| Objective The objective of this present study is to investigate(1)the differences of islet?-cell function and insulin resistance(IR)at 24-28 weeks of gestation,(2)the differences in plasma glucose compliance rates in patients with a single intensive lifestyle intervention during pregnancy,(3)the differences in glucose metabolism outcomes at 6-8 weeks postpartum,and(4)the differences in IR at 6-8 weeks postpartum among the pregnant women with gestational diabetes mellitus(GDM)under three different glucose metabolism states.Methods From January 2017 to January 2019,the single-pregnancy GDM pregnant women who were combined with the endocrinology administrations in the People's Hospital of Inner Mongolia Autonomous Region were selected,and then were diagnosed as GDM with 75 g oral glucose tolerance test(OGTT)during 24-28 weeks of gestation.Baseline data were collected.The fasting plasma glucose(FPG)and fasting insulin(FINS)were determined during 24-28 weeks of gestation.The plasma glucose was monitored when a single intensive lifestyle intervention has been given,and then insulin therapy was carried out if the plasma glucose control did not work.Follow the health guidance of the endocrinology department of this hospital,the 75 g OGTT and FINS will be determined repeatedly in the endocrinology clinic after 6-8 weeks of delivery.In this present study,there were 183 cases with complete data in the final results.183 pregnant women were assigned into three groups: CH group(n=90),IFH group(n=24)and IPH group(n=69)according to the diagnosis results of the 75 g OGTT test during 24-28 weeks of gestation.The differences of homeostasis model assessment of islet ?-cell function(HOMA-?)and homeostasis model assessment of insulin esistance(HOMA-IR)were compared among the three groups of pregnant women.The differences in blood glucose compliance rates during the gestation period among the three groups of pregnant women were compared.The differences in glucose metabolism rates at 6-8 weeks postpartum among the three groups were compared.The differences of HOMA-IR at 6-8 weeks postpartum among the three groups were compared.Results(1)Baseline data of 3 groups of pregnant women: no significant difference(P>0.05)was observed in age,weeks of pregnancy,and family history of first-degree relatives;the pre-pregnancy BMI comparison in CH group and IFH group were higher than that in IPH group,and the differences were statistically significant(P<0.01);meanwhile,the pre-pregnancy BMI comparison in CH group was lower than that in IFH group,and the difference was not statistically significant(P>0.05).(2)The proportion of three groups of pregnant women: 90 patients(49.18%)in the CH group,24 patients(13.11%)in the IFH group,and 69 patients(37.70%)in the IPH group.(3)Comparison of ln HOMA-? among the three groups of pregnant women during 24-28 weeks of gestation: the ln HOMA-? in CH group and IFH group were lower than that in IPH group,and the differences were statistically significant(P<0.01);at the same time,the ln HOMA-? in CH group was lower than that in IFH group,the difference was not statistically significant(P>0.05).The ln HOMA-IR in CH group was higher than those in IPH and IFH groups,the differences were statistically significant(P<0.01);the ln HOMA-IR in IFH group was higher than that in IPH group,and the difference was not statistically significant(P>0.05).(4)The plasma glucose compliance rate in three groups of pregnant women with a single intensive lifestyle: the results demonstrated that the plasma glucose compliance rate in CH group,IFH group and IPH group were47.78%(43/90),83.33%(20/24)and 76.81 %(53/69),respectively.The plasma glucose compliance rate in IFH group was higher than that in CH group,the plasma glucose compliance rate in IPH group was higher than that in CH group,and the difference was statistically significant(P<0.001);the plasma glucose compliance rate in IFH group was higher than that in IPH group,and the difference was not statistically significant P>0.05).(5)Glucose metabolism outcomes at 6-8 weeks postpartum: in total,the incidence of abnormal glucose metabolism was 44.81%(82/183),of which DM accounted for 12.02%(22/183),IGT accounted for 28.42%(52/183),IFG accounted for3.28%(6/193),and IFG+IGT accounted for 1.09%(2/183).The abnormal glucose metabolism rate in CH group,IFH group and IPH group were 56.67%(51/90),8.33%(2/24)and 42.03%(29/69),respectively.The abnormal glucose metabolism rate in CH group and IPH group were higher than that in IFH group,and these differences were statistically significant(P<0.01).There was no significant difference between the CH group and the IPH group(P>0.05).(6)ln HOMA-IR comparison between all pregnant women at 24-28 weeks of gestation and 6-8 weeks postpartum: the ln HOMA-IR during pregnancy(0.93 ± 0.04)was higher than that during postpartum(0.72 ± 0.04),and the difference was statistically significant(P<0.001).(7)Comparison of ln HOMA-IR among 3 groups of pregnant women at 6-8 weeks postpartum: There were no significant differences in CH group,IFH group and IPH group(P>0.05).Conclusions(1)The most common clinical phenotype of GDM patients is CH,and the least one is IFH.(2)GDM pregnant women often have a higher incidence of postpartum glucose metabolism abnormalities.(3)The patients from CH group with a single intensive lifestyle intervention during pregnancy have the lowest plasma glucose compliance rate,and of which more than half need to be combined with insulin therapy;the incidence of abnormal glucose metabolism is the highest at 6-8 weeks postpartum,and the weight during pregnancy is lower than that before pregnancy,and the IR is high,but islet ? cell function is poor during pregnancy.(4)The plasma glucose compliance rate and glucose metabolism outcome at 6-8 weeks postpartum in IFH patients with a single intensive lifestyle intervention during pregnancy are better than those in IPH patients;the pre-pregnancy weight and pregnancy IR in IFH patients are higher than those in IPH patients because that basal insulin secretion is impaired in IFH patients. |
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