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Liu Z, Zhang Q, Liu L, Liu W. Risk factors associated with early postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a systematic review and meta-analysis. Endocrine 2023; 82:498-512. [PMID: 37587390 DOI: 10.1007/s12020-023-03472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This meta-analysis was aimed at exploring the incidence and risk factors of glucose intolerance in women with gestational diabetes mellitus (GDM) at 6-12 weeks postpartum to inform the development of preventive strategies. METHOD We searched Pubmed, Embase, Web of Science, the Cochrane Library, Ovid, China Knowledge Resource Integrated Database (CNKI), Wanfang Database and China Biology Medicine Database for entries between January 1990 and September 2022. The search terms included gestational diabetes mellitus, postpartum, glucose intolerance and type 2 diabetes. The meta-analysis was conducted using Stata 14.0. RESULT We included 37 studies, with 21 and 16 having low and medium risk of bias, respectively. The incidence of glucose intolerance in women with GDM 6-12 weeks postpartum was 27% (95% CI: 0.22-0.33). The following risk factors for GDM 6-12 weeks postpartum were identified: insulin use during pregnancy (OR = 3.23; 95% CI: 2.35-4.44), family history of diabetes (OR = 2.94; 95% CI: 1.98-4.33), abnormal fasting glucose levels at 24-28 weeks of gestation (OR = 1.15; 95% CI: 1.07-1.25), high pre-pregnancy BMI (OR = 1.63; 95% CI: 1.23-2.15), abnormal triglyceride levels during 28-40 weeks of gestation (OR = 2.18; 95% CI: 1.18-4.03), abnormal HbA1c levels at 28-40 weeks of gestation (OR = 6.62; 95% CI: 4.71-9.30), history of previous GDM (OR = 2.11; 95% CI: 1.27-3.49), and high 1-h glucose levels at 24-28 weeks of gestation (OR = 1.16; 95% CI:1.06-1.28). CONCLUSION The incidence of glucose intolerance in GDM patients at 6-12 weeks postpartum was high. To prevent early postpartum glucose intolerance, healthcare providers should develop individualized interventions for GDM patients, depending on existing risk factors.
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Affiliation(s)
- Zhe Liu
- School of Nursing, Capital Medical University, Beijing, China
| | | | - Leyang Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Weiwei Liu
- School of Nursing, Capital Medical University, Beijing, China.
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Yang N, Zhang W, Ji C, Ge J, Zhang X, Li M, Wang M, Zhang T, He J, Zhu H. Metabolic alteration of circulating steroid hormones in women with gestational diabetes mellitus and the related risk factors. Front Endocrinol (Lausanne) 2023; 14:1196935. [PMID: 37396163 PMCID: PMC10310992 DOI: 10.3389/fendo.2023.1196935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Abnormally changed steroid hormones during pregnancy are closely related to the pathological process of gestational diabetes mellitus (GDM). Our aim was to systematically profile the metabolic alteration of circulating steroid hormones in GDM women and screen for risk factors. Methods This study was a case-control study with data measured from 40 GDM women and 70 healthy pregnant women during their 24-28 gestational weeks. 36 kinds of steroid hormones, including 3 kinds of corticosteroids, 2 kinds of progestins, 5 kinds of androgens and 26 kinds of downstream estrogens in serum were systematically measured using a combined sensitive UPLC-MS/MS method. The flux of different metabolic pathways of steroid hormones was analyzed. Logistic regression and ROC curve model analyses were performed to identify potential steroid markers closely associated with GDM development. Results Serum corticosteroids, progestins and almost all the estrogen metabolites via 16-pathway from parent estrogens were higher in GDM women compared with healthy controls. Most of the estrogen metabolites via 4-pathway and more than half of the metabolites via 2-pathway were not significantly different. 16α-hydroxyestrone (16OHE1), estrone-glucuronide/sulfate (E1-G/S) and the ratio of total 2-pathway estrogens to total estrogens were screened as three indicators closely related to the risk of GDM development. The adjusted odds ratios of GDM for the highest quartile compared with the lowest were 72.22 (95% CI 11.27-462.71, P trend <0.001) for 16OHE1 and 6.28 (95% CI 1.74-22.71, P trend <0.05) for E1-G/S. The ratio of 2-pathway estrogens to total estrogens was negatively associated with the risk of GDM. Conclusion The whole metabolic flux from cholesterol to downstream steroid hormones increased in GDM condition. The most significant changes were observed in the 16-pathway metabolism of estrogens, rather than the 2- or 4-pathway or other types of steroid hormones. 16OHE1 may be a strong marker associated with the risk for GDM.
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Affiliation(s)
- Na Yang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Wei Zhang
- Nanjing Qlife Medical Technology Co., Ltd, Nanjing, Jiangsu, China
| | - Cheng Ji
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jiajia Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaoli Zhang
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Meijuan Li
- Nanjing Qlife Medical Technology Co., Ltd, Nanjing, Jiangsu, China
| | - Min Wang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Tianqi Zhang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jun He
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huaijun Zhu
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
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Luo P, Fan Y, Xiong Y, Feng H, Yang Z, Zhang C, Mei B. Genetic variants of the GLP-1R gene affect the susceptibility and glucose metabolism of gestational diabetes mellitus: a two-center nested case‒control study. Diabetol Metab Syndr 2022; 14:190. [PMID: 36528605 PMCID: PMC9759872 DOI: 10.1186/s13098-022-00963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most common complication during pregnancy, occurring under the combined action of environmental and genetic factors. Genetic variants of glucagon-like peptide-1 receptor (GLP-1R) have been reported to affect insulin secretion and susceptibility to type 2 diabetes. This study aimed to explore the role of GLP-1R polymorphisms in GDM and glucose metabolism. METHODS A two-center nested case‒control study was designed, including 200 pregnant women with GDM and 200 pregnant women without GDM genotyped for five tag SNPs of GLP-1R using Sanger sequencing. Logistic regression was used to evaluate the relationship between GLP-1R polymorphisms and GDM risk. Glucose and insulin concentrations were measured based upon the 75 g oral glucose tolerance test (OGTT). Beta cell function of different genotypes was estimated with the 60 min insulinogenic index (IGI60) and OGTT-derived disposition index (DI). RESULTS Mutant genotype AG + GG of tag SNP rs6458093 nominally increased GDM risk (p = 0.049), especially among subjects younger than 35 years (p = 0.024) and with BMI no less than 24 (p = 0.041), after adjusting for confounders. Meanwhile, compared with subjects with wild genotype AA, subjects with genotype AG + GG of rs6458093 also showed nominally significantly lower IGI60 (p = 0.032) and DI (p = 0.029), as well as significantly higher 75 g OGTT-based 1 h glucose load plasma glucose levels (p = 0.045). Moreover, the mutant heterozygous genotype GA of tag SNP rs3765467 nominally decreased GDM risk among subjects older than 35 years (p = 0.037) but showed no association with insulin secretion and glucose homeostasis. CONCLUSIONS Tag SNP rs6458093 of GLP-1R was nominally associated with increased GDM risk and affected beta cell function and postprandial glucose metabolism, while tag SNP rs3765467 of GLP-1R was nominally associated with decreased GDM risk, providing evidence for molecular markers and etiological study of GDM.
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Affiliation(s)
- Ping Luo
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, China
| | - Ying Fan
- Gongan County Maternal and Child Health Care Hospital, Jingzhou, 434300, China
| | - Yusha Xiong
- Gongan County Maternal and Child Health Care Hospital, Jingzhou, 434300, China
| | - Hua Feng
- Gongan County Maternal and Child Health Care Hospital, Jingzhou, 434300, China
| | - Zhiping Yang
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, China
| | - Chunlin Zhang
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, China
| | - Bing Mei
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, China.
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Yang Z, Li Z, Cheng Y, Chen P, Wang D, Chen H, Chen W, Wang Z. Association between lipid trajectories during pregnancy and risk of postpartum glucose intolerance after gestational diabetes mellitus: a cohort study. Acta Diabetol 2022; 59:1209-1218. [PMID: 35790604 PMCID: PMC9329422 DOI: 10.1007/s00592-022-01905-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
AIMS To assess lipid trajectories throughout pregnancy in relation to early postpartum glucose intolerance in women with gestational diabetes mellitus (GDM). METHODS This prospective cohort study included 221 Chinese women with GDM who completed plasma lipid test in each trimester of pregnancy and oral glucose tolerance test at 6-9 weeks postdelivery between January 1, 2018 and January 8, 2020. Using the group-based trajectory modeling, total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-c), and high-density lipoprotein-cholesterol(HDL-c) were identified separately as three trajectories: low, moderate, and high trajectory. The associations between lipid trajectories and early postpartum glucose intolerance were all evaluated. RESULTS Seventy-three participants developed postpartum glucose intolerance. For patients in low, moderate and high trajectory, the incidence of postpartum glucose intolerance was 38.4%, 34.9%, and 17.9%, respectively. GDM women with lower LDL-c trajectories presented a higher risk of postpartum glucose intolerance. The adjusted odds ratio (95% CI) for glucose intolerance was 3.14 (1.17-8.39) in low LDL-c trajectory and 2.68 (1.05-6.85) in moderate trajectory when compared with the high one. However, TC trajectory was not associated with the risk of postpartum glucose intolerance, nor were TG trajectory and HDL-c trajectory. Moreover, a significant difference of insulin sensitivity was observed in participants with different LDL-c trajectories; participants in high LDL-c trajectory had the highest insulin sensitivity, whereas the women in low LDL-c trajectory had the lowest insulin sensitivity (P = 0.02). CONCLUSIONS The high trajectory of LDL-c during pregnancy may play a protective role on postpartum glucose intolerance in women with GDM. Further studies are warranted to explore the underlying mechanism. Trial registration The study was reviewed and approved by the Institutional Review Board of The First Affiliated Hospital of Sun Yat-sen University (reference number: [2014]No. 93). All participants provided written informed consent forms, and the ethics committee approved this consent procedure.
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Affiliation(s)
- Zhuofan Yang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Rd II, Guangzhou, 510080, China
| | - Zhuyu Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Rd II, Guangzhou, 510080, China
| | - Yunjiu Cheng
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peisong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dongyu Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Rd II, Guangzhou, 510080, China
| | - Haitian Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Rd II, Guangzhou, 510080, China
| | - Wei Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Rd II, Guangzhou, 510080, China
| | - Zilian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Rd II, Guangzhou, 510080, China.
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Effects of the original gymnastics for pregnant women program on glycaemic control and delivery outcomes in women with gestational diabetes mellitus: A randomized controlled trial. Int J Nurs Stud 2022; 132:104271. [DOI: 10.1016/j.ijnurstu.2022.104271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 12/22/2022]
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Lai F, Li Z, Yue S, Pei L, Xiao H, Li Z, Li Y, Xiao H, Cao X. Early postpartum abnormal glucose metabolism subtype differs according to mid-trimester lipid profile in women with gestational diabetes mellitus. Lipids Health Dis 2021; 20:91. [PMID: 34429117 PMCID: PMC8386098 DOI: 10.1186/s12944-021-01519-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is unknown whether early postpartum abnormal glucose metabolism (AGM) in women with previous gestational diabetes mellitus (GDM) is related to their mid-trimester lipid profile. The aim of this study was to characterize the mid-trimester lipid profile of women who experienced GDM and developed into different pathophysiologic subtypes of early postpartum AGM. METHODS A retrospective cohort study of 498 women with history of GDM was conducted. A 75-g oral glucose tolerance test (OGTT) and plasma lipid measurements were performed at 24-28 weeks of gestation and 6-12 weeks of postpartum. Insulin secretion and sensitivity were estimated using early postpartum OGTT-based indices. RESULTS Women in the mid-trimester dyslipidemia group had higher postpartum 30-min and 2-h plasma glucose, higher postpartum 2-h plasma insulin, higher postpartum triglyceride (TG), higher postpartum low density lipoprotein cholesterol (LDL-c) concentrations, lower postpartum 30-min insulinogenic index (IGI30), lower postpartum insulin sensitivity index (ISI), and lower postpartum disposition index than those in the normal lipid group (all P < 0.05). Abnormal mid-trimester TG and LDL-c concentrations were associated with postpartum AGM (adjusted odds ratio [OR] = 1.786, 95 % confidence interval [CI] = 1.142-2.425; and adjusted OR = 1.621, 95 % CI = 1.323-2.051, respectively; both P < 0.05). AGM women with low IGI30 and low ISI had higher mid-trimester total cholesterol and LDL-c concentrations, and AGM women with low ISI had higher mid-trimester TG concentrations than women with NGT or other subtypes of AGM (all P < 0.05). CONCLUSIONS GDM women with abnormal mid-trimester TG and LDL-c were predisposed to early postpartum AGM. Postpartum AGM women who experienced GDM had heterogeneous mid-trimester lipid profile when classified according to their pathophysiologic subtype.
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Affiliation(s)
- Fenghua Lai
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, 510080, Guangzhou, China
| | - Zeting Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, 510080, Guangzhou, China
| | - Shufan Yue
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, 510080, Guangzhou, China
| | - Ling Pei
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, 510080, Guangzhou, China
| | - Huangmeng Xiao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, 510080, Guangzhou, China
| | - Zhuyu Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, 510080, Guangzhou, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, 510080, Guangzhou, China
| | - Xiaopei Cao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, 510080, Guangzhou, China.
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Deng L, Huang Y, Li L, Chen H, Su J. Serum miR-29a/b expression in gestational diabetes mellitus and its influence on prognosis evaluation. J Int Med Res 2021; 48:300060520954763. [PMID: 32993411 PMCID: PMC7536503 DOI: 10.1177/0300060520954763] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate serum microRNA (miR)-29a/b expression in gestational diabetes
mellitus (GDM) and its influence on neonatal prognosis. Methods This was a retrospective study including 68 pregnant women with GDM (GDM
group) and 55 healthy pregnant women of similar age range and gestation
period (healthy group). Results The area under the curve was 0.829 for the diagnosis of GDM using serum
miR-29a expression, 0.857 for diagnosis using serum miR-29b expression, and
0.944 for combined diagnosis (using both miR-29a and miR-29b). The fasting
insulin (FINS) level of the GDM group was significantly lower than that of
the healthy group; levels of fasting plasma glucose (FPG), 2-h plasma
glucose (2hPG), and glycated hemoglobin (HbA1c) were significantly higher in
the GDM group than in the healthy group. Both miR-29a and miR-29b were
positively correlated with FINS levels and negatively correlated with FPG,
2hPG, and HbA1c levels. Serum miR-29a/b expression in pregnant women with
GDM was not correlated with neonatal weight, premature delivery, or asphyxia
but was correlated with pathologic jaundice. Conclusions Serum miR-29a/b expression was downregulated in pregnant women with GDM and
correlated with neonatal pathologic jaundice, showing good individual
(miR-29a or miR-29b) diagnostic value and excellent combined (miR-29a and
miR-29b) diagnostic value.
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Affiliation(s)
- Li Deng
- Department of Obstetrics, the Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yan Huang
- Department of Obstetrics, the Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ling Li
- Department of Obstetrics, the Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hongfei Chen
- Department of Obstetrics, the Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Junyou Su
- Department of Obstetrics, the Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Pei L, Xiao H, Lai F, Li Z, Li Z, Yue S, Chen H, Li Y, Cao X. Early postpartum dyslipidemia and its potential predictors during pregnancy in women with a history of gestational diabetes mellitus. Lipids Health Dis 2020; 19:220. [PMID: 33036614 PMCID: PMC7547505 DOI: 10.1186/s12944-020-01398-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/01/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND This study aimed to analyze the incidence of early postpartum dyslipidemia and its potential predictors in women with a history of gestational diabetes mellitus (GDM). METHODS This was a retrospective study. Five hundred eighty-nine women diagnosed with GDM were enrolled and followed up at 6-12 weeks after delivery. A 75 g oral glucose tolerance test (OGTT) and lipid levels were performed during mid-trimester and the early postpartum period. Participants were divided into the normal lipid group and dyslipidemia group according to postpartum lipid levels. Demographic and metabolic parameters were analyzed. Multiple logistic regression was performed to analyze the potential predictors for early postpartum dyslipidemia. A receiver operating characteristic curve (ROC) was calculated to determine the cut-off values. RESULTS A total of 38.5% of the 589 women developed dyslipidemia in early postpartum and 60% of them had normal glucose metabolism. Delivery age, systolic blood pressure (SBP), glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C) were independent predictors of early postpartum dyslipidemia in women with a history of GDM. The cut-offs of maternal age, SBP, HbA1c values, and LDL-C levels were 35 years, 123 mmHg, 5.1%, and 3.56 mmol/L, respectively. LDL-C achieved a balanced mix of high sensitivity (63.9%) and specificity (69.2%), with the highest area under the receiver operating characteristic curve (AUC) (0.696). When LDL-C was combined with age, SBP, and HbA1c, the AUC reached to 0.733. CONCLUSIONS A lipid metabolism evaluation should be recommended in women with a history of GDM after delivery, particularly those with a maternal age > 35 years, SBP > 123 mmHg before labor, HbA1c value > 5.1%, or LDL-C levels > 3.56 mmol/L in the second trimester of pregnancy.
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Affiliation(s)
- Ling Pei
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Huangmeng Xiao
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Fenghua Lai
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Zeting Li
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Zhuyu Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shufan Yue
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Haitian Chen
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Xiaopei Cao
- Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China.
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Fan Y, Wang L, Liu H, Zhang S, Tian H, Shen Y, Tuomilehto J, Yu Z, Yang X, Hu G, Liu M. β-Cell function or insulin resistance was associated with the risk of type 2 diabetes among women with or without obesity and a history of gestational diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001060. [PMID: 32900701 PMCID: PMC7478009 DOI: 10.1136/bmjdrc-2019-001060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 07/07/2020] [Accepted: 07/30/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To evaluate the single association of postpartum β-cell dysfunction and insulin resistance (IR), as well as different combinations of postpartum β-cell dysfunction, IR, obesity, and a history of gestational diabetes mellitus (GDM) with postpartum type 2 diabetes risk. RESEARCH DESIGN AND METHODS The study included 1263 women with prior GDM and 705 women without GDM. Homeostatic model assessment was used to estimate homeostatic model assessment of β-cell secretory function (HOMA-%β) and homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS Multivariable-adjusted ORs of diabetes across quartiles of HOMA-%β and HOMA-IR were 1.00, 1.46, 2.15, and 6.25 (ptrend <0.001), and 1.00, 2.11, 5.59, and 9.36 (ptrend <0.001), respectively. Women with IR only had the same diabetes risk as women with β-cell dysfunction only. Obesity, together with IR or β-cell dysfunction, had a stronger effect on diabetes risk. This stronger effect was also found for a history of GDM with IR or β-cell dysfunction. Women with three risk factors, including obesity, a history of GDM and β-cell dysfunction/IR, showed the highest ORs of diabetes. CONCLUSIONS β-cell dysfunction or IR was significantly associated with postpartum diabetes. IR and β-cell dysfunction, together with obesity and a history of GDM, had the highest ORs of postpartum diabetes risk.
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Affiliation(s)
- Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Huiguang Tian
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Yun Shen
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Six People's Hospital, Shanghai, China
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Xilin Yang
- Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
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