From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, and the Department of Maternal and Child Health, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Department of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, the Departments of Nutrition and Epidemiology, Harvard School of Public Health, the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and the Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Brigham Circle, Boston, Massachusetts.
Obstet Gynecol. 2011 Nov;118(5):1065-1073. doi: 10.1097/AOG.0b013e3182325f5a.
To estimate the independent effect of gestational impaired glucose tolerance, defined as a single abnormal oral glucose tolerance test value, on metabolic dysfunction at 3 years postpartum.
We used multiple linear regression to measure associations between glucose testing during pregnancy and metabolic markers at 3 years postpartum in Project Viva, a prospective cohort study of maternal and infant health. We compared metabolic measures at 3 years postpartum among four groups: normal glucose challenge test (less than 140 mg/dL, n=461); abnormal glucose challenge test but normal glucose tolerance test (n=39); impaired glucose tolerance (a single abnormal glucose tolerance test value, n=21); and gestational diabetes mellitus (n=16).
Adjusting for age, race, parity, parental history of diabetes, and maternal body mass index at 3 years postpartum, we found women with gestational diabetes mellitus had lower adiponectin (11.2 ng/mL compared with 20.7 ng/mL) and higher homeostatic model assessments of insulin resistance (3.1 compared with 1.3) and waist circumference (91.3 cm compared with 86.2 cm) compared with women with impaired glucose tolerance or normal glucose tolerance. Women in both the impaired glucose tolerance and gestational diabetes mellitus groups had lower high-density lipoprotein (gestational diabetes mellitus 44.7 mg/dL; impaired glucose tolerance 45.4/dL compared with normal glucose tolerance 55.8 mg/dL) and higher triglycerides (gestational diabetes mellitus 136.1 mg/dL; impaired glucose tolerance 140.1 mg/dL compared with normal glucose tolerance 78.3) compared with women in the normal glucose tolerance group. We found the highest values for hemoglobin A1c (gestational diabetes mellitus 5.1%, impaired glucose tolerance 5.3%, normal glucose tolerance 5.1%) and high-sensitivity C-reactive protein (gestational diabetes mellitus 1.4 mg/dL, impaired glucose tolerance 2.2 mg/dL, normal glucose tolerance 1.0 mg/dL) among women with impaired glucose tolerance.
Gestational diabetes mellitus and impaired glucose tolerance during pregnancy are associated with persistent metabolic dysfunction at 3 years postpartum, independent of other clinical risk factors.
评估妊娠期糖耐量受损（仅一次口服葡萄糖耐量试验异常）对产后 3 年代谢功能障碍的独立影响。
我们使用多元线性回归方法，在 Viva 项目中（一项关于母婴健康的前瞻性队列研究），测量了妊娠期间葡萄糖检测与产后 3 年代谢标志物之间的相关性。我们比较了产后 3 年 4 组的代谢指标：正常葡萄糖负荷试验（<140mg/dL，n=461）；异常葡萄糖负荷试验但正常葡萄糖耐量试验（n=39）；糖耐量受损（仅一次葡萄糖耐量试验异常，n=21）；妊娠期糖尿病（n=16）。
校正产后 3 年的年龄、种族、产次、父母糖尿病史和母亲体重指数后，我们发现妊娠期糖尿病患者的脂联素水平较低（11.2ng/mL 比 20.7ng/mL），胰岛素抵抗稳态模型评估值较高（3.1 比 1.3），腰围较大（91.3cm 比 86.2cm），与糖耐量受损或正常葡萄糖耐量患者相比。糖耐量受损和妊娠期糖尿病患者的高密度脂蛋白均较低（妊娠期糖尿病组 44.7mg/dL；糖耐量受损组 45.4/dL 比正常葡萄糖耐量组 55.8mg/dL），甘油三酯较高（妊娠期糖尿病组 136.1mg/dL；糖耐量受损组 140.1mg/dL 比正常葡萄糖耐量组 78.3mg/dL），与正常葡萄糖耐量组相比。我们发现糖耐量受损患者的血红蛋白 A1c（妊娠期糖尿病组 5.1%、糖耐量受损组 5.3%、正常葡萄糖耐量组 5.1%）和高敏 C 反应蛋白（妊娠期糖尿病组 1.4mg/dL、糖耐量受损组 2.2mg/dL、正常葡萄糖耐量组 1.0mg/dL）值最高。
妊娠期糖尿病和妊娠期糖耐量受损与产后 3 年持续的代谢功能障碍相关，独立于其他临床危险因素。
