Couch S C, Philipson E H, Bendel R B, Pujda L M, Milvae R A, Lammi-Keefe C J
Department of Nutritional Sciences, University of Connecticut, Storrs 06269, USA.
J Diabetes Complications. 1998 Jan-Feb;12(1):1-9. doi: 10.1016/s1056-8727(97)00007-x.
The objective of this study was to describe plasma and lipoprotein perturbations in gestational diabetes mellitus (GDM) compared to controls, and determine if alterations in lipids are related to gestational hormones and/or glucose control. Maternal HbA1c, free fatty acids (FFA), beta-estradiol, progesterone, prolactin, and plasma, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), HDL2 and HDL3 triglyceride (TG), cholesterol, and dietary intake were determined for women with diet-treated GDM and controls in a longitudinal design. Subjects (N = 25/group) were matched for age, race, and body-mass index (BMI). Women with GDM had significantly higher HbA1c than controls, although both groups were within the normal range (4%-6%). However, body weight gain was less for women with GDM. There was a trend for higher plasma FFAs at 37-38 weeks in GDM versus controls. Plasma and lipoprotein TG among the groups increased over the third trimester, and mean concentrations were greater for women with GDM. In GDM versus controls, VLDL and HDL3 TGs were higher at all times, HDL and HDL2 TGs at 33-34 and 37-38 weeks, and LDL TGs at 37-38 weeks. In VLDL, core lipids (TG + cholesterol) increased over gestation and were greater in GDM. In HDL, the TG/cholesterol ratio was greater in GDM. In GDM versus controls, plasma progesterone and prolactin were higher at all times; beta-estradiol was elevated at 37-38 weeks. HbA1c, progesterone, and prolactin correlated with all lipoprotein TG fractions. Exaggerated hypertriglyceridemia, particularly in the VLDL and HDL fractions, is a feature of GDM. The increase in VLDL TG is likely due to an increase in VLDL synthesis, whereas particle enrichment in TG is a plausible explanation for changes in HDL TG. Slight perturbations in glucose control and gestational hormones in diet-treated GDM may contribute to the observed increase in plasma and lipoprotein TG.
本研究的目的是描述与对照组相比，妊娠期糖尿病（GDM）患者血浆和脂蛋白的变化，并确定血脂改变是否与妊娠激素和/或血糖控制有关。采用纵向研究设计，测定了饮食治疗的GDM患者和对照组孕妇的糖化血红蛋白（HbA1c）、游离脂肪酸（FFA）、β-雌二醇、孕酮、催乳素，以及血浆、极低密度脂蛋白（VLDL）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、HDL2和HDL3的甘油三酯（TG）、胆固醇和饮食摄入量。受试者（每组N = 25）按年龄、种族和体重指数（BMI）进行匹配。GDM患者的HbA1c显著高于对照组，尽管两组均在正常范围内（4%-6%）。然而，GDM患者的体重增加较少。与对照组相比，GDM患者在37-38周时血浆FFA有升高趋势。各组血浆和脂蛋白TG在妊娠晚期均升高，GDM患者的平均浓度更高。与对照组相比，GDM患者的VLDL和HDL3 TG在所有时间均较高，HDL和HDL2 TG在33-34周和37-38周时较高，LDL TG在37-38周时较高。在VLDL中，核心脂质（TG + 胆固醇）在妊娠期增加，且GDM患者更高。在HDL中，GDM患者的TG/胆固醇比值更高。与对照组相比，GDM患者血浆孕酮和催乳素在所有时间均较高；β-雌二醇在37-38周时升高。HbA1c、孕酮和催乳素与所有脂蛋白TG组分相关。GDM的一个特征是甘油三酯血症过度，特别是在VLDL和HDL组分中。VLDL TG的增加可能是由于VLDL合成增加，而TG在颗粒中的富集是HDL TG变化的一个合理原因。饮食治疗的GDM患者血糖控制和妊娠激素的轻微变化可能导致观察到的血浆和脂蛋白TG增加。
