Postpartum Glucose Metabolism And Related Factors In Patients With Gestational Diabetes Mellitus

Gestational diabetes mellitus(GDM)is one of the common complications of pregnancy,which threatens the health of mothers and children.Due to the combination of environmental and genetic factors,the morbidity has been increasing year by year in recent years.In most GDM patients,postpartum blood glucose will return to normal in the short term,but the risk of type 2 diabetes mellitus(T2DM)in the long term is not reduced,and the risk of GDM recurrence is increased during the second pregnancy.Therefore,it is of great significance to explore the influencing factors of postpartum glucose metabolism.This study is divided into two parts.Part ? Analysis of factors related to abnormal postpartum glucose metabolism in patients with gestational diabetes mellitusObjective To investigate the changes and differences of body composition,glucose metabolism and insulin resistance in gestational diabetes mellitus patients at 6-8 weeks postpartum.To analyze the related factors of postpartum changes and the outcome of glucose metabolism,insulin resistance in GDM patients from pregnancy to postpartum was preliminarily discussed,which provided reference for postpartum follow-up intervention.Methods From August 2017 to December 2018,1376 cases of all parturient women who were followed up at 6-8 weeks after delivery in Shanghai sixth people's hospital were selected,including 454 women with GDM and 922 women with normal glucose tolerance(NGT)during pregnancy.Only 267 GDM patients received 75g glucose tolerance test(75g-OGTT)review,islet fixnction examination and blood lipid measurement.According to the results of OGTT,the patients were divided into the group with normal glucose metabolism(n=162)and the group with abnormal glucose metabolism(n=105).Multivariate Logistic regression was conducted to understand the influencing factors of abnormal postpartum glucose metabolism in GDM women.Multiple linear regression was used to analyze the relevant factors of postpartum insulin resistance in GDM patients.To compare the recovery of insulin level,insulin resistance and islet function from pregnancy to postpartum.Results(1)The postpartum BMI,total body fat rate,trunk fat rate,total body fat volume and trunk fat volume of women in GDM group were all greater than those in NGT group,and the differences were statistically significant.(2)The incidence of abnormal postpartum glucose metabolism in GDM women(n=105)was 39.3%,including 16 cases of T2DM(6%).The age,pre-pregnancy BMI and insulin treatment rate in the group with abnormal glucose metabolism were all higher than those in the group with normal glucose metabolism,and the differences were statistically significant(P<0.05).Logistic regression analysis of risk factors for postpartum persistent abnormal glucose metabolism showed that OGTT 2h blood glucose during pregnancy,postpartum BMI,postpartum 0.5-Ins,and postpartum 2h-Ins were risk factors for persistent abnormal glucose metabolism(OR=1.275,95%CI:1.022-1.592;OR=1.181,95%CI:1.045-1.335;OR=0.967,95%CI:0.953-0982;OR=1.045,95%CI:1.029-1.061).(3)Multiple linear regression analysis showed that prenatal BMI,postpartum total body fat rate and postpartum trunk fat rate were correlated with HOMA-IR(all P<0.05).(4)Analysis of insulin resistance and insulin function outcome:GDM women with persistent postpartum abnormal glucose metabolism have strong insulin resistance during pregnancy and impaired insulin secretion during early pregnancy,and the peak of insulin secretion moves to 120min later.Conclusion GDM women have a higher incidence of abnormal glucose metabolism in the short-term postpartum period.OGTT 2h plasma glucose during pregnancy and postpartum BMI had predictive value for postpartum glucose metabolism.GDM patients with postpartum persistent abnormal glucose metabolism had insulin resistance or islet secretion dysfunction during pregnancy,and postpartum insulin secretion still showed delayed peak.Postpartum body composition in GDM patients is mainly changed by body fat rate,which is associated with increased insulin resistance.Postpartum body composition measurement may also provide a reference for the intervention of insulin resistance.Part ? The study of the related factors of gestational diabetes in repregnancyObjective To analyze the risk factors of gestational diabetes mellitus in second pregnancy.To investigate the relationship between insulin resistance and islet beta cell function in previous pregnancy and gestational diabetes mellitus in second pregnancy.Methods A retrospective analysis was performed on the data of pregnant women who had been admitted to the sixth people's hospital affiliated to the school of medicine of Shanghai Jiao tong university from January 2016 to December 2018,and who had been admitted to the hospital to give birth in the previous pregnancy for no less than 2 times.The pregnancy diagnosis was divided into NGT group(n=263)and GDM group(n=180).The NGT group was divided into NI group(n=227,normal glucose tolerance in previous pregnancy),N2 group(n=36,GDM in previous pregnancy),GDM group(n=108,normal glucose tolerance in previous pregnancy),and G2 group(n=72,GDM in previous pregnancy).To understand the recurrence rate of GDM,multivariate Logistic regression was used to analyze the influencing factors of gestational diabetes after repregnancy.To compare the correlation between insulin resistance and islet beta cell function in the first trimester and GDM in the second trimester.Results(1)The incidence of GDM in women with normal glucose tolerance was 32.2%.The recurrence rate of second pregnancy in GDM patients was 66.7%.The gestational age,pre-pregnancy BMI,gestational interval and inter-gestational weight gain in the GDM group were all greater than those in the NGT group(all P<0.05).The GDM group had higher pre-pregnancy BMI,cesarean section rate,large delivery rate than the NGT group,and the difference was statistically significant.(2)Multivariate Logistic regression analysis showed that the risk factors with statistical significance for GDM of second pregnancy included:Pregnancy BMI 24-28 kg/m2(OR=1.92,95%CI:1.11-3.32),re-pregnancy BMI?28 kg/m2(OR=3.26,95%CI:1.14-9.3),two pregnancy interval of 4 or more years(OR=2.14,95%CI:1.2-3.84),the GDM history(OR=4.17,95%CI:2.56-6.8),the history of cesarean section(OR=1.74,95%CI:1.12-2.72).pre-pregnancy BMI and time interval between pregnancy were independent risk factors for GDM recurrence(OR=1.4?1.2,P<0.05).(3)WBISI and HOMA-IR of insulin resistance in N2 group were lower than those in N1 group,and the difference was statistically significant(P<0.05).Compared with GI group,HOMA-? was decreased,HOMA-IR was enhanced,and insulin secretion was decreased in the 1st and 2nd phases,the difference was statistically significant.The peak insulin secretion of N2 and G2 in the first trimester was delayed to 120min.Conclusion The interval between two pregnancies(?4 years),overweight before pregnancy and history of cesarean section were independent risk factors for GDM in second pregnancy.The insulin resistance in previous pregnancy was more obvious,and the delay of insulin secretion function curve or peak insulin secretion was closely related to the occurrence of GDM or the recurrence of GDM in the second pregnancy.Prenatal care for second pregnancy should improve the quality management of pregnant women,attach importance to the evaluation of insulin function,and early detection and intervention to reduce the incidence of GDM in second pregnancy.