Mosavat Maryam, Omar Siti Zawiah, Tan Peng Chiong, Razif Muhammad Fazril Mohamad, Sthaneshwar Pavai
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
Arch Gynecol Obstet. 2018 Mar;297(3):797-803. doi: 10.1007/s00404-017-4617-0. Epub 2017 Dec 21.
To assess the association of serum leptin and its receptor (SLeptinR) with the risk of gestational diabetes mellitus (GDM) and to evaluate the longitudinal circulation of these peptides in pregnancy.
This study consisted of 53 subjects diagnosed with GDM and 43 normal glucose tolerance (NGT) pregnant women. Serum leptin and SLeptinR were measured at 24-28 weeks, prior and after delivery, and post-puerperium.
Lower levels of leptin and SLeptinR were observed in GDM compared to NGT. Leptin [OR 0.97 (95% CI 0.94-1.0)] and SLeptinR [OR 0.86 (95% CI 0.79-0.93]) were inversely associated with GDM. Participants in the lowest tertile for leptin and SLeptinR had a 2.8-fold (95% CI 1.0-7.6) and a 5.7-fold (95% CI 1.9-17.3) higher risk of developing GDM compared with the highest tertile, respectively. These relationships were attenuated after adjustment for covariates. In both the groups, peak leptin was observed at 24-28 weeks, decreasing continuously during pregnancy (p > 0.05) and after delivery (p < 0.017). SLeptinR level increased (p < 0.001) during pregnancy and decreased (p < 0.005) after delivery in GDM, however, levels remained the same in NGT. In GDM, leptin and SLeptinR was positively and inversely correlated with BMI and HOMA-IR at 24-28 weeks and post-puerperium, respectively. The cord levels of both leptin and SLeptinR were lower than maternal levels. There were no significant differences in serum cord leptin and SLeptinR levels between the groups.
Leptin and SLeptinR are independently and inversely associated with GDM. Lower levels of these peptides may play an important role in the pathophysiology of GDM and pre-diabetic state in post-puerperium.
评估血清瘦素及其受体（SLeptinR）与妊娠期糖尿病（GDM）风险的关联，并评估这些肽在孕期的纵向循环情况。
本研究纳入了53例诊断为GDM的受试者和43例糖耐量正常（NGT）的孕妇。在孕24 - 28周、分娩前和分娩后以及产褥期测量血清瘦素和SLeptinR。
与NGT相比，GDM患者的瘦素和SLeptinR水平较低。瘦素[比值比（OR）0.97（95%置信区间[CI] 0.94 - 1.0）]和SLeptinR [OR 0.86（95% CI 0.79 - 0.93）]与GDM呈负相关。瘦素和SLeptinR处于最低三分位数的参与者发生GDM的风险分别比最高三分位数者高2.8倍（95% CI 1.0 - 7.6）和5.7倍（95% CI 1.9 - 17.3）。在调整协变量后，这些关系减弱。在两组中，瘦素峰值均出现在孕24 - 28周，孕期（p > 0.05）和分娩后（p < 0.017）持续下降。在GDM中，SLeptinR水平在孕期升高（p < 0.001），分娩后下降（p < 0.005），然而，在NGT中水平保持不变。在GDM中，瘦素和SLeptinR在孕24 - 28周和产褥期分别与体重指数（BMI）和稳态模型评估的胰岛素抵抗指数（HOMA - IR）呈正相关和负相关。脐带血中瘦素和SLeptinR水平均低于母体水平。两组间脐带血血清瘦素和SLeptinR水平无显著差异。
瘦素和SLeptinR与GDM独立且呈负相关。这些肽水平较低可能在GDM的病理生理过程及产褥期糖尿病前期状态中起重要作用。
