Leadership Sinai Centre for Diabetes, 60 Murray Street, Toronto, Ontario, Canada.
Nutr Metab Cardiovasc Dis. 2011 Sep;21(9):706-12. doi: 10.1016/j.numecd.2011.02.010. Epub 2011 Jun 23.
Women with gestational diabetes mellitus (GDM) have an enhanced cardiovascular risk factor profile at 3-months postpartum and an elevated risk of future cardiovascular disease, as compared to their peers. Recently, it has emerged that even mild dysglycemia on antepartum oral glucose tolerance test (OGTT) predicts an increased risk of future cardiovascular disease, although it is not known whether there exists an identifiable high-risk subgroup within this patient population. Since gestational impaired glucose tolerance (GIGT) due to isolated hyperglycemia at 1-h during the OGTT (1-h GIGT) bears metabolic similarity to GDM, we hypothesized that, like GDM, 1-h GIGT may predict a high-risk postpartum cardiovascular phenotype.
In this prospective cohort study, 485 women underwent antepartum OGTT, followed by cardiovascular risk factor assessment at 3-months postpartum. The antepartum OGTT identified 4 gestational glucose tolerance groups: GDM (n = 137); 1-h GIGT (n = 39); GIGT at 2- or 3-h (2/3-h GIGT)(n = 50); and normal glucose tolerance (NGT)(n = 259). After adjustment for age, ethnicity, breastfeeding and waist circumference, mean levels of the following cardiovascular risk factors progressively increased from NGT to 2/3-h GIGT to 1-h GIGT to GDM: LDL cholesterol (p = 0.0026); total cholesterol:HDL (p = 0.0030); apolipoprotein B (p = 0.004); apolipoprotein B:apolipoprotein A1 (p = 0.026); leptin (p = 0.018); and C-reactive protein (p = 0.011).
Amongst women without GDM, 1-h GIGT predicts an enhanced postpartum cardiovascular risk factor profile. It thus emerges, that amongst young women with mild dysglycemia in pregnancy, those with 1-h GIGT may comprise an unrecognized patient population at risk for future cardiovascular disease.
与同龄人相比，患有妊娠期糖尿病（GDM）的女性在产后 3 个月具有增强的心血管危险因素特征，并且未来患心血管疾病的风险增加。最近，即使在产前口服葡萄糖耐量试验（OGTT）中出现轻度糖血症，也预测未来心血管疾病的风险增加，尽管尚不清楚在该患者人群中是否存在可识别的高危亚组。由于 OGTT 中 1 小时时单纯高血糖引起的妊娠期葡萄糖耐量受损（1 小时 GIGT）与 GDM 具有代谢相似性，因此我们假设，与 GDM 一样，1 小时 GIGT 可能预测产后心血管高危表型。
在这项前瞻性队列研究中，485 名女性接受了产前 OGTT，随后在产后 3 个月进行了心血管危险因素评估。OGTT 确定了 4 种妊娠葡萄糖耐量组：GDM（n=137）；1 小时 GIGT（n=39）；2/3 小时 GIGT（n=50）；和正常葡萄糖耐量（NGT）（n=259）。在校正年龄、种族、母乳喂养和腰围后，以下心血管危险因素的平均水平从 NGT 逐渐增加至 2/3 小时 GIGT 至 1 小时 GIGT 至 GDM：LDL 胆固醇（p=0.0026）；总胆固醇：HDL（p=0.0030）；载脂蛋白 B（p=0.004）；载脂蛋白 B：载脂蛋白 A1（p=0.026）；瘦素（p=0.018）；和 C 反应蛋白（p=0.011）。
在没有 GDM 的女性中，1 小时 GIGT 预测产后心血管危险因素谱增强。因此，在妊娠期间出现轻度糖血症的年轻女性中，1 小时 GIGT 的女性可能构成未来心血管疾病风险未被识别的患者人群。
