Prognosis and related factors of postnatal glucose and lipid metabolism in women with hyperglycemia during pregnancy

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SUN Wei-jie(Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034)
WU Hong-hua()
YANG Hui-xia(Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034)
GUO Xiao-hui()
Journal Title:
Volume 14, Issue 04, 2011
Key Word:
Diabetes,gestational;Hyperglycemia;Postpartum period;Lipid metabolism;Follow-up studies

Abstract: Objective (1) To investigate the glucose and lipid metabolism 6-12 weeks after delivery in women with hyperglycemia during pregnancy. (2) To find out factors associated with the prognosis of women with hyperglycemia during pregnancy. (3) To investigate the feasibility of the diagnostic criteria set by the International Association of Diabetes and Pregnancy Study Group according to the follow-up data of women with hyperglycemia in pregnancy. Methods Clinical data of 262 women with hyperglycemia during pregnancy delivered in our hospital from January 1, 2007 to December 31, 2009 were collected. All patients underwent oral glucose tolerance test (OGTT) at 6-12weeks after delivery. They were divided into two groups according to the postnatal status of glucose and lipid metabolism. Multivariate Logistic regression model was used to analyze the factors affected glucose and lipid metabolism after 6-12 weeks of delivery. Results (1) Among the 262 women, 92(35.1%) were reported with abnormal glucose metabolism at 6-12 weeks of delivery, including one (0. 4 % ) woman with impaired fasting glucose, 81 (30. 9 % ) with impaired glucose tolerance, 4( 1.5 % )with impaired fasting glucose+impaired glucose tolerance and 6 (2. 3%) with diabetes mellitus.glucose levels in OGTT (OGTT 2hPG and the OGTT 3hPG) were risk factors for postpartum 0. 181-0. 918)]. (3) All markers of lipid metabolism were detected in 250 women with hyperglycemia during pregnancy at 6-12 weeks after delivery, the rate of abnormal postnatal lipid metabolism was 63.2%(158/250). In the abnormal group (n= 174), the most common abnormal marker was hypercholesterolemia (n = 126, 50. 4 % ), followed by high levels of low-density lipoprotein-cholesterol (n = 102, 40. 8 %), hypertriglyceridemia (n= 60, 24. 0 %) and low levels of high-density lipoproteincholesterol (n= 11, 4. 4 %). (4) Logistic regression model showed that elevated OGTT 2hPG was the risk factor for postpartum abnormal glucose metabolism [OR= 1. 364 (95%CI: 1. 063-1. 751)], while 0. 169-0. 851)]. Conclusions Women with hyperglycemia during pregnancy are more likely to present with abnormal glucose and lipid metabolism which commonly coexisted with insulin resistance.The risk factors for the postpartum abnormal glucose metabolism in mothers with hyperglycemia during pregnancy include early diagnosis, OGTT 2hPG and OGTT 3hPG, while the protective factor is breastfeeding. The risk factor for the postpartum dyslipidaemia in mothers with hyperglycemia during pregnancy is OGTT 2hPG, while the protective factor is high-density lipoprotein-cholesterol level in pregnancy.

  • [1]Yang W,Lu J,Weng J,et al.Prevalence of diabetes among men and women in China.N Engl J Med,2010,362:1090-1101.
  • [2]Bellamy L,Casas JP,Hingorani AD,et al.Type 2 diabetes mellitus after gestational diabetes:a systematic and metaanalysis.Lancet,2009,373:1773-1779.
  • [3]Jovanovic L,Pettitt DJ.Gestational diabetes mellitus.JAMA,2001,286:2516-2518.
  • [4]Ko GT,Chan JC,Tsang LW,et al.Glucose intolerance and other cardiovascular risk factors in chinese women with a history of gestational diabetes mellitus.Aust N Z J Obstet Gynaecol,1999,39:478-483.
  • [5]Cheung NW,Byth K.Population health significance of gestational diabetes.Diabetes Care,2003,26:2005-2009.
  • [6]Ratner RE.Prevention of type 2 diabetes in women with previous gestational diabetes.Diabetes Care,2007,30 Suppl 2:S242-S245.
  • [7]中华医学会妇产科学会产科分组,中华医学会围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病临床诊断与治疗推荐指南(草案).中华围产医学杂志,2007,10:283-284.
  • [8]World Health Organization.Definition,diagnosis and classification of diabetes mellitus and its complications.1999.[EB/OL].[2011-01-26].Http://whqlibdoc.Who.Int/hq/1999/WHO NCD NCS 99.2.Pdf.
  • [9]中国成人血脂异常防治指南制定联合委员会.中国成人血脂异常防治指南.中华心血管病杂志,2007,35:390-419.
  • [10]中华人民共和国卫生部疾病控制司.中国成人超重和肥胖症预防控制指南(试行).2003.[EB/OL].[2011-01-26].
  • [11]O'Sullivan JB,Mahan CM.Criteria for the oral glucose tolerance test in pregnancy.Diabetes,1964,13:278-285.
  • [12]Kitzmiller JL,Dang-Kilduff L,Taslimi MM.Gestational diabetes after delivery.Short-term management and long-term risks.Diabetes Care,2007,30 Suppl 2:S225-S235.
  • [13]Kim C,Newton KM,Knopp RH.Gestational diabetes and the incidence of type 2 diabetes:a systematic review.Diabetes Care,2002,25:1862-1868.
  • [14]Agarwal MM,Punnose J,Dhatt GS.Gestational diabetes:implications of variation in post-partum follow-up criteria.Eur J Obstet Reprod Biol,2004,113:149-153.
  • [15]Dornhorst A,Rossi M.Risk and prevention of type 2 diabetes in women with gestational diabetes.Diabetes Care,1998,21 Suppl 2:B43-B49.
  • [16]International Association of Diabetes and Pregnancy Study Groups Consensus Panel,Metzger BE,Gabbe SG,et al.International association of diabetes and pregnancy study group recommendations on the diagnosis and classification of hyperglycemia in pregnancy.Diabetes Care,2010,33:676-682.
  • [17]American Diabetes Association.Standards of medical care in diabetes-2010.Diabetes Care,2010,33 Suppl 1:S11-S61.
  • [18]吴连芳,刘冬岩,黄醒华,等.妊娠期糖尿病孕妇分娩后血糖异常的相关因素分析.中华妇产科杂志,2003,38:140-142.
  • [19]杨文英.2型糖尿病与脂代谢紊乱.中华心血管病杂志,2003,31:718-720.
  • [20]Turner RC,Millns H,Neil HA,et al.Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus:United Kingdom prospective diabetes study (UKPDS:23).BMJ,1998,316:823-828.
  • [21]Rosenzweig JL,Ferrannini E,Grundy SM,et al.Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk:an endocrine society clinical practice guideline.J Clin Endocrinol Metab,2008,93:3671-3689.
  • [22]吴红花,孙伟杰,惠岩,等.妊娠期糖代谢异常患者产后6~12周糖代谢转归的随访研究.中国糖尿病杂志,2009,17:466-469.
  • [23]Pallardo LF,Herranz L,Martin-Vaquero P,et al.Impaired fasting glucose and impaired glucose tolerance in women with prior gestational diabetes are associated with a different cardiovascular profile.Diabetes Care,2003,26:2318-2322.
  • [24]Cart DB,Utzschneider KM,Hull RL,et al.Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes.Diabetes Care,2006,29:2078-2083.
  • [25]Shah BR,Retnakaran R,Booth GL.Increased risk of cardiovascular disease in young women following gestational diabetes mellitus.Diabetes Care,2008,31:1668-1669.
  • [26]劳子僖.妊娠期糖尿病--中国人的危险因素和远期影响.中华围产医学杂志,2007,10:321-322.
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