| Objective:The study aimed to understand first year postpartum glucose metabolism of women with previous Gestational Diabetes Mellitus and to investigate influencing factors of abnormal postpartum glucose metabolism.The study also aimed to explore risk factors of type 2 diabetes and abnormal glucose metabolism.To provide a theoretical basis for the prevention of gestational diabetes mellitusto type 2 diabetes mellitus.Methods:A total of 204 women who were diagnosed with gestational diabetes mellitus by OGTT trial between 24 and 28 weeks of gestation in the maternal and child care service center of Tongling city in May 2014 to May 2015 were enrolled in the study.A one follow-up study was conducted on this part of women in July 2015 to May 2016.The body weight,blood pressure,body composition,breastfeeding and physical activity information were collected inthe first year after delivery.All the subjects underwent a 75-g,2h oral glucose tolerance test(OGTT)one year after delivery.Fasting blood glucose,2h postprandial blood glucose,triglyceride,total cholesterol,high density lipoprotein,low density lipoprotein,leptin,CRP,adiponectin and IL-6 levels were tested at the same time.Results:(1)204 GDM womenwere diagnosed by the OGTT test during 24-28 gestational weeks were included in this study.166 women with GDM one year afterdelivery were followed up successfully.The follow-up rate was 18.6%.Through OGTT test one year after delivery,3 patients with type 2 diabetes mellitus,24 patients with impaired fasting blood glucose,9 patients with impairedglucose tolerance,4 atients with impaired fasting glucose as well asimpaired glucose tolerance were diagnosed.The incidence of T2 DM to GDM was 1.81% and the incidence of abnormal glucose metabolism was 24.1%.(2)Compared with normal postpartum glucose metabolism GDM women,abnormal postpartum glucose metabolism GDM women had higher pre-pregnancy and postpartum BMI,higher fasting blood glucose in the early,second,third trimester and first year postpartum,higher 1h postprandial blood glucosein the second trimester,higher 2h postprandial blood glucose in the first year postpartum,higher fasting insulin level and insulin resistance level in the first year postpartum,higher serum TG level in the early,second trimester and first year postpartum,lower low lipoprotein level in the third trimester(P<0.05).In additionwaist circumference,triceps skinfold thickness,subscapular skinfold thickness,abdominal skinfold thickness,body fat percentage,body fat content,visceral fat content and systolic blood pressure were also higher in abnormal glucose metabolism GDM women.(3)CRP levels were positively correlated with fasting insulin and HOMA-IR levles(P<0.05).Leptin levels were positively correlated with fasting insulin and HOMA-IR levles(P<0.05).(4)Logistic regression analysis showed that the differences of fasting blood glucose and2 h postprandial blood glucose between pregnancy and first year postpartum,postpartum BMI,body fat content and visceral fat content were risk factors of abnormal postpartum glucose metabolism GDM women(OR=1.679,95%CI [1.085~2.596];OR=5.857,95%CI [1.957~17.529];OR=1.568,95%CI[1.130~2.176];OR=1.481,95%CI [1.042~2.105];OR=0.366,95%CI [0.182~0.732]).Conclusion:(1)Pre-pregnancy and postpartum BMI,gestational and postpartum blood lipids levels,first year postpartum waist circumference,body fat content and visceral fat content were all closely related to abnormal postpartum glucose metabolism,differences of fasting blood glucose and 2h postprandial blood glucose between pregnancy and first year postpartum,postpartum BMI,body fat content and visceral fat content were risk factors of abnormal postpartum glucose metabolism GDM women.(2)Women with gestational diabetes mellitus were prone to become T2 DM and abnormal glucose metabolism postpartum,so the gestational diabetes maternal postpartum follow-up is necessary for preventing and delaying the future occurrence of T2 DM. |
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