Risk Factors Screening for Gestational Diabetes Mellitus Heterogeneity in Chinese Pregnant Women: A Case-Control Study.
Risk Factors Screening for Gestational Diabetes Mellitus Heterogeneity in Chinese Pregnant Women: A Case-Control Study.
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中国孕妇妊娠期糖尿病异质性危险因素筛查：病例对照研究
DOI：
10.2147/dmso.s295071
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Cui W
中科院分区：
文献类型：
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作者：
Wang N;Peng Y;Wang L;Song L;Sun B;Wei J;Wang T;Mi Y;Cui W
探讨妊娠期糖尿病（GDM）异质性的危险因素，并评价其与肥胖的相关性。我们对452名妊娠期糖尿病妇女和516名糖耐量正常（NGT）妇女在妊娠早期和中期进行了病例对照研究。根据同时进行的胰岛素释放试验，我们将GDM妇女分为GDM抵抗亚型、GDM功能障碍亚型和GDM混合亚型，其中GDM妇女的主要胰岛素敏感性缺陷、胰岛素分泌缺陷或两种缺陷均存在。发现母亲年龄大、糖尿病家族史、孕早期空腹血糖水平升高（≥ 5.1mmol/L）是GDM各亚型的危险因素。孕前超重/肥胖和孕早期妊娠期体重增加（GWG）是GDM抵抗亚型的危险因素。初经年龄小、丙氨酸氨基转移酶（ALT）、总胆汁酸（TBA）、甘油三酯（TG）水平升高、高密度脂蛋白胆固醇（HDL-C）水平降低是GDM抵抗亚型的危险因素。经孕前体重指数（pre-BMI）和孕早期体重增加（GWG）校正后，上述危险因素与GDM抵抗亚型的相关性减弱。非酒精性脂肪性肝病（NAFLD）和TG水平的改善分别是GDM耐药亚型和GDM混合亚型的独立危险因素。GDM妇女表现出基于血糖生理学的异质性，其危险因素并不完全相同。一些肥胖相关的危险因素是特定于GDM抵抗亚型的，其由孕前超重/肥胖和妊娠早期GWG升高介导。
To study the risk factors of gestational diabetes mellitus (GDM) heterogeneity, and to evaluate the correlation between the risk factors and obesity. We performed a case–control study of 452 women with GDM and 516 women with normal glucose tolerance (NGT) at the first and second trimester. We defined GDM women as GDM-resistance subtype, GDM-dysfunction subtype, and GDM-mixed subtype, according to their simultaneous insulin-release test with predominant insulin-sensitivity defect, insulin-secretion defect, or both defects. We found that higher maternal age, family history of diabetes, the elevated level of fasting blood glucose in the first trimester (≥5.1 mmol/L) were risk factors of all GDM subtypes. Pre-pregnancy overweight/obesity and the increased gestational weight gain (GWG) in the first-trimester are risk factors of the GDM-resistance subtype. Indicators including younger age at first menstruation, the elevated levels of alanine aminotransferase (ALT), total bile acid (TBA), triglyceride (TG), and the decreased level of high-density lipoprotein cholesterol (HDL-C) are risk factors of the GDM-resistance subtype. However, the associations between those risk factors and GDM-resistance subtype attenuated after adjusted by pre-pregnancy body mass index (pre-BMI) and gestational weight gain (GWG) in the first trimester. Nonalcoholic fatty liver disease (NAFLD) and the improved level of TG are independent risk factors for the GDM-resistance subtype and the GDM-mixed subtype, respectively. Women with GDM exhibited heterogeneity based on glycemic physiology and their risk factors are not all the same. Some obesity-related risk factors are specific to the GDM-resistance subtype, which are mediated by pre-pregnancy overweight/obesity and the elevated GWG the first-trimester.