A Study Of Risk Factors For Gestational High Glucose And Its Relationship To CTLA4 Gene Polymorphism

OBJECTIVE Gestational diabetes mellitus (GDM) has been defined as a glucose intolerance of varying severity with onset of first recognition during pregnancy. GDM accounts for 1% to 5% of all pregnancies and is associated with an increased risk of morbidity and mortality. Standardization of oral glucose tolerance tests (OGTT) made it possible to define two different clinical entities: impaired glucose tolerance (IGT) and GDM. So we collect the samples according to WHO criteria of IGT and GDM to investigate the association of risk factors and CTLA4 (cytotoxic T lymphocyte associated antigen-4) gene polymorphism with gestational high glucose.METHODS An epidemiological screening of pregnant women at Commune hospitals in Tanggu District in Tianjin between Nov 2000 and Mar 2002. By using questionnaire to obtain information about demographic characteristics, and then some variables were measured including height, weight, waist circumference and 50g 1-h GCT blood glucose, 75g 2-h OGTT blood glucose and so on. Screening was performed with the 50g 1-hour oral glucose challenge test (GCT) between 24 and 28 weeks of gestation to see if fasting blood sugar (FBS) <7. Ommol/L4Patients with 50g 1-h GCT blood glucose ^7.8mmol/L were taken to undergo a 75g 2-hour oral glucose challenge test (OGTT) after an appropriate 2 days carbohydrate load and overnight fast. According to WHO criteria, the diagnosis of IGT is 7. 8mmol/L to 11. Immol/L and GDM is ^11. Immol/L. We collected the blood samples of 33 cases with IGT\ GDM and 66 controls at the same hospital. We used non-conditional logistic regression to analyze the risk factors of gestational high glucose; The promoter and exon 1 of CTLA4 gene were analyzed by PCR-RFLP to study the association between CTLA4 gene polymorphism and gestational high glucose.RESULTS l.A non-conditional logistic regression analysis showed: pre-pregnancy BMI (OR=7. 667, 95%CI: 1. 567 ?37. 514), WHR at the first examination(OR=2.794, 95%CI : 1.235 ~ 6.318) , history of hypertension(OR=1.317, 95%CI : 1.06 ~ 1.635) , history of operation(OR=12. 050, 95%CI: 3. 797?8. 24) and so on, nine variables were associated statistically with gestational high glucose. After adjusting for pre-pregnancy BMK WHR at the first examination, history of hypertension, history of operation, the results showed that they still increased the risk of gestational high glucose; Risk for developing gestational high glucose was increasing with first gestational age and family history of DM, but there were no statistical significance. Other patients' conditions were not associated with gestational high glucose.2. The difference of gestational hypertension syndrome and macrosomia ( ^4000g) between two groups is statistically significant (OR=9. 697,95%CI: 2.489?7.775 and OR=4. 254, 95%CI: 1.389?3.026) . 3. CTLA4 49A-籊 polymorphism of the genotype were A/G and G/G, differed significantly from those of normal controls OR =2. 914, 95% CI=1. 478?5. 743; the same as the C桾 transition polymorphism of the CTLA4 gene promotor OR =11.605, 95% 01=1.296?03.92, genotype was C/T only.CONCLUSION LA non-conditional logistic regression multivariate analysis showed: pre-pregnancy BMI, WHR at the first examination, history of hypertension, history of operation were independent risk factors for gestational high glucose.2. Hypertension syndrome during pregnancy and macrosomia have been increased in women with gestational high glucose.3. This study demonstrates that CTLA4 49 G allele and CTLA4 promotor C桾 mutation may be associated with gestational high glucose.