The Impact Of Gestational Diabetes Mellitus On Neonatal Lipid Metabolism And Growth

Objective: To investigate the impact of gestational diabetes mellitus on neonatal lipid metabolism and growth.Methods and materials: Pregnant women from the department of Gynaecology and Obstetrics in First People’s Hospital, Shanghai Jiao Tong University were enrolled in the study and divided into two groups: 50 pregnant women with normal glucose tolerant（NGT group） and 55 pregnant women with gestational diabetes mellitus（GDM group）. The level of maternal peripheral blood serum triglyceride（TG）, cholesterol（TC）, high-density lipoprotein cholesterol（HDL-C）, low density lipoprotein cholesterol（LDL-C）, Apo A Ⅱ, Apo B₁₀₀, Apo C Ⅲ, glycated albumin, glycated hemoglobin were obtained antepartum. At birth, fetal umbilical venous blood was obtained to detect the level of blood glucose and serum TG, TC, HDL-C, LDL-C, Apo A Ⅱ, Apo B₁₀₀, Apo C Ⅲ. Birth length, birth weight, head circumference, chest circumference, abdomen circumference, upper arm circumference, shoulder width, total skinfolds were measured within 24 h of birth.Results:（1） Compared with NGT group, women of GDM group had higher pre-gestational BMI（P<0.01）, lower gestational weight gain（P<0.01）,decreased antepartum serum level of TC, HDL-C, LDL-C, Apo A Ⅱ, Apo B₁₀₀ and Apo C Ⅲ（P<0.01）,increased serum level of glycated albumin, glycated hemoglobin（P<0.01）, but no significance was found in age and TG（P>0.05）.（2） Compared with infants of NGT group, infants of GDM group had increased Apo B₁₀₀（P<0.05）, decreased Apo A Ⅱ, Apo C Ⅲ（P<0.01）,but no significance was found in umbilical venous blood glucose and umbilical venous serum level of TG, TC, HDL-C and LDL-C（P>0.05）.（3） Compared with NGT group, infants of GDM group had increased risk of macrosomia（P<0.05） and larger chest circumference, abdomen circumference, shoulder width and total skinfolds（P<0.01）. But no significance was found in birth weight, birth length and upper arm circumference（P>0.05）.（4） Multiple linear regression analysis showed that GDM was inversely associated with Apo A Ⅱ（regression coefficients（β）:-94.47, P<0.0001） and Apo C Ⅲ（β:-22.86, P<0.0001） of neonatal umbilical venous blood. GDM was positively associated with Apo B₁₀₀ of neonatal umbilical venous blood（β:0.03, P=0.019）.（5） Logistic regression analysis showed GDM increased the risk of macrosomia（OR=6.75, P<0.0001）. Multiple linear regression analysis showed that GDM was positively associated with neonatal birth weight（β:0.25, P=0.0198）, chest circumference（β:2.81, P<0.0001）, abdomen circumference（β:2.09, P<0.0001）, shoulder width（β:0.58, P=0.0121） and total skinfolds（β:5.64, P<0.0001）.（6） Multiple linear regression analysis showed that Apo A Ⅱ was inversely associated with neonatal abdomen circumference（β:-0.01, P<0.0001） and total skinfolds（β :-0.035, P<0.0001）. Apo C III was inversely associated with neonatal chest circumference（β :-0.08, P<0.0001）.Conclusion: Compared with NGT group, neonates of GDM group had increased Apo B₁₀₀, decreased Apo A Ⅱ and Apo C Ⅲ in umbilical venous blood. Meanwhile, neonates of GDM had higher neonatal fat mass, increased birth weight, chest circumference, abdomen circumference, shoulder width and risk of macrosomia. Lower Apo A Ⅱ was associated with increased abdomen circumference and higher fat mass, while lower Apo C III level was associated with increased chest circumference. It needs prospective cohort study and further research to elucidate the mechanism of GDM on neonatal growth by regulating lipid metabolism.