Metabolic Diseases During Pregnancy And Adverse Pregnancy Outcomes

Part Ⅰ A study of adverse pregnancy outcomes in intrahepatic cholestasis of pregnancyObjectiveIntrahepatic cholestasis of pregnancy(ICP)is a common pregnancy-related liver disease and is associated with an increased risk of adverse neonatal outcomes.Ursodeoxycholic acid(UDCA)is recognized as the most effective treatment in treating ICP nowadays but has been challenged recently.This study aimed to investigate the adverse outcomes of ICP in both mothers and infants,and to evaluate the effects of treatment with UDCA in patients with ICP.Methods358 pregnant women with ICP and 3782 pregnant women without ICP who delivered in our hospital from 2017 to 2021 were enrolled.Pregnant women with ICP were divided into mild ICP group(n=242)and severe ICP group(n=116)according to the severity of the disease.They were also divided into UDCA group(n=329)and non-UDCA group(n=29)according to the administration of UDCA or not.We collected clinical data including maximum serum fasting TBA level and therapeutic approach to the treatment of ICP;obstetric outcomes,including gestational age and neonatal birth weight;and clinical maternal and neonatal outcomes.Each woman with ICP was matched to two controls.Logistic univariate and multivariate regression analysis was used to compare the adverse maternal and neonatal outcomes between those with ICP and matched controls as well as between those who received UDCA and those who did not.ResultsCompared with controls,women with ICP were more likely to have preeclampsia(adjusted odds ratio,aOR=6.12,95%CI 2.708-13.844),cesarean section(aOR=2.12,95%CI 1.609-2.801),and preterm birth(aOR=8.29,95%CI 3.345-20.528).The above abnormalities were aggravated by the severity of the disease.The administration of UDCA did not reduce these adverse pregnancy outcomes in patients with ICP.ConclusionsICP increased the risk of preeclampsia,cesarean section,and preterm birth.While the administration of UDCA did not reduce these adverse pregnancy outcomes in patients with ICP.Part Ⅱ Combination analysis of risk factors and metabolomics on abnormal glucose metabolism in postpartum women with gestational diabetes mellitusObjectiveGestational diabetes mellitus(GDM)refers to an abnormality of glucose tolerance that is first detected during pregnancy.And when the delivery is over,there are still some women have abnormal blood sugar.Therefore,this study aims to explore the metabolic molecular characteristics associated with abnormal outcome of postpartum blood glucose in patients with GDM,and to explore the efficacy of its combined prediction with risk factors of abnormal blood glucose(clinical indicators).Methods124 patients with GDM who underwent blood glucose screening,delivery and postpartum blood glucose examination in our hospital from 2015 to 2018 were retrospectively analyzed.According to their postpartum blood glucose(OGTT)indicators,these GDM patients were divided into abnormal blood glucose group(including impaired glucose tolerance and diabetes,35 cases)and normal blood glucose group(89 cases).Baseline data were collected:pre-pregnancy body mass index(BMI),postpartum blood glucose outcomes and other clinical data.Metabolomics tests were performed on serum samples collected during second or third trimester of gestation.The t test and χ2 test was used to find clinical indicators related to abnormal postpartum glucose in GDM.Multivariate Logistic regression analysis with corrected clinical indicators was used to find metabolic molecules associated with postpartum glucose outcome in GDM,and biological pathway enrichment analysis was conducted.The related clinical indicators and differences metabolites in multivariate Logistic regression forecasting model,using the partial likelihood ratio forward method to select variables into the model,according to the built prediction model to draw the receiver-operating characteristic curve(ROC)and calculate the area under the curve(AUC)in the evaluation of clinical indicators and metabolites molecules combined predictive value.ResultsThe comparison between groups showed that OGTT 2h blood glucose during pregnancy was a risk factor for abnormal postpartum blood glucose outcomes in GDM patients.Nine metabolites(Cinnamic acid,L-Tryptophan,L-Tyrosine,Methylcysteine,Oxalic acid,Oxoglutaric acid,Palmitoleic acid,N-Acetyl-D-glucosamine,2-Furoic acid)were identified by multivariate analysis after adjusting for 2-h glucose intake during pregnancy.The AUC of multiple factors combined to predict abnormal glycemic outcome in GDM patients was 0.821.ConclusionsOGTT 2h blood glucose during pregnancy is a clinical indicator related to abnormal postpartum glucose outcomes in patients with GDM.The changes in molecular levels of amino acids,organic acids,fatty acids,and monosaccharides are all related to the abnormal postpartum glucose outcomes in patients with GDM,and are metabolic molecular markers related to abnormal postpartum glucose outcomes in patients with GDM.