Study On The Relationship Between Gestational Diabetes Mellitus In The Third Trimester And The Intestinal And Oral Flora Of The Mother

Background and ObjectiveGestational diabetes mellitus(GDM)is a common complication of pregnancy,which is one of the main reasons for the increase of the incidence of pregnancy hypertension,excessive amniotic fluid,macrosomia,abortion and preterm delivery[1,2].Its pathogenesis is complex and there are mutual influences,which may involve insulin resistance,inflammatory response,genetic factors,etc.[3,4].In recent years,the number of GDM patients is increasing,but the daily blood glucose monitoring is only limited to invasive blood sampling,and the treatment only includes independent diet control,appropriate exercise and insulin supplement when necessary.Therefore,the prevention,monitoring and treatment of GDM is a very challenging problem.Many studies have pointed out that[5,6]diabetes is closely related to intestinal and oral flora.The research on GDM and flora has gradually become a hot topic,but most of the related researches focus on intestinal flora,and the conclusions of various researches are controversial[7,8].This article will pass 16S RRNA gene amplification technology was used to compare the composition and diversity of intestinal and oral microflora of GDM patients and normal pregnant women in the same period.In addition,through the analysis of correlation network,the relationship between the microflora of GDM patients,maternal and infant blood glucose and inflammatory markers was further explored,in order to explore the correlation between GDM in the late pregnancy and maternal intestinal and oral microflora,and to provide a new direction for the prevention and treatment of GDM.ObjectiveThe purpose of this study is to explore the relationship between GDM in the third trimester and the intestinal and oral flora of the mother,so as to provide non-invasive biomarkers for the systematic management of GDM.MethodAccording to the inclusion and exclusion criteria,we selected 30 pregnant women with GDM in the Third Affiliated Hospital of Zhengzhou University from January to August 2018 and 31 normal pregnant women in the same period.For all the subjects,we recorded the clinical data,sequenced 16S rRNA gene of the collected fecal and oral samples,compared the differences of intestinal and oral microflora between the two groups through the analysis of biological information,and analyzed the correlation between the microflora of GDM patients,maternal and infant blood glucose and inflammatory markers.Results①In the intestinal flora,the dominant genera of GDM patients include Bacteroides,Bifidobacterium,Blautia,Coprococcus and Faecalibacterium.The βdiversity of GDM patients measured by unweight UniFrac was significantly different from that of the control group(p=0.001),Lefse analysis showed that Haemophilus increased significantly in GDM patients(P=0.028).The area under the curve(AUC value)was 0.664 when Haemophilus was used to predict GDM status through the operating characteristic curve(ROC curve).②In the oral flora,the advantages of GDM patients are as follows:Leptotrichia,Neisseria,Porphyromonas,Prevotella,Streptococcus and Veillonella.The a diversity of ACE and Chao index decreased significantly in GDM patients(p=0.002,p=0.015).Lefse analysis showed that there was a significant decrease in Leptotrichia level in GDM patients(P=0.010).ROC curve showed AUC=0.698 when using oral Leptotrichia to predict GDM status.③ Under GDM condition,the co-occurrence and co-exclusion of bacterial population changed obviously.The number of neutrophils in pregnant women was negatively correlated with Bifidobacterium and Ruminococcus(p=0.001,q=0.050;p=0.002,q=0.058),The WBC count of pregnant women was also negatively correlated with Bifidobacterium and Ruminococcus(p=0.002,q=0.058;p=0.005,q=0.097)There was a positive correlation between neonatal body weight and intestinal Gemmiger(p=0.003,q=0.072).ConclusionsGDM in late pregnancy is closely related to intestinal and oral flora of the mother.Intestinal Gammaproteobacteria class and its Haemophilus genus and oral Leptotrichia may be potential noninvasive indicators for monitoring GDM system management.