Maternal Pregravid Weight Is the Primary Determinant of Serum Leptin and Its Metabolic Associations in Pregnancy, Irrespective of Gestational Glucose Tolerance Status
Maternal Pregravid Weight Is the Primary Determinant of Serum Leptin and Its Metabolic Associations in Pregnancy, Irrespective of Gestational Glucose Tolerance Status
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DOI：
10.1210/jc.2012-2290
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发表时间：
2012-11-01
影响因子：
5.8
通讯作者：
Retnakaran, R.
中科院分区：
文献类型：
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作者：
Maple-Brown, L.;Ye, C.;Retnakaran, R.
背景：以前的几项研究调查了循环中脂肪因子瘦素水平与妊娠期糖尿病（GDM）的关系。然而，这些研究产生了明显矛盾的结果，包括增加，减少，和不变的瘦素水平在妇女与GDM相比，他们的peer.Objective：我们试图评估血清瘦素的代谢决定因素在一个良好的特征队列，反映了整个频谱的葡萄糖耐受不良在怀孕。设计，设置，和参与者：对817名孕妇进行了代谢特征分析，包括口服葡萄糖耐量试验（OGTT）和血清瘦素、胰岛素、血脂、脂联素和C反应蛋白的测定。结果：正常糖耐量组（33.7 ng/ml）、妊娠期糖耐量减低组（36.3 ng/ml）和GDM组（36.4 ng/ml）的瘦素中位数无显著性差异（P = 0.085）。在单因素相关分析中，瘦素与孕前体重指数（BMI）的相关性最强（r = 0.54，P < 0.0001），空腹胰岛素（r = 0.60，P < 0.0001），C反应蛋白（r = 0.38，P < 0.0001），但仅与OGTT的葡萄糖曲线下面积（AUC（葡萄糖））弱相关（r = 0.10，P = 0.0066）。多元线性回归分析显示，瘦素最强的独立决定因素是孕前BMI（t = 11.55，P < 0.0001），而AUC（葡萄糖）不是一个重要的预测因素（t =-0.95，P = 0.34）。此外，虽然其各自的关联与空腹胰岛素，甘油三酯，脂联素不同的三分位数的孕前BMI，瘦素是没有显着相关的AUC（葡萄糖）在任何BMI三分位数。结论：Pregravid BMI，而不是妊娠期糖耐量，是在怀孕期间血清瘦素浓度的主要决定因素。（临床内分泌代谢杂志97：4148-4155，2012）
Context: Several previous studies have investigated circulating levels of the adipokine leptin in relation to gestational diabetes mellitus (GDM). However, these studies have yielded markedly conflicting results, including increased, decreased, and unchanged leptin levels in women with GDM as compared with their peers.Objective: We sought to evaluate the metabolic determinants of serum leptin in a well-characterized cohort reflecting the full spectrum of glucose intolerance in pregnancy.Design, Setting, and Participants: Metabolic characterization, including oral glucose tolerance test (OGTT) and measurement of serum leptin, insulin, lipids, adiponectin, and C-reactive protein, was performed in 817 pregnant women. The OGTT identified 198 women with GDM, 142 with gestational impaired glucose tolerance, and 477 with normal glucose tolerance.Results: Median leptin (ng/ml) did not differ between the normal glucose tolerance (33.7), gestational impaired glucose tolerance (36.3), and GDM (36.4) groups (P = 0.085). On univariate correlation analysis, leptin was most strongly associated with prepregnancy body mass index (BMI) (r = 0.54, P < 0.0001), fasting insulin (r = 0.60, P < 0.0001), and C-reactive protein (r = 0.38, P < 0.0001) but only weakly associated with area under the glucose curve (AUC(glucose)) on the OGTT (r = 0.10, P = 0.0066). On multiple linear regression analysis, the strongest independent determinant of leptin was prepregnancy BMI (t = 11.55, P < 0.0001), whereas AUC(glucose) was not a significant predictor (t = -0.95, P = 0.34). Furthermore, although its respective associations with fasting insulin, triglycerides, and adiponectin varied across tertiles of prepregnancy BMI, leptin was not significantly associated with AUC(glucose) in any BMI tertile.Conclusions: Pregravid BMI, rather than gestational glucose tolerance, is the primary determinant of serum leptin concentration in pregnancy. (J Clin Endocrinol Metab 97: 4148-4155, 2012)