Mild gestational diabetes in pregnancy and the adipoinsular axis in babies born to mothers in the ACHOIS randomised controlled trial.
Mild gestational diabetes in pregnancy and the adipoinsular axis in babies born to mothers in the ACHOIS randomised controlled trial.
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DOI：
10.1186/1471-2431-7-18
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发表时间：
2007-04-12
期刊：
影响因子：
2.4
通讯作者：
Robinson, Jeffrey S
中科院分区：
文献类型：
--
作者：
Pirc, Louise K;Owens, Julie A;Robinson, Jeffrey S
背景：轻度妊娠期糖尿病是妊娠的常见并发症，影响高达9%的孕妇。众所周知，轻度妊娠期糖尿病的治疗可以减少围产期的不良结局，如巨大儿和相关的出生损伤，如肩难产、骨折和神经性瘫痪。本研究旨在比较非妊娠期糖尿病(GDM)孕妇、常规护理的轻度GDM孕妇和接受治疗的轻度GDM孕妇的脐血血糖浓度和血清胰岛素、瘦素和脂联素水平。方法：95例轻度GDM孕妇在一家三级妇产科医院接受口服葡萄糖耐量试验(OGTT)，随机分为治疗组(n=46)、常规护理组(n=49)和OGTT正常的对照组(n=133)。轻度妊娠期糖尿病患者(治疗组或常规护理组)和OGTT正常妇女接受常规妊娠护理。此外，治疗轻度妊娠期糖尿病的妇女还接受饮食建议、血糖监测和必要时的胰岛素治疗。主要观察指标为脐带血中葡萄糖、胰岛素、脂联素和瘦素的浓度。结果：接受常规护理的孕妇脐血血糖高于对照组，但经轻度妊娠期糖尿病治疗后恢复正常(p=0.01)。脐血胰岛素和胰岛素/血糖比值在三组间无明显差异。妊娠期糖尿病治疗组脐血瘦素浓度低于常规护理组(p=0.02)，与对照组无差异(p=0.11)。两组轻度GDM患者的脂联素水平均低于对照组(P=0.02和P=0.07)，而常规护理组的脂联素/瘦素比值低于治疗组(P=0.08)和对照组(P=0.05)。结论：对轻度GDM患者进行饮食、血糖监测及必要时加用胰岛素治疗，可影响妊娠期轻度GDM患者胎儿脂肪轴的改变。
BACKGROUND: Mild gestational diabetes is a common complication of pregnancy, affecting up to 9% of pregnant women. Treatment of mild GDM is known to reduce adverse perinatal outcomes such as macrosomia and associated birth injuries, such as shoulder dystocia, bone fractures and nerve palsies. This study aimed to compare the plasma glucose concentrations and serum insulin, leptin and adiponectin in cord blood of babies of women (a) without gestational diabetes mellitus (GDM), (b) with mild GDM under routine care, or (c) mild GDM with treatment.METHODS: 95 women with mild GDM on oral glucose tolerance testing (OGTT) at one tertiary level maternity hospital who had been recruited to the ACHOIS trial at one of the collaborating hospitals and randomised to either Treatment (n = 46) or Routine Care (n = 49) and Control women with a normal OGTT (n = 133) were included in the study. Women with mild GDM (treatment or routine care group) and OGTT normal women received routine pregnancy care. In addition, women with treated mild GDM received dietary advice, blood glucose monitoring and insulin if necessary. The primary outcome measures were cord blood concentrations of glucose, insulin, adiponectin and leptin.RESULTS: Cord plasma glucose was higher in women receiving routine care compared with control, but was normalized by treatment for mild GDM (p = 0.01). Cord serum insulin and insulin to glucose ratio were similar between the three groups. Leptin concentration in cord serum was lower in GDM treated women compared with routine care (p = 0.02) and not different to control (p = 0.11). Adiponectin was lower in both mild GDM groups compared with control (Treatment p = 0.02 and Routine Care p = 0.07), while the adiponectin to leptin ratio was lower for women receiving routine care compared with treatment (p = 0.08) and control (p = 0.05).CONCLUSION: Treatment of women with mild GDM using diet, blood glucose monitoring and insulin if necessary, influences the altered fetal adipoinsular axis characteristic of mild GDM in pregnancy.