Study On The Correlation Of The Trend Of Plasma Glucose To The Pregnancy Outcome And Insulin Secretion During Pregnancy

BackgroundPregnancy will have an influence on the plasma glucose metabolism,which sometimes may even causes the gestational diabetes(hereof and after refer to GDM).Therefore the management on the plasma glucose during pregnancy is of great importance.A poor management will increase the risk of adverse pregnancy outcomes,which may even affect the mother and the offspring's long-term health.Currently,as a major diagnostic method for abnormal glucose metabolism,the 75g oral glucose tolerance test(OGTT)is used throughout the world with the diagnostic criteria of the IADPSG,the result of the HAPO research.It is one of the manifestation of the T2DM ?-cell function damage that the insulin secretion in the early phase of OGTT is inadequate or delayed even disappeared.When under a sugar load,there will be a plasma glucose peak in about 30 minutes and a slow back down in 1 to 2 hours to reach the fasting plasma glucose level in normal people.But people with abnormal plasma glucose metabolism do not follow this pattern.There is a delay in the metabolic procedure,that is,its metabolic curve showed a gradual upward trend.At the same time,as an important hormone to regulate the body's plasma glucose metabolism,the insulin is secreted mainly by the ?-cell of islet.When the secretion of insulin is insufficient or delayed,as well as the insulin resistance(hereof and after refer to IR),the procedure of the plasma glucose metabolism will be harmfully affected.Insulin related evaluation indicators,to a certain extent,can reflect the incretion function of the islet ?-cell and the IR.Furthermore,it is believed that the cause of diabetes is related to the shortage of insulin secretion as well as the increasing IR.Chapter 1 Studies on the correlation of the trend of plasma glucose during pregnancy to the pregnancy outcomeObjectiveTo explore the correlation of the trend of plasma glucose during pregnancy to the pregnancy outcome,so to provide a reliable theoretical basis of the early intervention for the pregnant women with high plasma glucose.MethodsThe clinical data of 716 cases were retrospectively analyzed.Patients were chosen from the pregnant women undergoing routine antenatal examination in our hospital during 2014.According to the results of 75g OGTT,226 patients were analyzed as the observation group,in whom the level of postprandial 2 hours plasma glucose was higher than that of postprandial 1 hour plasma glucose.255 pregnant women with GDM were analyzed as the GDM group.Meanwhile 235 pregnant women without DM or GDM were randomly selected as the control group.SPSS 19.0 was used to analyze the data.ResultsWomen with elderly age during pregnancy seemed with higher risk of GDM(P<0.05).The levels of fasting plasma glucose,1 hour postprandial plasma glucose and the 2 hours postprandial plasma glucose as well as the HbAic in GDM group were the highest among the three groups(P<0.05).The levels of fasting plasma glucose and 1 hour postprandial plasma glucose were lower,but of 2 hours postprandial plasma glucose was higher in observation group than in control group(P<0.01).There was statistical difference existed between the GDM group and the others in premature labor(P<0.05).However,No statistical difference existed between the three groups(P>0.05)in the incidences of polyhydramnios,oligohydramnios,fetal growth restriction(FGR),pregnancy induced hypertension(PIH),complicated with premature rupture of membrane(PROM),intrauterine fetal death(IUFD)and non scar uterus cesarean section rate(CSR).Compared with the observation group and the GDM group,the rates of the newborn transfer rate were lower in the control group,which was statistically different(P<0.01).ConclusionThere might be a delayed plasma glucose metabolism in the patients with reversely increased result of 75g OGTT during pregnancy,which may affect the long-term prognosis of the newborn.Therefore,more attention should be paid to such patients with reversely increased result of 75g OGTT.Chapter 2 Studies on the correlation of the trend of plasma glucose during pregnancy to the insulin secretionObjectiveOn the basis of the first chapter,to explore the correlation of the trend of plasma glucose during pregnancy to the insulin secretion,so to explain the difference between the three groups as well as to provide a reliable theoretical basis of the early intervention for the pregnant women with high plasma glucose.MethodsUsing prospective research methods,brought into a total of 90 pregnancy women.They were from the pregnant women undergoing routine antenatal examination in our hospital during 2016.According to the results of 75g OGTT and the admission criteria in the first chapter,24 patients were analyzed as the observation group,28 pregnant women with GDM were analyzed as the GDM group.Meanwhile 38 pregnant women without DM or GDM were randomly selected as the control group.While they were doing 75g OGTT,their blood samples were taken at the same time to measure the insulin secretion with their consent.SPSS 19.0 was used to analyze the data.ResultsThe plasma glucose levels in the control group were correlated with the level of insulin secretion(P<0.05).While the fasting plasma glucose in observation group and the 1 hour postprandial plasma glucose in GDM group were not correlated with the same time insulin secretion(P>0.05).Moreover,the trend of insulin secretion in GDM group was similar to the observation group.The HOMA-?F in the GDM group was the lowest,while the index in control group was the highest among the three groups(P<0.05).The MBCI was significantly higher in the observation group than the other two groups after giving the glucose load(P<0.05).Furthermore,there was statistical significant that,in GDM group,the ISI ?I60/?G60 was the lowest and the HOMA-IR was the highest one in comparison with the others(P<0.05).ConclusionAs an important hormone in regulating the body's plasma glucose,insulin secretion has moderate correlation to the plasma glucose.The patients with reversely increased result of 75g OGTT during pregnancy may suffer from the relatively lack of insulin secretion,which will be more obviously under the sugar load.And its insulin secretion trend is similar to the GDM group,which suggests that it may be in the period of pre-GDM.As for patient with GDM,their insulin lack is mainly manifested in the first hour after giving the sugar load.