Study On Glucose Metabolism And Related Risk Factors In Early Postpartum Period Of Gestational Diabetes Patients

Objective:This study aimed to analyze the glucose metabolism status of gestational diabetes patients(GDM)at 6-12 weeks postpartum,to explore the relationship between pre-pregnancy,pregnancy and postpartum indicators and the outcome of 6-12 weeks postpartum glucose metabolism,to analyze the changes in insulin levels of the gestational diabetes patients during pregnancy and postpartum,and to assess islet β-cell function and insulin resistance(IR)recovery at 6-12 weeks postpartum.Methods:This study was a single-center prospective cohort study.This study included patients who were diagnosed as GDM in the endocrinology and metabolic diseases / gynecology and obstetrics outpatient department of Suining Central Hospital from June 2018 to December 2018.This study included pre-pregnancy indicators(age,family history,pre-pregnancy BMI,pregnancy history),pregnancy indicators(24-28 weeks of pregnancy 75 g glucose tolerance test(OGTT)blood glucose values and insulin levels,blood lipids,blood uric acid,total gall bilirubin,insulin usage,weight gain during pregnancy),pregnancy outcomes(newborn weight,neonatal asphyxia,and hypoglycemia),and 75 g OGTT and insulin release experiments were performed at 6-12 weeks postpartum.According to the postpartum OGTT blood glucose value,objects divided into the normal glucose metabolism group and the abnormal glucose metabolism group.The pre-pregnancy,pregnancy,and postpartum indicators of the two groups were compared and analyzed.The incidence of abnormal glucose metabolism at 6-12 weeks postpartum in GDM women was analyzed,and univariate analysis and multivariate logistic regression analysis on relevant indicators to explore the risk factors that affect the early postpartum glucose metabolism outcome of gestational diabetes was performed.At the same time,the changes of insulin levels during pregnancy and postpartum in patients with gestational diabetes and the recovery of islet β-cell function and insulin resistance(IR)at 6-12 weeks postpartum were analyzed.Results:(1)According to the inclusion criteria and exclusion criteria,132 women diagnosed with GDM during pregnancy were finally included,and 106 GDM women were followed up at 6-12 weeks postpartum,with a loss of follow-up rate of 19.7%.The glucose tolerance returned to normal at 6-12 weeks postpartum in 76.4%(81/106)of objects,the blood glucose level was abnormal in 23.6%(25/106)of objects,of which 4 cases were diagnosed as type 2 diabetes and 18 cases were impaired glucose tolerance(IGT),3 cases were impaired fasting glucose(IFG).The incidence of T2 DM,IGT,and IFG were 3.8%(4/106),17.0%(18/106),and 2.8%(3/106),respectively.(2)The BMI before pregnancy of the abnormal glucose metabolism group was higher than that of the normal glucose metabolism group,and the difference between the two groups was statistically significant(P<0.05);The OGTT 1h,2h blood glucose,area under the blood glucose curve,triglyceride level and insulin use rate in the second trimester in the abnormal glucose metabolism group were significantly higher than those in the normal glucose metabolism group(P < 0.05);There was no significant difference between the two groups in gestational age,family history,pregnancy history,weight gain during pregnancy,OGTT 0h blood glucose and insulin levels,HOMA-IR,HOMA-β,total cholesterol,low-density lipoprotein,uric acid and total bilirubin(P>0.05).(3)Compared with the normal glucose metabolism group,OGTT 0h,1h,2h blood glucose,area under insulin curve,area under blood glucose curve and HOMA-IR in the postpartum 6-12 weeks were significantly higher in the abnormal glucose metabolism group(P<0.05);There was no significant difference in OGTT 0h and 1h insulin levels between the normal glucose metabolism groups and the abnormal glucose metabolism group(P>0.05),but the level of insulin in OGTT 2h in the abnormal glucose metabolism group was significantly higher than that in the normal glucose metabolism group(P<0.05),and the level of HOMA-β in the abnormal group was significantly lower than that in the normal metabolism group(P<0.05).(4)The logistic regression analysis showed that BMI before pregnancy,OGTT 2h blood glucose level in the second trimester were independent risk factors for abnormal glucose metabolism at 6-12 weeks postpartum(OR = 2.475,95% CI [1.242-4.931];OR = 5.786,95% CI [1.454-23.023]);OGTT 2h insulin level during the second trimester is a protective factor for abnormal glucose metabolism at 6-12 weeks postpartum of GDM(OR = 0.840,95% CI [0.746-0.946]).(5)The average birth weight and the incidence of macrosomia in the abnormal glucose metabolism group were significantly higher than those in the normal glucose metabolism group(P<0.05).(6)The postpartum homeostasis model insulin resistance index(HOMA-IR)of the two groups was lower than that during pregnancy.The degree of decrease of postpartum HOMA-IR of the normal glucose metabolism group was greater than that in the abnormal glucose metabolism group(P<0.05).The postpartum HOMA-β level of the abnormal glucose metabolism group was significantly lower than that of the normal glucose metabolism group(P <0.05).The postnatal HOMA-β levels of the two groups of patients were decreased compared with that during pregnancy,and there was no significant difference in the degree of decrease.Conclusion: 1.The incidence of abnormal glucose metabolism is higher in patients with gestational diabetes at 6-12 weeks postpartum.2.Pre-pregnancy BMI,OGTT 2h blood glucose level are independent risk factors for abnormal glucose metabolism at 6-12 weeks postpartum,and OGTT 2h insulin level during the second trimester is a protective factor for abnormal glucose metabolism at 6-12 weeks postpartum of GDM.3.The early postpartum insulin resistance of GDM patients will be relieved,and the remission of normal glucose metabolism group is more obvious than that of abnormal glucose metabolism group;the impaired function of β cell in GDM patients during pregnancy will continue to exist in postpartum,and it is worse in the abnormal glucose metabolism group.4.Attention should be paid to the reassessment of early postpartum blood glucose of GDM,and follow up the blood glucose regularly to prevent and delay the occurrence of T2 DM in the future.