| Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. With the increasing of living level, changes of dietetic habit, the reduction in physical activity,the first gestational age increaseing and other adverse factors, the incidence of gestational diabetes is increasing year by year. The latest investigation shows that,the incidence of GDM increased from less than3%up to more than7%now.Its specific pathogenesis is not very clear, and studies show that it may be related to various factors such as islet cell function and insulin resistance, insulin signaling defects in system disorders, fatty cell factors, genetic factors, gene mutation and so on. Neonates delivered by diabetic mothers prone to obstetric complications, fetal macrosomia, hypoglycemia, intracranial hemorrhage and organ immaturity and so on. And it do great harm to life quality of newborns, and even life-threatening. Macrosomia which have birth weight reached or exceeded4000g,may have hypoglycemia, birth injury, intracranial hemorrhage and other complications. Incidence of macrosomia rate of7%in China. Birth rate of GDM macrosomia was12.5%, and it is significantly higher than the incidence of macrosomia. Children of GDM mother may get impaired glucose tolerance, systolic pressure and mean arterial pressure riseing at puberty, and the incidence of type Ⅱ diabetes and impaired glucose tolerance increased less than50 years old.Objective:To discusse the changes of serum lipid including triglyceride (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), apolipoprotein A (ApoA) and apolipoprotein B (ApoB), and blood glucose of GDM macrosomia, health macrosomia and normal neonates.To strengthen the health guidance for pregnant women before and during pregnancy and reduce the incidence of gestational diabetes mellitus and macrosomia, and GDM mother’s short-term or long-term complications.Methods:To select40cases of full-term macrosomia (birth weight>4000g) of GDM as GDM macrosomia group, and36cases of macrosomia of healthy pregnant women borning at the same period as control group1, and39cases of normal neonates(birth weight more than2500g and less than4000g) of heathy mothers as control group2. All the neonates were born in maternity of provincial hospital affiliated to shangdong university and of hospital of laiwu iron and stell company.22cases were males and18cases were females in GDM macrosomia group;35cases were caesarean birth, and5cases were vaginal birth. In the control group1,21cases were male and15cases were females;32cases were caesarean birth, and4cases were vaginal birth. In the control group2,22cases were males and17cases were females;18cases were caesarean birth, and21cases were vaginal birth. To record the ages, height, gestational weeks, weight before delivery of maternal of three groups and calculate prenatal body mass index (body mass index, BMI), BMI=weight (kg)/height2(m2). After birth,all neonates were weighed immediately using the same electronic scales,mining the heel peripheral blood in0.5h,adopted scalp venous blood3ml in24-48h,at early morning7:00-7:30.To measure the serum lipid and apolipoprotein levels of cases using enzyme method and immune turbidimetry repectively and detecte blood glucose by microanalysismeter, and statistical analysis was conducted.Results:1. The general condition of three groups:compared with the control group of1, BMI of GDM macrosomia group were obviously increased (P<0.05),and the age, weight gain during pregnancy, gestational weeks had no significant difference (P>0.05). Compared with the control group2, BMI and weight gain during pregnancy of GDM macrosomia group were significantly higher (P<0.01); and the age, gestational weeks had no significant difference (P>0.05).2. Comparison between GDM macrosomia group and the control group of1in serum lipids and blood glucose:In GDM macrosomia group, the apolipoprotein A (ApoA) and apolipoprotein B (ApoB) and trace glucose were all significantly reduced. And triglyceride (TG) increased significantly (P<0.05), the high density lipoprotein (HDL) was reduced, low density lipoprotein (LDL) increased, but the difference had no statistically significant (P>0.05).3. Comparison between GDM macrosomia group and the control group of2in serum lipids and blood glucose:In GDM macrosomia group, the triglyceride (TG) was significantly elevated, apolipoprotein A (ApoA) and apolipoprotein B (ApoB) was significantly reduced., and neonatal trace glucose was decreased (P<0.01), high density lipoprotein (HDL) reduced, low density lipoprotein (LDL) increased, but there was no statistically significant (P>0.05).4.Correlative analysis on the birth weight and serum lipid of GDM macrosomic neonate:there was a positive correlation between birth weight and triglyceride (TG) of GDM macrosomia (r=0.415, P<0.01), and had no correlation with high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), apolipoprotein A (ApoA) and apolipoprotein B (ApoB).5. Correlative analysis on the birth weight and blood glucose of GDM macrosomic neonate:birth weight and glucose of GDM macrosomic neonate were negatively correlated (r=-0.489, P<0.01)Conclusion:Occurrence of macrosomia was related with pre-pregnancy BMI and weight gain during pregnancy.GDM macrosomic have abnormal metabolism of serum lipid, triglyceride (TG) and low density lipoprotein (LDL) are all rise, high density lipoprotein (HDL) reduce, apolipoprotein A (ApoA) and apolipoprotein B (ApoB) significantly reduce. GDM macrosomia and health macrosomia all have trace glucose abnormalities.GDM macrosomia are more prone to abnormalities in lipid metabolism and hypoglycemia compared to health macrosomia.Birth weight of macrosomia was related with abnormalities of lipid and glucose. We should strengthen the health guidance on pregnant women before and during pregnancy.It can reduce the incidence of macrosomia in diabetic pregnancies,reduce complications of GDM neonatal and improve the quality of life of GDM neonatal. |
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