Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand; School of Basic Medical Sciences, Youjiang Medical University for Nationalities, Baise, Guangxi, China.
Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Can J Diabetes. 2022 Dec;46(8):804-812.e2. doi: 10.1016/j.jcjd.2022.05.009. Epub 2022 May 31.
At the time of diagnosis, the blood glucose of women with gestational diabetes mellitus (GDM) who require subsequent insulin treatment does not differ from that of women with adequate diet control. Hence, in this study, we aimed to determine the role of maternal gut microbiota as a marker of insulin necessity in GDM and to identify the effect of insulin therapy on gut microbiota composition in mothers with GDM and their newborns.
Seventy-one pregnant women were enrolled into the study, including 38 GDM and 33 non-GDM participants. During the follow-up period, 8 of the 38 GDM subjects required insulin therapy (GDM-I group), whereas 30 of the 38 GDM cases with sufficient glycemic control by diet alone (GDM-D group). Maternal blood and feces were obtained at the time of GDM diagnosis (pretreatment; 24 to 28 weeks of gestation) and before delivery (posttreatment; ≥37 weeks of gestation). Meconium and first feces of the newborns were also collected.
Pretreatment, the glycemic profile did not differ between the GDM-D and GDM-I groups. However, the proportions of Clostridiales, Lactobacillus and Bacteroidetes were higher in the GDM-I group than in the non-GDM and GDM-D groups. After treatment, gut microbiota composition showed no difference between non-GDM and GDM-I groups. Interestingly, a higher Firmicutes/Bacteroidetes (F/B) ratio was displayed in GDM-D mothers at posttreatment, and this was also observed in both meconium and first feces of GDM-D newborns.
Insulin therapy changed maternal gut microbiota composition, which could be transferable to the mothers' newborns.
在诊断时，需要后续胰岛素治疗的妊娠期糖尿病（GDM）女性的血糖与饮食控制良好的女性并无差异。因此，本研究旨在确定母体肠道微生物群作为 GDM 胰岛素需求标志物的作用，并确定胰岛素治疗对 GDM 母亲及其新生儿肠道微生物群组成的影响。
本研究纳入了 71 名孕妇，包括 38 名 GDM 孕妇和 33 名非 GDM 孕妇。在随访期间，38 名 GDM 患者中有 8 名需要胰岛素治疗（GDM-I 组），而 38 名 GDM 患者中有 30 名通过饮食控制血糖充足（GDM-D 组）。在 GDM 诊断时（治疗前；妊娠 24 至 28 周）和分娩前（治疗后；≥37 周妊娠）采集母体血液和粪便。还收集了新生儿的胎便和首次粪便。
治疗前，GDM-D 组和 GDM-I 组的血糖谱没有差异。然而，与非 GDM 组和 GDM-D 组相比，GDM-I 组的梭菌目、乳杆菌属和拟杆菌属的比例更高。治疗后，非 GDM 组和 GDM-I 组的肠道微生物群组成没有差异。有趣的是，GDM-D 组母亲在治疗后显示出更高的厚壁菌门/拟杆菌门（F/B）比值，这在 GDM-D 新生儿的胎便和首次粪便中也观察到。
胰岛素治疗改变了母体肠道微生物群组成，这可能会传递给母亲的新生儿。
