| ObjectivesTo clarify the influence of gestational diabetes mellitus（GDM）on postpartum cardiovascular metabolic indicators,and to explore the role of the third-trimester inflammatory factors in this association,providing clues for early prevention and control of postpartum cardiovascular disease（CVD）risk after GDM.MethodsOur current study was based on the Ma’anshan birth cohort（MABC）established from May 2013 to September 2014.The subjects in the cohort were followed up at 6 years postpartum,with 335 women having completed followed-up,after excluding 12 women with a pre-pregnancy history of liver or kidney diseases,1 women without intact follow-up data and 2 women with a pre-pregnancy history of cardiovascular disease,320 women were finally incuded in our current study.During the follow-up period,the demographic information and lifestyle information such as sleep,physical activity and dietary intake were collected using self-made questionnaires,and the physical data were measured.The fasting blood samples were collected to measure 16 metabolic indicators:fasting blood glucose（FPG）,glycosylated hemoglobin（Hb A1c）,hemoglobin F（Hb F）,insulin（RI）,triglycerides（TG）,total cholesterol（TC）,high-density lipoprotein（HDL）Low-density lipoprotein（LDL）,total protein（TP）,albumin（ALB）,apolipoprotein A（Apo A）,apolipoprotein B（Apo B）,blood uric acid（UA）,blood urea nitrogen（BUN）,creatinine（Scr）and cystatin（Cys）.Seven inflammatory factors in the third trimester during pregnancy,including TNF-α,IFN-γ,IL-1β,IL-6,IL-10,IL-12p70,IL-17A,were measured in serum samples using Luminex liquid phase suspension protein technology.Two comprehensive indexes,si MS index and triglyceride-glucose index（Ty G）were further calculated based on physical measurements and metabolic indicators.The prevalence of fasting blood glucose abnormalities,hypercholesterolemia,hypertriglyceridaemia,low level of HDL and high level of LDL was described according to the clinical criteria.Linear regression model and logistic regression model were used to analyze the associations between GDM and metabolic indicators at 6 years postpartum,the relationship between GDM and the level of 7 inflammatory factors in the third trimester,the relationship between 7 inflammatory factors in the third trimester and metabolic indicators at the 6 years postpartum.Because of multiple testing,two-sided P values were adjusted according to the method of Benjamini/Hochberg（B/H）to control the false discovery rate（FDR）.Moderating effect analysis was performed using the PROCESS plug-in embedded in SPSS to explore the role of the third-trimester inflammatory factors in the association between GDM and postpartum cardiovascular metabolic indicators.ResultsOf the 320 women,105（32.8%）had a prior GDM history.Between the GDM and non-GDM groups significant differences of the indicators of FPG,TC,TG,LDL,Hb A1c,RI,Apo B,Scr,UA,si MS,Ty G,and the proportions of fasting blood glucose abnormalities,hypercholesterolemia,hypercholesterolemia,low HDL and high LDL were observed.After adjusting for age,pre-pregnancy BMI,education,total household income,parity,family history of diabetes,family history of cardiovascular disease,sleep,physical activity and red meat intake,except for low HDL postpartum,which was marginally associated with a prior GDM history(OR=9.34,95%CI:1.54 to 56.84,P-FDR=0.105),no other metabolic disorder was observed to be significantly associated with GDM history.Linear regression analysis showed that the association between GDM and FPG(β=0.32,95%CI:0.10 to 0.5.,P-FDR=0.027),Hb A1c(β=0.19,95%CI:0.07 to 0.32,P-FDR=0.027)at 6 years postpartum was statistically significant,while Hb F(β=0.08,95%CI:0.01 to 0.15,P-FDR=0.087),Scr(β=2.63,95%CI:0.27 to 4.98,P-FDR=0.087),si MS(β=0.22,95%CI:0.03 to 0.42,P-FDR=0.087)and Ty G(β=0.20,95%CI:0.05 to 0.34,P-FDR=0.060)only reached nominal significance.Analysis of the association of inflammatory factors in the third trimester with GDM and postpartum metabolic profile did not reveal any significant association of GDM with 7inflammatory factors in the third trimester,nor revealed any significant association of 7inflammatory factors in the third trimester with postpartum metabolic indicators.However,there was a positive moderating effect of the inflammatory factor IFN-γin the third trimester on the association between GDM and FPG at 6 years postpartum,with an interaction termβvalue of 0.2314,which reached a significant level of moderating effect（P=0.041）.ConclusionsA prior history of GDM could significantly increase the levels of fasting plasma glucose,glycosylated hemoglobin and Ty G at 6 years postpartum,and the third-trimester inflammatory factors did not mediate this association,but the effect of GDM on fasting plasma glucose 6 years postpartum was shown to be enhanced by elevated levels of the inflammatory factor IFN-γin the third trimester,which still needs further investigation. |
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