| Objectives To determine the levels of body composition,serum adiponectin and fatty acid-binding protein 4(FABP4)in the second trimester of pregnancy in patients with gestational diabetes mellitus(GDM),and to analyze the correlation between body composition,serum adiponectin,FABP4 and insulin resistance(IR),and to analyze the correlation between adiponectin,FABP4 and body composition.Methods A case-control study was conducted in 309 pregnant women who underwent75 g oral glucose tolerance test(OGTT)during 24-28 weeks of pregnancy in the Department of Obstetrics of He Bei General Hospital from April 2021 to July 2021.The OGTT results of the two groups were recorded.90 Cases in the GDM group were taken as the case group and 219 cases in the normal blood glucose group as the control group.Body composition analyzer was used to determine the body composition of two groups of pregnant women.The levels of serum adiponectin,FABP4 and fasting insulin(FINS) were measured by enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was used to explore the risk factors of GDM.The diagnostic value of fat mass percentage,fat mass index and pre-pregnancy body mass index(BMI)in GDM were compared by receiver operating characteristic curve.Spearman correlation was used to analyze the relationship between body composition,adiponectin,FABP4 and insulin resistance,and the correlation between adiponectin,FABP4 and body composition.Results 1 There was no significant difference in homeostasis model assessment-β(HOMA-β)and FABP4 between the two groups.In the case group,pre-pregnancy weight,pre-pregnancy BMI,fasting plasma glucose(FPG),one hour postprandial blood glucose(1h PG)and two hours postprandial blood glucose(2h PG),insulin and homeostasis model assessment insulin resistance(HOMA-IR)were significantly higher than those in the control group(P<0.001),while insulin sensitivity index(ISI)and adiponectin in the case group were lower than those in the control group(P<0.05).2 The fat mass percentage(FMP),the ratio of extracellular water to intracellular water(ECW/ICW)and fat mass index(FMI)in the case group were significantly higher than those in the control group(P<0.001).The muscular mass percentage(MMP),the fat free mass percentage(FFMP),the percentage of protein(PP)and the ratio of muscle to body fat(M/F)in the case group were significantly lower than those in the control group(P<0.001).3 Univariate Logistic regression analysis showed that pre-pregnancy BMI,body fat percentage,ECW/ICW and FMI were risk factors for GDM,while fat-free body weight percentage,muscle percentage,protein percentage,M/F and ISI were protective factors for GDM.Multivariate Logistic regression analysis showed that ISI was a protective factor for GDM after adjusting for pre-pregnancy BMI and other factors.4 Receiver operating characteristic curve showed that pre-pregnancy BMI(AUC=0.650,P<0.001),fat mass percentage(AUC=0.641,P<0.001),ECW/ICW(AUC=0.616,P=0.001),body fat index(AUC=0.645,P<0.001)had similar diagnostic value for GDM,but BMI before pregnancy was slightly better than FMP,ECW/ICW and FMI.5 Spermanan correlation analysis showed that in the case group,HOMA-IR was positively correlated with pre-pregnancy BMI and FMI,and negatively correlated with PP,ISI and was positively correlated with protein percentage,and negatively correlated with FMI.There was no correlation between adiponectin and FABP4 and body composition in GDM patients.Conclusions 1 There are significant differences in body composition between pregnant women with GDM in the second trimester and those with normal glucose tolerance.2Mid-pregnancy FMP,FMI,ECW/ICW were risk factors for GDM.FFMP,MP,M/F,and protein percentage were protective factors for GDM.After adjusting for pre-pregnancy BMI,this difference no longer showed.3 Pre-pregnancy BMI,FMP,FMI and ECW/ICW had similar diagnostic efficacy for GDM,and pre-pregnancy BMI was slightly superior to other indicators.4 There was no difference in serum FABP4 between GDM and normal glucose in the second trimester of pregnancy.5 High body fat and low protein in pregnant women during the second trimester of pregnancy may contribute to the occurrence of GDM by increasing insulin resistance and reducing insulin sensitivity.6There is no correlation between body fat and adiponectin and FABP4 in the second trimester of pregnant women with GDM.Figure1;Table7;Reference 170... |
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