Relationship Between Adiponectin、Leptin And Postpartum Glucose Metabolism In Gestational Diabetes

Gestational diabetes melitus(GDM) is a common complication of pregnancy. It affects maternal metabolism that could cause macrosomia or fetal growth restriction. GDM seriously threatens the health of pregnant women, fetus and neonates, which Can easily lead to macrosomia, polyhydramnios, gestational hypertension and neonatal complications et al.The mechanism of GDM is remain unknown, and the traditional opinion is that the reproductive hormones are important parts in the pathogenesis of GDM. With the discoveries of various adipokines, many researchers believe that diacrisis of adipokines is main part in the pathogenesis of GDM.Leptin,a hormone that suppresses appetite, is the first adipokine which have been found. It can regulate food intake through the effect on hypothalamus. According to reports in the literature,in pregnancy, the leptin level of GDM group is significantly higher than that of control group. The higher leptin level may lead to insulins abnormal function through the influence on insulin receptor and insulin receptor signal after et al,and the higher insulin level may lead to the increasing of leptin level. This vicious circle aggravate IR degree. Adiponectin is a kind of spolypeptidal adipokines, containing224Amino acids. According to reports in the literature,in the whole pregnany,control group and GDM group both have lower adiponectin levels progressively, and GDM group is more obvious with statistical significance. The decrease of adiponectin level is related to the decrease of insulin sensibility and pancreatic beta cells function lessening.As much reports been on the relationship of adipokines and glycometabolism in pregnancy, this study focus on the relationship postpartum.Objective:Analyzing the results of the75g oral glucose tolerance test (OGTT) in gestational diabetes mellitus (GDM) at six weeks after delivering to investigate the Relationship between Adiponectin, leptin, BMI, Pregnancy related index and6weeks postpartum glucose metabolism In gestational diabetes.Methods:A retrospective study was conducted on the clinical data of36women with gestational diabetes,who delivered and underwent a2hours75g OGTT at42days postpartum from april to november in2011in our hospital.on the basis of the results of OGTT(according to the WHO diagnosis criteria), they were reclassified into two groups to analyse the relationship between adiponectin, leptin, BMI,Pregnancy related index and 6weeks postpartum glucose metabolism.Results:According to the OGTT results, all participants were reclassified into two group:normal group (I group,24cases,66.7%), abnormal group (Ⅱ group,12cases,33.3%).According to the results of comparation of pregnancy related index, the incidence rate of I group family diabetes history is significantly lower (P<0.05), and the mean diagnose time is significantly posterior to that of the Ⅱ group(P<0.05). in the Ⅰ group, the mean fasting blood-glucose was much lower, the mean leptin concentration was significantly higher than those of the Ⅱ group(P<0.05). There was not significant differences in BMI、adiponectin, fasting blood-insulin and HOMA-IR between two groups. The multiple logistic regression model showed that the leptin concentratiodn was significantly negatively correlated with fasting blood-glucose (R=-0.51, P=0.02), and was significantly positively correlated with HOMA-IR (R=0.7,P=0.003). There was not significant correlation between adiponectin、BMI with fasting blood-glucose,so did adiponectin,BMI with HOMA-IR.The linear regression model showed that the fasting blood-glucose was significantly negatively correlated (R=-0.56, P=0.01) with HOMA-IR.the leptin concentratiodn was significantly positively correlated with fasting blood-insulin concentration (R=0.73, P=0.001)Conclusion:(1) in the Ⅰ group, the mean fasting blood-glucose was much lower than those of the Ⅱ group, the mean leptin concentration was significantly higher than those of the II group.(2) The leptin concentratiodn was significantly negatively correlated with fasting blood-glucose,and was significantly positively correlated with HOMA-IR.Leptin could act on GDM may be through the varying of IR,and raising leptin level Can be a new target on the recovery of GDMin the future.(3)There was not significant correlation between adiponectin,BMI with fasting blood-glucose, so did adiponectin^BMI with HOMA-IR.(4) Early final diagnosis time of GDM and family medical history of diabetes mellitus are the risk factors that trigger postpartum abnormal blood glucose of GDM patients.