [15.90％ (13/76) vs 3.92％(4/102)] in food-restricted diet group were both higher than in the control group (P＜0.05); and smaller number of offsprings was obtained than the control group (76 vs 102,P＜0.05),the number of offsprings in high-fat-diet group was 99,which was less than the control group without statistical difference (P＞0.05).Conclusions Pregnancy malnutrition,including overnutrition and undernutrition,may affect the lipid metabolism and glucose tolerance of pregnant rats,leading to insulin resistance,and may also contribute to the abnormal birth weight of the offspring,including macrosomia and low birth weight.
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ObjectiveTo investigate the influence of positive serum thyroid peroxidase antibody (TPOAb) on pregnancy outcomes in biochemically euthyroid women during gestation.MethodsFrom July 2006 to December 2010,in the prenatal care unit all pregnant women,who had no medical and family history of thyroid diseases,underwent thyroid function screening.Serum TPOAb was tested among those pregnant women with euthyroidism.Pregnancy outcomes,including obstetric complications,neonate birth weight,and Apgar score,were compared between 185 TPOAb positive women and 1417 TPOAb negative women.ResultsCompared with TPOAb negative women,it was more frequent for TPOAb positive women to suffer from various obstetric complications.The prevalences of umbilical cord entanglement ( 18.9％ vs 12.9％,RR =1.47,95％ CI 1.06-2.03,P＜0.05 ),threatened premature delivery or abortion (3.8％ vs 1.0％,RR =3.83,95％ CI 1.57-9.37,P＜0.05 ),intrauterine growth retardation (5.4％ vs 0.8％,RR =6.96,95％ CI 3.00-16.17,P＜0.01 ),and neonatal pneumonia ( 4.9％ vs 1.3％,RR =3.83,95％ CI 1.75-8.40,P＜0.01 ) in the group of TPOAb positive women were higher than those in the group of TPOAb negative women.Apgar score of those newborns whose mothers had positive TPOAb was 9.27 ±1.13 at one minute and 9.44 ± 1.09 at five minutes,being lower than that of the TPOAb negative group (9.49 ±0.69 and 9.68 ±0.52,both P＜0.01 ).The rate of newborns with Apgar score at 7 or less by 5 min in group with positive TPOAb was higher than that of group with negative TPOAb ( 1.6％ vs 0.1％,RR =11.49,95 ％ CI 1.93-68.31,P＜ 0.05 ).ConclusionsThese results indicate that pregnant women with normal thyroid function but positive TPOAb may be liable to increase risk of serious pregnancy outcomes,such as threatened premature delivery or abortion,intrauterine growth retardation,and a lower Apgar score in neonatal.
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Objective To investigate the expression of type Ⅱ and type Ⅲ iodothyronine deiodinases (D2 and D3 ) of human placenta on pregnant women with different thyroid diseases and different autoimmunity.Methods Pregnant women with different thyroid diseases and autoimmunity were selected into the experiment group,and pregnant women who had no individual or family history of thyroid diseases with normal thyroid function and negative thyroid peroxidase antibody (TPOAb) were selected into the control group.Expression level of iodothyronine deiodinase( D2 and D3 )on placenta was measured by RT-PCR.Results D2 and D3 were both expressed on human placenta.D2 showed significantly higher expression level in hypothyroidism uncontrolled group than that in control group ( 0.916 ± 0.035 vs 0.833 ± 0.029,P ＜ 0.05 ),however,D3 showed a lower expression(0.766 ±0.038 vs 0.848 ±0.052),on placenta and the difference was not significant(P ＞ 0.05 ).In those who had history of hyperthyroidism or hypothyroidism but whose thyroid function become normal by effective treatment,D2 and D3 expression exhibited no difference from that of the control(P ＞ 0.05).In those pregnant women with normal thyroid function and TPOAb-positive,D2 and D3 expression was (0.842 ± 0.032 ) and ( 0.837 ± 0.053 ) respectively and there was also no difference from that of the control( P ＞ 0.05 ).Conclusion D2 and D3 were simultaneously expressed on human placenta.In those pregnant women with hypothyroidism,the level of D2 expression is high and the level of D3 expression is low.Those changes might be important and helpful for the stabilization of thyroid hormone transportation between mother and fetus.
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Objective To investigate the relationship between maternal serum lipid levels and newborn weight in pregnant women with single positive diabetic screening test. Methods On the basis of 75 g oral glucose tolerance test (OGTT), 406 pregnant women during 24-28 gestational week whose 50 glucose challenge test (GCT)≥7.8 mmol/L were separated to gestational diabetes mellitus (GDM) group with 115cases, gestational impaired glucose tolerant (GIGT) group with 60 cases,and GCT (+) group with 231 cases.The serum levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol(LDL-C), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) were measured at the same time. Results Serum TG concentration was significantly higher in GDM group than that in GIGT group and GCT(+) group(P＜0.01).The level of HDL-C, ApoB in GDM group were lower than those in GIGT group and GCT(+) group (P＜0.01). In the 231 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of macrosomia was significantly higher in those with TG levels higher than 3.5 mmol/L (25.0%, 11/44) than in mothers who TG levels were lower than 3.5mmol/L (11.2%, 21/187) (P=0.017). Multiple regression analysis (stepwise) showed that the independent risk factors of macrosomia was the level of TG and ApoB (F=7.677,P=0.006;F = 7.842,P = 0.001 ).Conclusion Among pregnant women with single positive diabetic screening test,maternal serum TG and ApoB are independently associated with neonatal birth weight.
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Objective To investigate the prevalence of thyroid disorders and positive thyroid autoantibodies,and evaluate the necessity for universal thyroid screening during the second and third trimesters of pregnancy.Methods The pregnant women during the second and third trimesters who visited Shanghai Jiaotong University Affiliated First People's Hospital between June 2006 and February 2008 were chosen for thyroid screening by determining serum free triiodothyronine,free thyroxine,thyrotropin,thyroid peroxidase antibody (TPOAb),and thyrotropin receptor antibody.A personal and family history of thyroid disease and other autoimmune diseases was investigated by questionnaire.The pregnant women were divided into high risk or low risk groups for thyroid disease based on their personal or family histories.Results A total of 2 101 pregnant women were screened,712 ( 33.89％ ) of them were identified to suffer from thyroid disorders or with positive thyroid autoantibody.The prevalence of thyroid dysfunction was increased in high risk group.While in low risk group( n =1 983 ),the prevalence of clinical hypothyroidism was 2.27％ ( n =45 ),subclinical hypothyroidism 11.60％ ( n =230 ),clinical hyperthyroidism 0.20％ ( n =4 ),subclinical hyperthyroidism 1.06％ ( n =21 ),hypothyroxinemia 6.45％ ( n =128 ),and euthyroid with positive TPOAb 10.74％ ( n =213 ) in our study.Pregnant women with positive TPOAb were susceptible to thyroid dysfunction.It was shown that 79.74％ of pregnant women with thyroid disorders were diagnosed by universal thyroid screening.Conclusions 33.89％ of pregnant women in the second and third trimesters were identified to suffer from thyroid disorders or positive thyroid autoantibody by universal thyroid screening.Increased prevalence of thyroid dysfunction was found in pregnant women with positive TPOAb.79.74％ of pregnant women with thyroid disorders might be missed if screening was made only in the high risk cases.
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Objective To investigate the relationship between different expression of gastrocolic omentum visfatin (VF) mRNA and gestational diabetes mellitus (GDM) in late trimester pregnancy. Methods One hundred cases of pregnant women in late trimester were divided into two groups, including 45 GDM women( GDM group) and 55 normal glucose tolerance women( NGT group). Semi-quantitative RT-PCR was applied to determine the expression of VF mRNA in gastrocolie omentum. Fast-blood glucose, insulin,cholesterol(TC) and triglyceride (TG) levels were measured. The progestational body mass index(BMI) and the homeostasis model assessment(HOMA) insulin resistance(IR) were calculated in these cases. Results The expression of gastrocolic omentum VF mRNA in GDM group and NGT group were 0.8 ±0.4,0.5±0.3. Fast-blood glucose levels were(4.12±0.14),(3.65±0.13) mmol/L. Insulin levels were (72±5) ,(61±5) pmo]/L TG levels were (5.6±0.3), (3.8±0.3) mmol/L TC levels were(5.6±0.9 ), (3.9±0.3) mmol/L HOMA-IR were 12.5±5.9,9.5±0.8. The progestatianal BMIs were(22.6±0.8), (20.9±0.4) kg/m2. All the indices in the GDM group were significantly higher than NGT group (P<0.05). Furthermore, the expression of gastrocolic omentum VF mRNA had a positive correlation with BMI (r=0.32, P<0.01), but had no association with insulin resistance or metabolic parameters. Conclusion The experiment demonstrates that different expression of VF mRNA has a strong correlation with GDM and obesity.
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Objective To investigate the variations of serum levels of visfatin in pregnant women with different types of glucose intolerance and the associations with insulin resistance.metabolic parameters and newborn birth weight.Methods Totally,120 pregnant women in late trimester were divided into 3 groups according to the results of 50 g glucose challenge test(GCT)and 75 g oral glucose tolerance test:GDM group(n=45),GCT(+)group(n=20),and NGT group(n=55).Fasting levels of visfatin,insulin,total cholestrol and triglyceride were measured and the newborn birth weight was recorded.Results The serum visfatin level was significantly elevated in GDM group compared with the NGT group[(374.9±23.1)ng/ml vs(308.9±16.8)ng/ml,P＜0.05],but no significant difference was shown when compared with the GET(+)group[(346.5±23.1)ng/ml].Furthermore,serum visfatin levels had no relationship with insulin resistance,metabolic parameter and newbom birth weight.Conclusions Visfatin is elevated in GDM women and closely related with GDM,but not with insulin resistance,metabolic parameters and newborn birth weight.
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Objective To investigate the diagnosis and treatment of HELLP syndrome through analyzing the clinical data of seven patients of HELLP syndrome.Methods We reviewed the study.There were three patients in the absolute HELLP group,four patients in the partial HELLP group.The laboratory data,clinical symptom,delivery method and the outcome of the pregnant women and infants of the two groups were analyzed.Results All the seven patients had clinical presentations of PIH.Total bilirubin(TB) value in absolute HELLP group was significantly higher than that in partial HELLP group(P
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Objective To investigate the relationship between impaired glucose test and insulin resistance in pregnancy. Methods Ninety-three pregnant women who had one abnormal result among 4 of oral glucose tolerance test (OGTT) and 179 pregnant women who had normal results of OGTT from 11 hospitals of Shanghai during May 1999 to Aug 1999 were included. Insulin release test were performed at the same time. Insulin sensitive index (ISI), islet secretive function index (IFI) were calculated. Area under sugar curve (SAUC)?area under insulin curve (IAUC)?ISI? IFI?fast plasma sugar(PGO) and fast plasma insulin (INO) were compared between two groups. Results PGO, INO, SAUC, IAUC and ISI of the IGT group and control group were(5.1?1.0)mmol/L vs(4.3?0.4)mmol/L?(142?77) pmol/L vs (114?40)pmol/L?(1186?437) pmol/L vs (1058?407)pmol/L?(23?4) mmol/L vs (18?3)mmol/L and 30?20 vs 22?24 respectively, the differences were significant(P0.05). Conclusions Insulin resistance is one of the causes of impaired glucose test in pregnancy.
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Objective To investigate whether insulin resistance is a cause of pregnancy induced hypertension (PIH). Methods All patients who had abnormal 50g glucose screening test accepted 75g oral glucose tolerance test (OGTT) and insulin sensitive index (ISI) was calculated. These patients were followed up and divided into two groups (PIH group and normal pregnancy group) at third trimester of pregnancy. The difference of ISI between the PIH group and normal pregnancy group was compared. Results Fast blood glucose, fast blood insulin and ISI were (4.2?0.7)mmol/L vs. (3.8?0.7)mmol/L, (107.8?48.8)pmol/L vs. (50.4?40.5)pmol/L, and -3.25?0.27 vs. -2.58?0.66 in PIH group and normal group, respectively ( P 0.05). Conclusions Insulin resistance during second trimester of pregnancy may be one of the causes of pregnancy induced hypertension.
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36 gestational weeks. Venous blood was taken to measure the level of glycosylated hemoglobin. Results The mean value of glycosylated hemoglobin in normal pregnant women was 4.1%(95%CI=2.5～5.7%). No difference was shown among different gestational weeks. Conclusions The normal value of glycosylaed hemoglobin in pregnancy is 2.5%~5.7%.
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(0.05,) respectively). Conclusions OGTT ignoring the third-hour plasma specimen is easy to be administered, has a low rate of undiagnosis and can be used in the diagnosis of GDM.