Rizvi Ali A, Cuadra Silvia, Nikolic Dragana, Giglio Rosaria V, Montalto Giuseppe, Rizzo Manfredi
Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy.
Curr Pharm Biotechnol. 2014;15(1):38-46. doi: 10.2174/1389201015666140330193653.
Gestational diabetes mellitus (GDM) represents a condition of glucose intolerance with first appearance or recognition at the time of a pregnancy, associated with an inadequate pancreatic response to the advanced insulin resistance of the later stages of pregnancy, and accompanied by enhancing β-cell mass and secretion of insulin. Women who had GDM exhibit a higher risk for later advent of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). Additionally, previous GDM has been proposed as independently correlated with higher risk for development of atherosclerosis in a healthy population, similar to the metabolic syndrome (MetS) and independently of the presence of established CVD risk factors. Available data indicate multiple metabolic abnormalities common in women with GDM, including a high small dense low-density lipoprotein (sdLDL) concentration and a resultant high prevalence of CVD and the MetS. Preliminary data indicate that a measurement of sdLDL is worthwhile in women with GDM during pregnancy as well as the postpartum period. A close follow up of these women should be emphasized in clinical practice because GDM could predict not only eventual health risks for these mothers, but also their offspring. Thus, an improvement in care and risk modification of women with GDM may not only contribute towards improved CVD profile, but also potentially prevent adverse outcomes in their offspring. Lifestyle changes should be promoted in order to prevent excessive weight gain during pregnancy and decrease the risk of MetS in the postpartum and long-term.
妊娠期糖尿病（GDM）是指在妊娠期间首次出现或被诊断出的葡萄糖不耐受情况，与孕期后期胰腺对增强的胰岛素抵抗反应不足相关，同时伴有β细胞量增加和胰岛素分泌增多。患有妊娠期糖尿病的女性日后患2型糖尿病（T2DM）和心血管疾病（CVD）的风险更高。此外，既往妊娠期糖尿病已被认为与健康人群中动脉粥样硬化发生风险增加独立相关，类似于代谢综合征（MetS），且独立于已确定的心血管疾病危险因素的存在。现有数据表明，妊娠期糖尿病女性存在多种常见的代谢异常，包括小而密低密度脂蛋白（sdLDL）浓度升高以及由此导致的心血管疾病和代谢综合征的高患病率。初步数据表明，在妊娠期糖尿病女性的孕期及产后测量sdLDL是有价值的。在临床实践中应强调对这些女性进行密切随访，因为妊娠期糖尿病不仅可以预测这些母亲最终的健康风险，还能预测其后代的健康风险。因此，改善妊娠期糖尿病女性的护理和风险调整不仅可能有助于改善心血管疾病状况，还可能预防其后代出现不良结局。应提倡生活方式改变，以防止孕期体重过度增加，并降低产后及长期患代谢综合征的风险。
