| Gestational diabetes mellitus (GDM) is defined as glucose intolerance that is first detected during pregnancy, its incidence rate is about1.3%to19.9%, and has increased year by year. It is a common perinatal complication and harm to maternal and child, leads to energy metabolism disorders in pregnant women. It is association with a variety of adverse pregnancy outcomes, such as macrosomia, polyhydramnios, spontaneous abortion, fetal malformation, fetal distress, stillbirth, neonatal hypoglycemia, hypocalcemia, and hyperbilirubinemia, maternal ketoacidosis. Its pathogenesis is indefinite. At present, the traditional viewpoint is GDM and type2diabetes (T2DM) have a similar pathogenesis that there are insulin resistance (IR) and insulin secretion insufficiency on the basis of genetic defects, in which IR plays a major role. IR means that a certain amount of insulin concentration can not affect the metabolism of expected nutrients and biological response in target tissues (mainly muscle, fat, liver). During normal pregnancy, the most important metabolic change is that insulin resistance is increased, and sensitivity to insulin in liver, muscle and adipose tissue is decreased, especially in third trimester, sensitivity to insulin decreased by45%to80%. During pregnancy can be viewed as a normal physiological state of IR, when the body can not produce enough insulin to compensate abnormal increase of IR, that GDM is occurred. Previous view is that elevated placental lactogen, oxytocin, progesterone and glucocorticoid, which result in nsulin resistance, is the main reason for the incidence of GDM. In recent years, adipokines and their secreted factors, mediating the incidence of IR, has got our attention. Weight gain during pregnancy is the fastest accumulation of fat in women’s life. Socholars widely considerred that synthesis and secretion of adipocytokines are increased as the growth of the placenta and maternal accumulation of fat during normal pregnancy and play the role in the regulation of energy metabolism and regulating insulin activity. At the same time, synthesis, secretion and receptor expression of adipocytokines between GDM and normal pregnant women are different. This is association with insulin resistance, suggesting that imbalance of adipocytokines network play the role in the development of GDM.Human adipose tissue is one of the most important endocrine organ, synthesize and secrete a variety of adipocytokines, including leptin, adiponectin, tumor necrosis factor-α (TNF-α), interleukin-6(IL-6) and resistin, visfatin, apelin, fasting-induced adipose factor (FIAF), retinol-binding4(RBP4) and so on. Visfatin, synthesized by visceral adipose tissue, has insulin-like effect, can reduce blood glucose, but also promote differentiation, synthesis and accumulation of adipose tissue through the role of paracrine pathway in visceral adipose tissue. The incidence of type2diabetes has increased year by year, make great influence on human health and society. Insulin is known to be the only hormone to reduce blood glucose. People study around the pancreas and insulin for diabetes research. Visfatin mainly secreted by the abdominal fat, and abdominal fat accumulation and insulin resistance is closely related to type2diabetes. This provides an important trial for a causal relationship of obesity and type2 diabetes. Many studies show that plasma concentrations of visfatin and its mRNA expression in tissue is related to a variety of metabolic and inflammatory diseases. The blood concentration of visfatin is increased for obesity, type2diabetes, insulin resistance, chronic inflammation and GDM. In recent years, more and more researchers focus on visfatin and IR and GDM during pregnancy, but the relationship between visfatin and GDM is still controversial:some studies suggest that level of visfatin in blood circulation in GDM women is higher than normal pregnant women, is association with reduced efficiency on target tissue, biosynthesis disorders or against state of hyperglycemia of visfatin; another part of the study suggests that level of visfatin in blood circulation in GDM women is lower than normal pregnant women, low levels of visfatin is one of the reasons about insulin resistance in GDM patients. The role of visfatin in GDM is not clear, research on the relationship between visfatin and lipids is rare, and its short-term dynamics at prenatal and postnatal is rarely reported. To explore the correlation between Visfatin with GDM, we studied visfatin in patients with GDM and normal pregnant women at prepartum and postpartum day1,2,3, and the relationship of visfatin and BMI, lipids, blood glucose.Objective:To explore the correlation between Visfatin with GDM, this study measured visfatin in patients with GDM and normal pregnant women at prepartum and postpartum day1,2,3, and the relationship of visfatin and BMI, lipids, blood glucose.Methods:Choose pregnant women who did regularly prenatal examination in maternity clinic and delivered in inpatient department of Women’s Hospital School of Medicine Zhejiang University during January2010to October2011.38pregnant women were diagnosed GDM according to the diagnostic criteria NDDG. At the same period,35 normal pregnant women,with normal blood glucose or OGTT screening,and age, gestational age,prepregnant BMI are match with the experimental group,were chose as a control group.The pregnant women of two groups delivered in inpatient department at37-40weeks gestation.Made a detailed record of maternal age,height,prepregnant weight and weight gain during pregnancy after admission.Fasting plasma glucose (FPG),insulin(Fins),HemoglobinAlc(HbAlc),Total Cholesterole(TC),Triglyceride (TG),low-density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol(HDL-C)were measured in two groups.Then we calculated insulin resistance index(HOMA-IR).Visfatin were measured in blood samples of two groups by enzyme-linked immunosorbent assay(ELISA)at prenatal and postnatal day1,2,3.Results:(1)Weight gain,BMI in GDM group was significantly higher than the control (40.3±8.3kg,32.1±2.1and33.3±7.3kg,29.4±3.2,respectively,both P<0.05).(2) Plasma visfatin levels in GDM group were significantly higher than the control at prenatal(189.4±77.3ng/ml,117.9±44.3ng/ml,respectively,P<0.01)；FPG,Fins,TG, LDL-C,HbAlc and HOMA-IR in GDM group were higher than control(5.4±0.5mmoll/L,19.1±4.3mu/L,3.2±1.1mmol/L,3.2±1.1mmol/L,6.1±1.9%,3.1±1.0and4.4±0.6mmol/L,12.1±3.3mu/L,2.4±0.9mmol/L,2.2±0.8mmol/L,5.2±0.9%,2.6±0.7,respectively,all P<0.05),HDL-C in GDM group was lower than the normal group(1.9±0.4mmol/L,2.4±0.8mmol/L,respectively,P<0.05),while there is no significant difference in TC levels between the two groups(5.9±2.7mmol/L,4.8±2.0mmol/L,respectively,P>0.05).(3)two sets of plasma visfatin at prenatal were higher than the corresponding groups at postnatal day1,2,3(189.4±77.3ng/ml,128.3±47.9ng/ml,109.2±39.2ng/ml,84.5±32.1ng/ml in GDM group, respectively,and117.9±44.3ng/ml,89.8±39.2ng/ml,78.3±30.6ng/ml,76.7± 29.6ng/ml in control, respectively). Plasma visfatin in GDM group at postnatal day1,2were higher than the corresponding value of the control group (P<0.05), but there was not significant in plasma visfatin between the two groups at postnatal day3(P>0.05).(4) Correlation analysis:Visfatin were negatively correlated with FPG, HOMA-IR, TG in normal control group at prenatal (r=-0.47,-0.51,-0.57, respectively, all P<0.05), positively correlated with HDL (r=0.32, P<0.05). There is no correlation between visfatin and these indicators in GDM group at prenatal. But there are positively correlation between visfatin and weight gain, BMI in GDM group (R=0.36,0.45, respectively, both P<0.05).Conclusions:(1) The levels of visfatin in GDM group at prenatal were significantly higher than the control, but also were correlated with weight gain and BMI. The result suggested that weight gain during pregnancy and visfatin are related with GDM.(2) Visfatin in two groups were significantly decreased at postpartum, but Plasma visfatin in GDM group at postpartum day1,2were still higher than the corresponding value of the control group. These represented visfatin involved in physiological processes of pregnancy, the abnormal secretion is association with pathological.(3) Visfatin were negatively correlated with the index of blood glucose, lipids metabolism in normal control group at prenatal, suggested that visfatin participate in lipid metabolism to maintain blood glucose and lipids at normal levels during normal pregnancy.(4) Disorders of visfatin, blood glucose and lipid metabolism in GDM group might be one of the factors involved in the pathogenesis of GDM. |
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