| Background and Objective: Gestational Diabetes Mellitus(GDM)is one of the most common complications of pregnancy,with elevated blood glucose as the main manifestation,affecting maternal and infant health,but the pathogenesis of the disease is not clearly defined,hindering the development of disease prevention and treatment modalities.Clinical studies and animal experiments have shown that breastfeeding is beneficial in preventing the development of postpartum type 2 diabetes mellitus(T2DM);intestinal flora is closely related to the development of insulin resistance and inflammation in the body,and the aim of this study was to sequence the intestinal flora in the stool of postpartum women with GDM using 16 S r RNA amplicon sequencing technology and analyze the intestinal flora of breastfeeding and non-breastfeeding women.The aim of this study is to analyze the intestinal flora and clinical characteristics of lactating and non-lactating postpartum women with GDM,to investigate the correlation between lactation and intestinal flora,to confirm the close relationship between lactation and insulin resistance,and to provide a theoretical basis for further clarifying the mechanism of lactation beneficial to the prevention of postpartum T2 DM and finding new therapeutic targets.Methods: Thirty-one postpartum women with GDM were recruited as study subjects by collecting data from 2017-2020 from the one-day outpatient clinic for GDM at the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,combining inclusion and exclusion criteria.According to their breastfeeding status,they were divided into 20 cases in the Lactating Group(L group)and 11 cases in the Nonlactating Group(NL group).Clinical data related to insulin resistance were obtained during the Oral Glucose Tolerance Test(OGTT),and the clinical data of both groups were statistically analyzed using the software SPSS26.0.Fresh faeces was collected on the day of OGTT,and the dominant bacterial genera were screened for correlation with clinical indicators using the Illumina Hi Seq platform for sequencing and bioinformatics analysis against the V3-V4 variable region of bacterial 16 S r RNA.Results: The Homeostasis Model Assessment for Insulin Resistance(HOMA-IR)in the L group(1.65±0.77)was significantly lower than that in the NL group(2.35±1.08)(P<0.05),and the Insulin Sensitivity The Insulin Sensitivity Oral Glucose Tolerance Test(IS-OGTT)[110.04(62.56,157.16)] was significantly higher in the L group than in the NL group [54.68(51.04,95.95)](P<0.05),and the systolic blood Systolic Blood Pressure(SBP)and Aspartate Transaminase(ALT)were significantly lower in L group than in NL group(P<0.05),and Free Serum Tetraiodothyronine(FT4)was significantly higher in L group than in NL group(P<0.05).The abundance of Synergistetes(P<0.05)and Lachnobacterium(P<0.05)was significantly higher in the L group and Sutterella(P<0.05)in the NL group.There were significant correlations between the dominant genera and clinical indicators in the gut of postpartum women with GDM.Lachnobacterium was positively correlated with IS-OGTT(P<0.05),and Sutterella was positively correlated with ALT levels(P<0.05).Conclusion: Compared with the NL group,the HOMA-IR was significantly lower and the insulin sensitivity index IS-OGTT was significantly higher in postpartum women with GDM in the L group.There was significant difference in the beta diversity of intestinal flora in postpartum women with GDM in the L and NL groups.Among them,the abundance of Synergistetes and Lachnobacterium was significantly higher in postpartum women with GDM in L group compared with NL group,and Lachnobacterium was positively correlated with IS-OGTT.The abundance of Sutterella was significantly higher in the NL group compared to the L group and was positively correlated with ALT levels.Lactation may improve the body’s insulin resistance and prevent the development of T2 DM in postpartum women with GDM by altering the composition of the intestinal flora. |
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