| 【Objective】Investigate the postpartum cardiometabolic risk (CMR) in women with previousgestational diabetes mellitus(GDM), and analysis the related factors of CMR, whichproviding a foundation for female cardiovascular disease (CVD) prevention.【Methods】1. Object and group1.1Object of studySelected the women who regular check and delivery in our hospital from January2009to August2011, there are559GDM women and1539normal pregnancywomen.1.2Group in pregnancyGDM group and normal control group according to gestational diabetesdiagnostic criteria1.3Group in postpartumNormal metabolism group(including abnormal metabolism in GDM and NC) andabnormal metabolism group((including abnormal metabolism in GDM and NC) for allfollow-ups.2. Collecting prenatal information Age, basis weight, admission weight, height, basis blood pressure, admissiongestational age, blood pressure, pregnancy history, family history; the using of insulinduring pregnancy, OGTT, HbA1c, FPG, FINS, TCH, TG, HDL, LDL, FFA;premature, macrosomia,large for gestational age infant, neonatal hypoglycemia,neonatal asphyxia situation, and calculating the body mass index (BMI), insulinresistance index (HOMA-IR), beta cell function index (HBCI).3.Postpartum follow-upIncluding height, weight, blood pressure, OGTT, HbA1C, TCH, TG, HDL,LDL testing, and calculating the body mass index (BMI), insulin resistance index(HOMA-IR), beta cell function index (HBCI, FBCI).4.Comparing the general information, metabolic changes and pregnancy outcomes inpregnancy for the two groups.5.Comparing the postpartum outcome of the two groups, including abnormal glucosemetabolism (including diabetes and pre-diabetes), abnormal lipid metabolism,hypertension, overweight/obesity and metabolic syndrome; analyzeing the postpartummetabolic characteristics of the GDM; using logistic regression analysis metabolicabnormalities related to the CMR, screening the predictors of postpartumcardiovascular metabolic risk.【Results】1. Metabolic change in pregnancy between the two groups: compared with normalcontrol group, mean age (30.8±4.44vs.27.38±4.03) year, basis BMI (21.96±3.22vs.20.56±2.59) Kg/m~2, family history of diabetes (21.35vs.8.33)%, D-BP (71.94±10.09vs.68.6±8.21) mmHg, FPG (4.53±0.67vs.4.17±0.3) mmol/L, FINS (9.73±4.87vs.8.85±5.22) uU/mL, HOME-IR (1.95±1.26vs.1.7±1.1), TG (3.2±1.48vs.2.74±1.16)mmHg, FFA (620.78±226.06vs.528.38±170.11) ummol/L; HBCI(188.6±218.98vs.316.36The±153.45), HDL (1.42±0.32vs.1.56±0.33) mmol/L,the differences are significant (P <0.05); admission gestational age (37.64±1.78vs.38.42±1.28) weeks，the difference is not significant (P>0.05).2. Pregnancy outcome in pregnancy between the two groups: compared with the normal control group, premature (12.42%vs.7.97%), macrosomia (10.02%vs.5.08%),large for gestational age infant (15.43%vs.3.64%), neonatal hypoglycemia (2.9%vs.1.1%), neonatal asphyxia (9.63to%vs.5.84%), the differences are statisticallysignificant (P <0.05).3. Postpartum metabolic changes between GDM group and NC group: compared withnormal control group, OGTT0h (5.3±0.93vs.5.04±0.31) mmol/L, OGTT2h (6.98±1.84vs.5.92±1.11) mmol/L, HbA1c (5.52±0.54vs.5.30±0.28)%, HOMA-IR(2.03±1.34vs.1.67±0.77), TG (1.16±0.6vs.0.71±0.32) mmol/L, LDL (2.67±0.76vs.2.15±0.57) mmol/L, S-BP (110.3±14.38vs.105.66±10.56) mmHg, S-BP(72.13±10.29vs.68.9±8.31) mmHg, BMI (23.16±3.23vs.21.63±2.88)Kg/m~2,HBCI/IR (56.63±25and61.77±17.95), FBCI/IR (1.59±0.74and1.45±0.56), HDL (1.19±0.23and1.42±0.2) mmol/L, the differences are statisticallysignificant (P <0.05).4. Postpartum normal metabolism group in GDM and NC group: HOMA-IR (1.79±0.82vs.1.66±0.76), TG (0.91±0.33vs.0.71±0.32)mmol/L, LDL (2.4±0.51vs.2.15±0.57)mmol/L, HDL (1.3±0.19vs.1.42±0.2) mmol/L, S-BP (108±11.1vs.101±9.3)mmHg, BMI (21.7±1.74vs.20.5±1.93), the differences are statisticallysignificant ((P<0.05)); postpartum abnormal metabolism group group between GDMand NC group: FPG (5.66±1.25vs.5.11±0.42), HOMA-IR (2.46±1.76vs.1.88±0.83), HBCI/IR (46.8±22.3vs.60±21.2), FBCI/IR (0.76±0.19vs.0.88±0.14),TG (1.43±0.71vs.1.26±0.61), S-BP (145[137-158] vs.138[135-151) mmHg in theD-BP (96[92-99of the] and89[87-96]) mmHg, BMI (27.2±2.92vs.25.72±1.81),the differences are statistically significant (P <0.05).5. Mean follow-up of1.4years, post-natal outcome in GDM and NC gropus:abnormal glucose metabolism(45.48to%vs.23.31%), abnormal lipid metabolism(47.9%vs23.1%), hypertension (6.18%vs.1.61%), overweight/obesity (26.49%vs.21.68%), metabolic syndrome (5.74%vs.1.69%), the differences are statisticallysignificant (P <0.05).6. Comparing with normal controls, in GDM group, the relative risk of CMR are:abnormal glucose metabolism (RR4.61,95%CI:3.59-5.93), abnormal lipid metabolism (RR1.57,95%CI:1.23-7.29). hypertension (RR1.57,95%CI:1.23-7.29),overweight/obesity (RR1.30,95%CI:1.01-1.67), metabolic syndrome (RR3.52,95%CI:1.95-6.40).7.Logistic regression analysis showed that the use of insulin(OR26.99,95%CI:2.0-364.01, P=0.013), the basis of BMI of (OR5.48,95%CI:1.18-25.49, P=0.03), the HBCI decreased in pregnancy(OR,0.99,95%CI:0.985-0.998, P=0.012)are the independent risk factor for abnormal glucose metabolism; basis BMI of (OR1.13,95%CI:1.009-1.275, P=0.035), OGTT2h (OR,1.3995%CI:1.06-1.82, P=0.039),TG (OR,1.65,95%CI:1.18-2.30, P=0.002) are independent risk factor forpostpartum abnormal lipid metabolism, pregnancy HDL (OR0.19,95%CI:0.06-0.64,P=0.007) is a protective factor; basis BMI (OR1.36,95%CI,:1.009-1.823, P=0.044), admission D-BP (OR1.33,95%CI:1.069-1.65P=0.01) are independent riskfactors for postpartum hypertension; basis BMI (OR2.57,95%CI:1.89-3.48, P<0.001),weight gain during pregnancy (OR1.22,95%CI:1.06-1.4, P=0.005) areindependent risk factors for postpartum overweight/obesity; basis BMI (OR2.93,95%CI:1.19-7.19, P=0.019), admission systolic blood pressure (OR1.12,95%CI:1.003-1.241, P=0.043), LDL (OR9.02,95%CI:1.07-75.92, P=0.043) areindependent risk factors for postpartum MS.【Conclusion】1. There are significant glucose and lipid metabolism disorders, insulin resistance andβ-cell secretory function decline in patients with GDM during pregnancy.2. The GDM patients have an adverse pregnancy outcomes significantly higher thannormal pregnant women, including: premature, macrosomia, neonatal hypoglycemia,neonatal asphyxia.3. Patients with GDM in postpartum still have a relatively higher lever of bloodglucose, lipids, blood pressure, BMI, and continuous insulin resistance and β cellfunction decline.4. The GDM women have a higher incidence of postpartum glucose metabolismabnormalities, abnormal lipid metabolism, hypertension, overweight/obesity, metabolic syndrome, these are CMR factors. GDM women have a higher postpartumcardiovascular metabolic risk, a high-risk groups for future CVD.5．The Patients with GDM whose postpartum metabolite levels is normal, still has apotential CVD risk; In crowds of metabolic abnormalities there are more severer leverof metabolic abnormalities in GDM than normal pregnant women.6. The use of insulin during pregnancy, basis BMI, HBCI are independent risk factorfor postpartum abnormal glucose metabolism;basis BMI, OGTT2h, TG areindependent risk factors for postpartum abnormal lipid metabolism; basis BMI,hospitalization D-BP are independent risk factors for postpartum hypertension; basisBMI, weight gain during pregnancy are independent risk factors for postpartumoverweight/obesity; basis BMI, admission S-BP, LDL are independent risk factorsfor postpartum metabolic syndrome. Among them, the basic BMI is the common riskfactors of GDM postpartum CMR.7. Postpartum management for GDM should include evaluation of the overallmetabolism, rather than just OGTT, aimed at early detection and intervention ofvarious CVD risk factors. |
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