| Objective To investigate the local incidence of gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM). To study the change of maternal serum leptin level in patients with GIGT and GDM and analyze its relationship with blood glucose value, thus determine whether serum lepin level can be used as an indicator of GDM screening. To study the relationship between lepin and progesterone, estradiol as well as prolactin, therefore preliminarily investigate the potential pathogenesis of GDM.Method All the pregnant women who attended prenatal care in XinQiao Hospital were screened for GDM by means of the 50g oral glucose challenge test. Those whose one-hour blood glucose value was equal or beyond to 7.8 mmol/L had to receive 75g oral glucose tolerance test 3 days later without dietary control. GDM was diagnosed when two of the four values were abnormal. GIGT was diagnosed if only one value was abnormal or the 2nd hour value ranged from 6.7-9.1 mmol/L. Serum leptin level of all the pregnant women were detected by radioimmunoassay. Serum progesterone, estradiol and prolactin concentration were detected by ELISA in 30 cases of the normal glucose tolerance (NGT) and all of the GIGT and GDM pregnant women. Placenta tissue (15 cases of NGT, GIGT, GDM respectively) was collected to measure the expression of leptin by semiquantitative immunohischemistry.Result (1) 583 cases underwent screening totally.140 of all the pregnant women show abnormal blood value in GCT. 15 cases was diagnosed GDM and 61 cases were GIGT. If the value of 8.3 mmol/L was used as the cut-point of 50g GCT to screen the GDM, 25.71% of the pregnant women would avoid being tested by OGTT with all the GDM and 91.80% of GIGT still being recognized. (2) The GCT value was positively correlated with body weight, BMI and weight gain during pregnancy. The GCT value was also positively correlated with the incidence of GIGT and GDM. (3) The rate of preterm labor and polyhydramnios was 8.57% and 7.86% respectively in GCT abnormal group, which were markedly higher than that of GCT normal group(P<0.001). (4) 65.85% of those who had a family history of diabetes mellitus were found to have different degree of glucose intolerance. Family history of diabetes mellitus came out top of the risk factors. (5) Maternal age positively correlated with the rate of abnormal GCT and the incidence of GIGT and GDM. 74.96% of all the pregnant women were beyond 25 years old, 68.88% of whom ranged between 25 and 30 years old. (6) The serum leptin concentration of normal pregnant women ascended gradually from 6.02±3.04 ng/ml in early pregnancy to 9.36±2.11 ng/ml during 34-36 gestational week, and then declined a little but was still high till delivery. (7) The serum leptin concentration of the glucose intolerant pregnant women show no difference among different gestational weeks (P>0.05). Glucose intolerant pregnant women had higher serum leptin concentration than the control group in any gestational week (P<0.05). Serum leptin level of the GDM, GIGT and NGT group was 14.45±4.72ng/ml, 12.11±3.13ng/ml, 8.45±2.59ng/ml, respectively (P<0.05). (8) Serum leptin level positively correlated with the GCT value. Serum leptin level also positively correlated with the rate of abnormal GCT and the incidence of GIGT and GDM. (9) The expression level of leptin in placenta tissue was noticeably higher in GDM and GIGT group than that of NGT group(P<0.05). Serum leptin concentration positively correlated with the expression level of leptin in placenta tissue. (10) Serum progesterone, estradiol and prolactin concentration in GDM group was markedly higher than that of NGT and GIGT group(P<0.05), but leptin was only correlated with progesterone.Conclusion 1. 24.1% of all the pregnant women show abnormal blood value in GCT. The incidence of GIGT and GDM was 10.46% and 2.57% respectively. The value of 8.3 mmol/L used as the cut-point of 50g GCT to screen the GDM is more appropriate. 2. The GCT value was positively correlated with the incidence of GIGT and GDM. GCT false...
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