The Study On The Relationship Between Adiponectin And Gestational Diabetes Mellitus And Fetal Growth And Development

Adiponectin is secreted specifically by adipose. It can enhance insulin sensitivity and involve in organism metabolism and energy balance. It is considered that it is an important protecting factor of insulin resistance (IR) and metabolic syndrome. It can be deduced that adiponectin is involved in the development of GDM and fetus development in utero. So we conducted subsequent research.Two-part study is carried out.SectionⅠ:The Study on the Relationship between Serum Adiponectin and Gestational Diabetes Mellitus.Following the development of economy and the change of man's food constrution, GDM morbility shows an increasing tendency year by year. GDM has great consequence on pregnancy outcome and long-term complication of mothers and infant. However, its etiopathogenisis has still not been clarified. Lately researcher focused on some IR-related cytokine, and adiponectin is one of the hot research spots. Since few researches have been reported by now and the result differed significantly from each other, we began the following part one research.Objective: To investigate the level and the relationship of serum adiponectin and insulin resistance in different glucose tolerance station; to approach the related factors in development of GDM; to elucidate the relation of adiponectin and impaired glucose tolerance and the development of fetus; to promote aristogenesis at last.Methods: According to the results of 50g-GCT and 75g-OGTT, research subjects were devided into NGT, IGT and GDM groups. We assayed their height, weight, fasting blood glucose, insulin, C-peptide, adiponectin concentration of mothers and newborn's birth weight, calculated mother's HOMA-IR and BMI. Fasting insulin and C-peptide were measured by RIA and Adiponectin by ELISA.Results:(1)In the NGT, IGT and GDM groups, HOMA-IR tendes to increase and serum adiponectin level tends to decline gradually. There are significant differences between GDM and IGT, GDM and NGT, IGT and NGT(P<0.001).(2)In GDM and IGT groups, There are significant negative correlations between serum adiponectin and gestation age, progestation BMI, predelivery BMI, FBG, FINS, C-peptide, HOMA-IR and newborn's birth weight(P<0.05). In NGT group, There are significant negative correlations between serum adiponectin and predelivery BMI, FINS and HOMA-IR(P<0.05).In multiple linear regression analysis, predelivery BMI, FINS and HOMA-IR are the most significant inflencing factor of adiponectin in GDM and IGT groups, however, predelivery BMI and HOMA-IR are the most inflencing factor of adiponectin in NGT groups.Conclusions:(1) Adiponectin metabolic disorder may affect the development of GDM, and is supposed to be an index to evaluate the extent of blood glucose metabolic disorder.(2) GDM has more serious IR station than normal pregnancy. And it has relationship with adiponectin's reduction.(3)Maternal adiponectin level has no correlation to gestation age in all groups. Weight gain is the most influencing factor to adiponectin level.(4)Different from normal pregnant woman, GDM and IGT mother's serum adiponectin negtively correlate to newborn's birth weight.SectionⅡ:The Study on the Relationship between Adiponectin and Fetal Growth and Development.Adiponectin was first found in human cord blood in 2003, and it came from fetus mostly. However, the regulation of fetus adiponectin and the relation to large for gestational age infant and small for gestational age infant have not been clarified yet. Research of amniotic fluid adiponectin has not been reported. So we began the following part two research.Objective: To investigate the level and the influencing factor of maternal serum, amniotic fluid and cord blood adiponectin; to explore their relationship to the development of fetus; to clarify their clinical meaning.Methods: According to newborn's birth weight, research subjects were devided into LGA, AGA and SGA gtoups. Adiponectin measurement was carried out using the ELISA method and Insulin using RIA.Results:(1)Mean cord blood (25.63±6.10μg/ ml) adiponectin concentration was higher than maternal serum(10.06±4.24μg/ml) and amniotic fluid(2.02±1.98ng/ml) adiponectin concentrations (P<0.001).(2)There was no signficant difference among the maternal blood adiponectin of LGA, AGA and SGA (P>0.05). Higher cord blood and amniotic fluid adiponectin concentrations were detected in LGA infants than AGA infants, and AGA higher than SGA (P<0.05).(3)No significant differences were found between female and male neonates in cord blood, maternal blood and amniotic fluid adiponectin levels (P>0.05).(4)Maternal serum adiponectin levels correlated negtively with maternal predelivery BMI and insulin concentration. Cord adiponectin levels correlated positively with birth weight, Ponderal index, placental weight and amniotic fluid adiponectin concentration. There were significantly positive correlations between amniotic fluid adiponectin levels and birth weight, Ponderal index.Conclusions:(1) Maternal adiponectin concentration reflect mother's changes in body fat mass and regulate energy metabolism and adipose storage, but is not an direct indicator of fetal growth.(2) Cord blood adiponectin is associated with fetal introuterine growth and body fat mass and it can be taken as a marker of fetal introuterine growth and development. The placenta is also a source of cord blood adiponectin during pregnancy.(3) Adiponectin in amniotic fluid is mainly produced by fetus. Examing amniotic fluid Adiponectin can indirectly reflect fetal introuterine growth and development.(4) No differences between neonate genders were found in cord blood, maternal blood and amniotic fluid adiponectin levels. Neonate gender difference can be ignored in the pregnancy woman's adiponectin research.