Serum Apelin Level In Pregnant Women With Gestational Diabetes Mellitus And Related Influencing Factors

Objective(1)To study the general demographic differences between the women with gestational diabetes and the women without gestational diabetes.(2)To study the difference in glucose and lipid metabolism between the women with gestational diabetes and the women without gestational diabetes.(3)To compare the level of Apelin in women with gestational diabetes and women without gestational diabetes and to analyze the possible mechanism.Methods(1)A total of 196 pregnant women at 24-32 weeks of gestation were enrolled from October 2018 to May 2019.They were divided into normal glucose metabolism group(NGT group)and abnormal glucose metabolism group(GDM group)stratified by OGTT results,and were further analyzed between those with normal and higher LDLC in NGT group(NGT-NL and NGT-HL subgroups)and in GDM group(GDM-NL and GDM-HL subgroups),respectively.(2)The age,pre-pregnancy weight,gestational age,family history and other relevant indicators of the subjects were recorded in the form of questionnaire survey,and the height and weight of the subjects were measured by the same researcher,and then the body mass index was calculated.(3)Data were recorded,including general demographic information,glycemic parameters measured by the 2-hour 75-gram oral glucose tolerance test(OGTT)[fasting blood glucose(FBG),1-hour postprandial glucose(1h BG),2-hour postprandial glucose(2h BG)],insulin response parameters measured by the 2-hour insulin response test(IRT)[fasting insulin(FINS),1-hour postprandial insulin(1h INS),2-hour postprandial insulin(2h INS)],and parameters of C-peptide [fasting C-peptide(FCP,1-hour postprandial C-peptide(1h CP),2-hour postprandial C-peptide(2h CP)],serum lipid parameters(TC,TG,HDL-C and LDL-C),and calculated HOMA-IR,homeostasis model assessment of β-cell function(HOMA-β),glucose AUC(AUC-G),insulin AUC(AUC-I),and ELISA-detected fasting serum Apelin.Apelin level and glycolipid metabolism parameters were analyzed between those with normal and abnormal glucose metabolism(NGT and GDM groups,98 cases respectively)stratified by OGTT results,and were further analyzed between those with normal and higher LDL-C in NGT group(NGT-NL and NGT-HL subgroups)and in GDM group(GDM-NL and GDM-HL subgroups),respectively.Results(1)Comparison of general data: There was no statistically significant difference between NGT group and GDM group in terms of gestational age,height,increased weight during pregnancy,and increased BMI value during pregnancy(P >0.05);Compared with the NGT group,age,pre-pregnancy body weight and pre-pregnancy BMI were higher in the GDM group(P <0.05).(2)Comparison of biochemical data: Compared with NGT group,FBG,1h BG,2h BG,FINS,1h INS,2h INS,FCP,2h CP,HOMA-IR,AUC-G,AUC-I in GDM group were significantly increased in the GDM group(P <0.05),HOMA-β and ISI were significantly lower(P <0.05).Compared with NGT group,serum Apelin level in the GDM group was lower(P <0.001);TC,HDL,and LDL-C levels in the NGT-HL subgroup were higher than those in the NGT-NL subgroup(P <0.05).The FBG of the GDM-HL subgroup was lower than that of the GDM-NL subgroup,and the levels of TC,HDL,and LDL-C were higher than that of the GDM-NL subgroup(P <0.05).(3)Comparison of Apelin level: GDM patients with normal LDL-C had lower average level of serum Apelin than NGT patients with normal or higher LDL-C(P<0.05),so did GDM patients with higher LDL-C(P<0.05).(4)Correlation analysis: Pearson correlation analysis shows that serum Apelin is negatively correlated with pre-pregnancy BMI,FBG,1h BG,2h BG,FINS,2h INS,FCP,1h CP,2h CP,HOMA-IR,AUC-G,AUC-I(P <0.005);but was positively correlated with ISI(P <0.05).Multivariate logistic regression analysis showed that Apelin was the influencing factor of GDM [OR=0.977,95%CI(0.964,0.990),P<0.001].Conclusion(1)Compared with the NGT group,body weight and pre-pregnancy BMI were higher in the GDM group,suggesting that obesity may be involved in the pathological process of GDM.(2)Compared with the NGT group,the blood glucose,insulin,HOMA-IR of the GDM group increased,and ISI decreased,suggesting that the impaired function of pancreatic β cells may be involved in the pathological process of GDM.(3)Compared with the NGT group,the serum Apelin level in the GDM group was lower,suggesting that Apelin may be involved in the pathological process of GDM.(4)Compared with NGT-NL,the level of Apelin in the NGT-HL group was higher;compared with GDM-NL,the level of Apelin in the GDM-HL group was higher,suggesting that Apelin may participate in the lipid metabolism process.(5)Serum Apelin level is negatively correlated with pre-pregnancy BMI,FBG,1h BG,2h BG,FINS,2h INS,FCP,1h CP,2h CP,HOMA-IR,AUC-G,AUC-I,and positively correlated with ISI,suggesting that Apelin participates in the development of GDM through islet cell function.