Gether Ida M, Andersen Emilie S, Foghsgaard Signe, Ellegaard Anne-Marie, Kelstrup Louise, Sonne David P, Brønden Andreas, Gillum Matthew P, Holst Jens J, Hartmann Bolette, Rehfeld Jens F, Vilsbøll Tina, Knop Filip K
Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
Diabetes Obes Metab. 2025 Feb;27(2):697-709. doi: 10.1111/dom.16064. Epub 2024 Nov 14.
Gestational diabetes mellitus (GDM) has been associated with reduced postprandial glucagon-like peptide 1 (GLP-1) responses. As pregnancy induces changes in gallbladder motility and bile acids stimulate GLP-1 secretion, we investigated postprandial gallbladder emptying and GLP-1 responses in women with GDM.
Women with and without GDM underwent two 240-min mixed meal tests; one during third trimester of pregnancy and one 3-6 months postpartum. We evaluated ultrasonography-assessed gallbladder emptying, plasma concentrations of glucometabolic hormones including GLP-1, paracetamol absorption (proxy for gastric emptying) and circulating factors known to affect gallbladder dynamics.
Fifteen women with GDM and 15 pregnant women with normal glucose tolerance (NGT) (baseline median age 31 (interquartile range 29;33) versus 32 (28;33) years, body mass index (BMI) 27.2 (24.7;30.7) versus 28.4 (26.2;31.0) kg/m, HbA 30 (29;32) versus 30 (28;31) mmol/mol) were included. No differences in postprandial gallbladder emptying or GLP-1 responses were observed between women with and without GDM, neither during pregnancy nor postpartum. Pregnancy increased fasting gallbladder volumes by 69 (30;122)% and 103 (59;156)% and postprandial gallbladder emptying by 77 (28;236)% and 99 (37;190)% compared with postpartum in women with and without GDM, respectively. Postprandial GLP-1 responses were reduced by 60 (3;82)% and 81 (11;90)% during pregnancy compared with postpartum in women with and without GDM, respectively.
Pregnancy-induced changes in gallbladder motility seem to play no or a limited role in previously reported GDM-associated reduced postprandial GLP-1 responses as gallbladder emptying was greater and postprandial GLP-1 response was lower in pregnancy than postpartum regardless of GDM status.
妊娠期糖尿病（GDM）与餐后胰高血糖素样肽1（GLP-1）反应降低有关。由于妊娠会引起胆囊运动的变化，且胆汁酸会刺激GLP-1分泌，我们研究了GDM女性的餐后胆囊排空及GLP-1反应。
患有和未患有GDM的女性均接受了两次240分钟的混合餐试验；一次在妊娠晚期进行，另一次在产后3至6个月进行。我们评估了超声检查测定的胆囊排空情况、包括GLP-1在内的糖代谢激素的血浆浓度、对乙酰氨基酚吸收情况（胃排空的指标）以及已知影响胆囊动力学的循环因子。
纳入了15名患有GDM的女性和15名糖耐量正常（NGT）的孕妇（基线中位年龄分别为31岁（四分位间距29；33）和32岁（28；33），体重指数（BMI）分别为27.2（24.7；30.7）kg/m²和28.4（26.2；31.0）kg/m²，糖化血红蛋白（HbA）分别为30（29；32）和30（28；31）mmol/mol）。无论在孕期还是产后，患有和未患有GDM的女性之间在餐后胆囊排空或GLP-1反应方面均未观察到差异。与产后相比，妊娠使患有和未患有GDM的女性空腹胆囊容积分别增加了69（30；122）%和103（59；156）%，餐后胆囊排空分别增加了77（28；236）%和99（37；190）%。与产后相比，妊娠期间患有和未患有GDM的女性餐后GLP-1反应分别降低了60（3；82）%和81（11；90）%。
妊娠引起的胆囊运动变化似乎在先前报道的GDM相关的餐后GLP-1反应降低中不起作用或作用有限，因为无论GDM状态如何，妊娠期间的胆囊排空均大于产后，且餐后GLP-1反应低于产后。
