妊娠期体重增加对妊娠期糖尿病和糖耐量正常女性母体葡萄糖代谢的影响
Contribution of Gestational Weight Gain on Maternal Glucose Metabolism in Women with GDM and Normal Glucose Tolerance.
作者信息
Alvarado Fernanda L, O'Tierney-Ginn Perrie, Catalano Patrick
机构信息
Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA.
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
出版信息
J Endocr Soc. 2020 Dec 31;5(2):bvaa195. doi: 10.1210/jendso/bvaa195. eCollection 2021 Feb 1.
CONTEXT
Efforts to decrease the risk of developing metabolic complications of pregnancy such as gestational diabetes (GDM) through lifestyle intervention (decreasing excessive gestational weight gain (GWG)) during pregnancy have met with limited success.
OBJECTIVE
The purpose of this study was to determine the relationship between the longitudinal changes in weight/body composition and insulin sensitivity and response in women with normal glucose tolerance (NGT) and those who developed GDM.
DESIGN
We conducted a secondary analysis of a prospective cohort developed before conception and again at 34 to 36 weeks gestation. A total of 29 NGT and 17 GDM women were evaluated for longitudinal changes in insulin sensitivity/response using the hyperinsulinemic-euglycemic clamp and an IV-glucose tolerance test. Body composition was estimated using hydrodensitometry. Both absolute change (Δ) and relative change (%Δ) between these 2 time points were calculated. We performed simple and multiple linear regression analysis to assess the relationship between GWG and measures of glucose metabolism, ie, insulin sensitivity and response.
RESULTS
Based on the primary study design there was no significant difference in clinical characteristics between women with NGT and those developing GDM. Prior to pregnancy, women who developed GDM had lower insulin sensitivity levels ( = 0.01) compared with NGT women. Absolute change and %Δ in insulin sensitivity/insulin response and body weight/body composition were not significantly different between NGT and GDM women. Changes in body weight contributed to only 9% of the Δ in insulin sensitivity both in women developing GDM and NGT women.
CONCLUSIONS
These data suggest that other factors-such as maternal pre-pregnancy insulin sensitivity and placental derived factors affecting insulin sensitivity-rather than maternal GWG account for the changes in glucose metabolism during human pregnancy.
背景
通过孕期生活方式干预（减少孕期过度体重增加（GWG））来降低妊娠代谢并发症（如妊娠期糖尿病（GDM））发生风险的努力成效有限。
目的
本研究旨在确定糖耐量正常（NGT）女性和发生GDM的女性体重/身体成分的纵向变化与胰岛素敏感性及反应之间的关系。
设计
我们对孕前及孕34至36周时建立的前瞻性队列进行了二次分析。使用高胰岛素-正常血糖钳夹技术和静脉葡萄糖耐量试验，对29名NGT女性和17名GDM女性的胰岛素敏感性/反应的纵向变化进行了评估。使用水下密度测定法估算身体成分。计算了这两个时间点之间的绝对变化（Δ）和相对变化（%Δ）。我们进行了简单和多元线性回归分析，以评估GWG与葡萄糖代谢指标（即胰岛素敏感性和反应）之间的关系。
结果
根据主要研究设计，NGT女性和发生GDM的女性在临床特征上没有显著差异。孕前，发生GDM的女性与NGT女性相比，胰岛素敏感性水平较低（P = 0.01）。NGT女性和GDM女性在胰岛素敏感性/胰岛素反应及体重/身体成分的绝对变化和%Δ方面没有显著差异。在发生GDM的女性和NGT女性中，体重变化对胰岛素敏感性Δ的贡献均仅为9%。
结论
这些数据表明，在人类妊娠期间，影响葡萄糖代谢变化的是其他因素，如孕妇孕前胰岛素敏感性和影响胰岛素敏感性的胎盘衍生因素，而非孕妇的GWG。
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