Vilmi-Kerälä Tiina, Palomäki Outi, Kankkunen Päivi, Juurinen Leena, Uotila Jukka, Palomäki Ari
School of Medicine, University of Tampere, Tampere, Finland.
Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
Acta Obstet Gynecol Scand. 2016 Dec;95(12):1425-1432. doi: 10.1111/aogs.13029.
Gestational diabetes mellitus (GDM) is an indicator of future cardiovascular disease. We investigated whether sensitive biomarkers of increased cardiovascular risk differ between women with and without a history of GDM few years after pregnancy, and whether obesity affects the results.
We studied two cohorts - 120 women with a history of GDM and 120 controls, on average 3.7 years after delivery. Circulating concentrations of oxidized low-density lipoprotein (oxLDL) were determined by ELISA. The homeostasis model assessment of insulin resistance (HOMA-IR) index was used to estimate insulin resistance. Central blood pressure (cBP) was measured noninvasively from a radial artery pulse wave. The primary outcomes were possible differences in oxLDL, HOMA-IR or cBP between the groups. Secondly, we investigated the influence of obesity on the results, also using adjusted multiple linear regression analyses.
OxLDL concentrations or cBP did not differ between the two cohorts, but HOMA-IR was significantly higher in women with previous GDM than in controls, 1.3 ± 0.9 (SD) and 1.1 ± 0.9, respectively (p = 0.022). In subgroup analyses, HOMA-IR (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) cBP were significantly higher in obese subgroups compared with non-obese ones. Body mass index was an important determinant of HOMA-IR and cBP in multiple linear regression analyses.
Over 3 years after delivery, women with GDM were still more insulin-resistant than controls. Obesity turned out to be a more important determinant of insulin resistance and cBP compared with GDM.
妊娠期糖尿病（GDM）是未来心血管疾病的一个指标。我们调查了妊娠后几年有和没有GDM病史的女性之间，心血管风险增加的敏感生物标志物是否存在差异，以及肥胖是否会影响结果。
我们研究了两个队列——120名有GDM病史的女性和120名对照者，平均在分娩后3.7年。通过酶联免疫吸附测定法（ELISA）测定氧化低密度脂蛋白（oxLDL）的循环浓度。使用胰岛素抵抗稳态模型评估（HOMA-IR）指数来估计胰岛素抵抗。通过桡动脉脉搏波无创测量中心血压（cBP）。主要结局是两组之间oxLDL、HOMA-IR或cBP可能存在的差异。其次，我们还使用调整后的多元线性回归分析研究了肥胖对结果的影响。
两个队列之间oxLDL浓度或cBP没有差异，但既往有GDM的女性的HOMA-IR显著高于对照组，分别为1.3±0.9（标准差）和1.1±0.9（p = 0.022）。在亚组分析中，肥胖亚组的HOMA-IR（p < 0.001）、收缩压（p < 0.001）和舒张压（p < 0.001）cBP均显著高于非肥胖亚组。在多元线性回归分析中，体重指数是HOMA-IR和cBP的重要决定因素。
分娩后3年多，有GDM的女性仍然比对照组更具胰岛素抵抗性。与GDM相比，肥胖被证明是胰岛素抵抗和cBP更重要的决定因素。
