-
Wei-Wei Zhu,
Ling Fan, Hui-Xia Yang,
Ling-Ying Kong,
Shi-Ping Su,
Zi-Lian Wang,
Ya-Li Hu,
Mei-Hua Zhang,
Li-Zhou Sun,
Yang Mi,
Xiu-Ping Du,
Hua Zhang,
Yun-Hui Wang,
Yin-Ping Huang,
Li-Ruo Zhong,
Hai-Rong Wu,
Nan Li,
Yun-Feng Wang,
Anil Kapur
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE
To evaluate the usefulness of a fasting plasma glucose (FPG) at 24-28 weeks' gestation to screen for gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS
The medical records and results of a 75-g 2-h oral glucose tolerance test (OGTT) of 24,854 pregnant women without known pre-GDM attending prenatal clinics in 15 hospitals in China were examined.RESULTSFPG cutoff value of 5.1 mmol/L identified 3,149 (12.1%) pregnant women with GDM. FPG cutoff value of 4.4 mmol/L ruled out GDM in 15,369 (38.2%) women. With use of this cutoff point, 12.2% of patients with mild GDM will be missed. The positive predictive value is 0.322, and the negative predictive value is 0.928.CONCLUSIONSFPG at 24-28 weeks' gestation could be used as a screening test to identify GDM patients in low-resource regions. Women with an FPG between ≥4.4 and ≤5.0 mmol/L would require a 75-g OGTT to diagnose GDM. This would help to avoid approximately one-half (50.3%) of the formal 75-g OGTTs in China.
Diabetes care 03/2013; · 8.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To study newborns weight in singleton term births and the association between newborns birth weight and mode of delivery in 3 hospitals.
From Jan. 2005 to Dec. 2009, 13 963 singleton term live neonates born in the Department of Obstetrics and Gynecology of Peking University First Hospital (PU group), 6519 neonates in Affiliated Hospital of Binzhou Medical College (BMC group,) and 8725 neonates in Miyun Hospital Affiliated to Capital Medical University, Yanjing Medical College (MYC group) were enrolled in this retrospective study. The newborns weight and the rate of macrosomia was calculated and compared. Those newborns from PU group and MYC group were divided into 2288 neonates at macrosomia group and 20 400 neonates at non-macrosomia group, their mode of deliveries were analyzed.
(1) The mean neonatal birth weight were (3386 ± 414) g at PU group, (3389 ± 446) g at BMC group and (3445 ± 449) g at MYC group. Neonates born weight in MYC was significantly higher than those from in PU group and BMC group (P = 0.000). Neonates born weight in BMC showed higher than those in PU group, which did not reached statistical difference (P = 0.638). (2) The incidence of macrosomia were 7.935% (1108/13 963) in PU group, 9.802% (639/6519) in BMU group and 13.524% (1180/8725) in MYU group. The incidence of macrosomia in MYC group was higher than those in PU and BMC group, the incidence of macrosomia in BMC group was higher than that in PU group, which reached statistically difference (P = 0.000). (3)The proportion of cesarean delivery were 75.306% (1723/2288) at macrosomia group, 50.765% (10 356/20 400) at non-macrosomia group, which showed statistical difference (P = 0.000).
(1) The difference of newborns birth weight existed in different administrative level hospital. (2) The risk of cesarean delivery due to macrosomia is higher than that of non-macrosomia. (3) Obstetricians should pay more attention to nutrition in gestation period to lessen the incidence of macrosomia and cesarean section.
Zhonghua fu chan ke za zhi 02/2013; 48(2):98-101.
-
Wei-Wei Zhu, Hui-Xia Yang,
Yu-Mei Wei,
Jie Yan,
Zi-Lian Wang,
Xue-Lan Li,
Hai-Rong Wu,
Nan Li,
Mei-Hua Zhang,
Xing-Hui Liu,
Hua Zhang,
Yun-Hui Wang,
Jian-Min Niu,
Yu-Jie Gan,
Li-Ruo Zhong,
Yun-Feng Wang,
Anil Kapur
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE
To evaluate the value of fasting plasma glucose value in first prenatal visit to diagnose gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS
Medical records of 17,186 pregnant women attending prenatal clinics in 13 hospitals in China, including the Peking University First Hospital (PUFH), were examined. Patients with pre-GDM were excluded; data for FPG at the first prenatal visit and one-step GDM screening with 75-g OGTT performed between 24 and 28 weeks of gestation were collected and analyzed.RESULTSThe median ± SD FPG value was 4.58 ± 0.437. FPG decreased with increasing gestational age. FPG level at first prenatal visit was strongly correlated with GDM diagnosed at 24-28 gestational weeks (χ(2) = 959.3, P < 0.001). The incidences of GDM were 37.0, 52.7, and 66.2%, respectively, for women with FPG at the first prenatal visit between 5.10 and 5.59, 5.60 and 6.09, and 6.10-6.99 mmol/L. The data of PUFH were not statistically different from other hospitals.CONCLUSIONS
Pregnant women (6.10 ≤ FPG < 7.00 mmol/L) should be considered and treated as GDM to improve outcomes; for women with FPG between 5.10 and 6.09 mmol/L, nutrition and exercise advice should be provided. An OGTT should be performed at 24-28 weeks to confirm or rule out GDM. Based on our data, we cannot support an FPG value ≥5.10 mmol/L at the first prenatal visit as the criterion for diagnosis of GDM.
Diabetes care 11/2012; · 8.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: To study whether the current Institute of Medicine (IOM) pregnancy weight gain recommendations vary by pre-pregnancy body mass index (BMI) was suitable to Chinese people. METHODS: A study was conducted on 4736 term singleton live birth gravidas, who were diagnosed normal glucose metabolism and delivered in Peking University First Hospital in 2005 and 2009, by reviewing the medical records. Based on the pre-pregnant BMI, the selected cases were divided into 3 groups: low body mass group (BMI < 18.5 kg/m(2), n = 465), normal body mass group (BMI 18.5 - 24.9 kg/m(2), n = 3549), over body mass group (BMI ≥ 25 kg/m(2), n = 722). All the cases were divided into 3 subgroups based on pregnancy weight gain as below, within, and above the IOM recommendations in each pre-pregnant BMI group. Totally 4736 newborns were divided by birth weight into 3 groups: normal birth weight group (weight 2500 - 4000 g, n = 4339), macrosomia group (weight ≥ 4000 g, n = 359) and low birth weight group (weight < 2500 g, n = 38). The difference of age, gestational age, pre-pregnant weight, pre-pregnant BMI and history of delivery of cases between 2005 and 2009 were analyzed. The difference of pregnancy outcome of women whose gestational weight gain was below, within, and above the IOM recommendations was analyzed. RESULTS: (1) Compared to mothers with pregnancy weight gain within IOM recommendations in low body mass group, risk of low birth weight in offspring was elevated tendency with pregnancy weight gain below IOM recommendations (OR = 3.71, 95%CI: 0.97 - 14.12, P = 0.055). (2) In normal body mass group, compared to women with pregnancy weight gain within IOM recommendations, risk of macrosomia in offspring was elevated with pregnancy weight gain above IOM recommendations (OR = 2.14, 95%CI: 1.62 - 2.83, P < 0.01). (3) In over body mass group, compared to women with pregnancy weight gain within IOM recommendations, risk of macrosomia in offspring was elevated (OR = 3.25, 95%CI: 1.65 - 6.39, P = 0.001) and risk of hypertensive disorders complicating pregnancy was high (OR = 1.79, 95%CI: 1.04 - 3.09, P = 0.037) in women with pregnancy weight gain above IOM recommendations. CONCLUSION: The current IOM pregnancy weight gain recommendations vary by pre-pregnancy BMI may be suitable to Chinese people.
Zhonghua fu chan ke za zhi 09/2012; 47(9):646-650.
-
Ling Yu,
Dong Li,
Qin-Ping Liao, Hui-Xia Yang,
Bin Cao,
Guodong Fu,
Gang Ye,
Yang Bai,
Hao Wang,
Nana Cui,
Ming Liu,
Yu-Xia Li,
Jun Li,
Chun Peng,
Yan-Ling Wang
[show abstract]
[hide abstract]
ABSTRACT: The pregnancy-specific disorder preeclampsia is a major cause of maternal mortality and morbidity. Activin A has been suggested as a potential biomarker of the disease, but whether it plays a role in the pathology of preeclampsia or is just a manifestation of the disease is not fully understood.
The objective of the study was to examine the roles of Activin A on placental trophoblast cells under pathological conditions of preeclampsia.
Placental and plasma productions of Activin A in healthy pregnant women and preeclamptic patients were compared by using clinical samples obtained from Peking University First Hospital during November 2005 to November 2007. The role of Activin A at pathological doses was investigated in human trophoblast cells.
Plasma and placental productions of Activin A were significantly higher in preeclamptic patients when compared with normal pregnant subjects in a Chinese Han population. Treatment of trophoblast cells with high doses of Activin A resulted in a significant increase in cell apoptosis. This effect was blocked not only by silencing Activin A's receptor activin receptor-like kinase 4 but also by knockdown of Nodal's receptor ALK7. Important to note was that Activin A could significantly increase Nodal expression in trophoblast cells, and knockdown of Nodal resulted in evident blockage on Activin A-induced trophoblast cell apoptosis.
High levels of Activin A observed in preeclamptic placenta may play a role in the pathogenesis of preeclampsia by inducing excessive apoptosis in placenta indirectly through enhancing Nodal expression.
The Journal of clinical endocrinology and metabolism 06/2012; 97(8):E1370-9. · 6.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Preeclampsia is represented by hypertension and proteinuria in pregnancy. It usually occurs after 20 gestational weeks. There are few reports on preeclampsia before 20 gestational weeks. In this case, we report a patient with chronic hypertension superimposed with preeclampsia at 13 gestational weeks.
Chinese medical journal 06/2012; 125(11):2067-9. · 0.86 Impact Factor
-
Chinese medical journal 04/2012; 125(7):1206-8. · 0.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Osteogenesis imperfecta is a group of inherited connective-tissue disorders in which synthesis or structure of type I collagen is defective and causes osseous fragility. Type IV osteogenesis imperfecta is dominant inheritance. Here, we report a case of type IV osteogenesis imperfecta family and their female member's pregnancy. Abnormal sonographic findings (marked bowing and shortening of long bones) and family history made the diagnosis of fetus with osteogenesis imperfecta. The parents decided to give up rescuing the infant and a caesarean section at 27 weeks of gestation was implemented. In conclusion, it is possible to make a prenatal diagnosis of osteogenesis imperfecta by ultrasound. For the pregnant women with osteogenesis imperfecta, management decision should be made on an individual basis.
Chinese medical journal 04/2012; 125(7):1358-60. · 0.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Prenatal hyperglycaemia may increase metabolic syndrome susceptibility of the offspring. An underlying component of the development of these morbidities is hepatic gluconeogenic molecular dysfunction. We hypothesized that maternal hyperglycaemia will influence her offsprings hepatic peroxisome proliferator-activated receptor coactivator-1α (PGC-1α) expression, a key regulator of glucose production in hepatocytes.
We established maternal hyperglycaemia by streptozotocin injection to induce the maternal hyperglycaemic Wistar rat model. Offspring from the severe hyperglycemia group (SDO) and control group (CO) were monitored until 180 days after birth. Blood pressure, lipid metabolism indicators and insulin resistance (IR) were measured. Hepatic PGC-1α expression was analyzed by reverse transcription polymerase chain reaction and Western blotting. mRNA expression of two key enzymes in gluconeogenesis, glucose-6-phosphatase (G-6-Pase) and phosphoenolpyruvate carboxykinase (PEPCK), were analyzed and compared.
In the SDO group, PGC-1α expression at protein and mRNA levels were increased, so were expression of G-6-Pase and PEPCK (P < 0.05). The above effects were seen prior to the onset of IR.
The hepatic gluconeogenic molecular dysfunction may contribute to the metabolic morbidities experienced by this population.
Chinese medical journal 04/2012; 125(7):1224-9. · 0.86 Impact Factor
-
Yang Bai,
Weiwei Yang, Hui-xia Yang,
Qinping Liao,
Gang Ye,
Guodong Fu,
Lei Ji,
Peng Xu,
Hao Wang,
Yu-xia Li,
Chun Peng,
Yan-ling Wang
[show abstract]
[hide abstract]
ABSTRACT: Preeclampsia (PE) is a pregnancy-specific syndrome manifested by on-set of hypertension and proteinuria after 20 weeks of gestation. Abnormal placenta development has been generally accepted as initial cause of the disorder. Recently, miR-195 was found to be down-regulated in preeclamptic placentas compared with normal pregnant ones, indicating possible association of this small molecule with placental pathology of preeclampsia. By far the function of miR-195 in the development of placenta remains unknown.
Bioinformatic assay predicted ActRIIA as one of the targets for miR-195. By using Real-time PCR, Western blotting and Dual Luciferase Assay, we validated that ActRIIA was the direct target of miR-195 in human trophoblast cells. Transwell insert invasion assay showed that miR-195 could promote cell invasion in trophoblast cell line, HTR8/SVneo cells, and the effect could be abrogated by overexpressed ActRIIA. In preeclamptic placenta tissues, pri-miR-195 and mature miR-195 expressions were down-regulated, whereas ActRIIA level appeared to be increased when compared with that in gestational-week-matched normal placentas.
This is the first report on the function of miR-195 in human placental trophoblast cells which reveals an invasion-promoting effect of the small RNA via repressing ActRIIA. Aberrant expression of miR-195 may contribute to the occurrence of preeclampsia through interfering with Activin/Nodal signaling mediated by ActRIIA in human placenta.
PLoS ONE 01/2012; 7(6):e38875. · 4.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To study the value of cervical length (CL) by transvaginal sonography in the mid-trimester and late-trimester for the prediction of preterm delivery.
The CL was measured by transvaginal sonography for 5277 pregnant women between 22 - 24 weeks and 28 - 32 weeks gestation, who were prenatal cared and delivered at the First Hospital of Peking University from June 2008 to November 2009. The pregnancy outcomes were followed, and the relationship between CL and preterm delivery and preterm premature rupture of membrane was studied.
(1) The incidence of preterm delivery was 5.4% (289/5370) total, among of them the incidence of therapeutic preterm delivery was 1.7% (93/5370), spontaneously preterm delivery was 1.2% (62/5370), and preterm premature rupture of membrane was 2.5% (134/5370). There are 4 cases (4/5370) who occured late abortion. (2) Excluding the 93 women who had therapeutic preterm delivery, the mean CL of 22 - 24 weeks was (38.8 ± 4.0) mm. The relative risk for preterm delivery when the CL < 30 mm was 5.2, when CL < 25 mm, the relative risk was 11.1, and when CL < 15 mm the relative risk for preterm delivery was 13.8. The average CL during 28-32 weeks of gestation was (34.6 ± 4.8) mm, was significantly shorter than that of 22 - 24 weeks (P < 0.05). During this period the relative risk for preterm delivery when the CL < 30 mm was 6.9, when CL < 25 mm, the relative risk was 11.1, and when CL < 15 mm the relative risk for preterm delivery was 20.0. (3) A CL < 30 mm as the cut-off value for predicting preterm delivery during 22 - 24 weeks of gestation has only a 3% sensitivity and 19% positive predictive value, but had a 99% specificity and 96% negative predictive value. The sensitivity, positive predictive value, specificity and negative predictive value for a CL < 30 mm as the cut-off value for predicting preterm delivery during 28 - 32 weeks of gestation was 33%, 21%, 95% and 97% respectively. (4) The total number of preterm premature rupture of membrane pregnant women was 134 (2.5%), who had a mean CL of (38.4 ± 4.7) mm during 22 - 24 weeks of gestation, was similar with the women without preterm premature rupture of membrane (PPROM), but during 28 - 32 weeks of gestation the women who occured PPROM had a mean cervical length of (30.6 ± 8.1) mm, and was significantly shorter than that of women without PPROM (34.7 ± 4.6) mm.
(1) CL in 28 - 32 weeks of gestation is significantly shorter than that of in the mid-gestation, but more than 90% of women has a CL ≥ 30 mm. (2) The shorter the CL is, the greater the relative risk of preterm delivery. According to different CL for clinical consulting objective relative risk could be provide. (3) The CL during 28 - 32 weeks of gestation can also predict preterm delivery, the sensitivity is obviously better than that of 22 - 24 weeks of gestation. (4) The CL during 28 - 32 weeks of gestation is valuable for predicting of PPROM.
Zhonghua fu chan ke za zhi 10/2011; 46(10):748-52.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the relationship between gestational hyperglycemia and adverse pregnancy outcomes and find out the optimum diagnostic criteria of gestational diabetes mellitus in China.
A retrospective population-based study of 14 593 pregnant women, who delivered between Jan.2005 and Dec.2009 and accepted the gestational diabetes mellitus (GDM) screening and diagnosis was performed. The prevalence of gestational hyperglycemia according to different criteria was calculated, and the incidence of adverse pregnant outcomes relation to gestational hyperglycemia according to different criteria was analyzed.
(1) According to National Diabetes Data Group (NDDG) criteria and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the prevalence of gestational hyperglycemia that intervention required was 8.9% (1293/14 593) and 14.7% (2138/14 593) respectively; the prevalence of gestational hyperglycemia differed significantly between NDDG and IADPSG criteria (P < 0.05). (2) The prevalence of macrosomia, large for gestational ages (LGA), cesarean section, preterm birth and neonatal hypoglycemia etc would increase in gestational glucose metabolic disorders according to any criteria. The prevalence of the complications in gestational hyperglycemia according to NDDG criteria, IADPSG criteria and the patients with normal glucose metabolism is as follows, macrosomia: 8.4% (108/1293), 11.3% (241/2138) and 6.7% (835/12 403); LGA: 9.7% (125/1293), 11.7% (250/2138) and 5.5% (687/12 403); cesarean section: 59.0% (763/1293), 60.4% (1291/2138) and 51.6% (6397/12 403); preterm birth: 11.4% (147/1293), 9.5% (203/2138) and 6.3% (777/12 403); neonatal hypoglycemia: 2.6% (33/1293), 2.2% (46/2138) and 0.7% (89/12 403).(3) About 71.3% (922/1293) of the gestational hyperglycemia according to NDDG criteria could be well control only by diet control.
The prevalence of perinatal complications would increase in gestational hyperglycemia that achieved IADPSG criteria without intervention, so IADPSG criteria is reasonable in China.
Zhonghua fu chan ke za zhi 08/2011; 46(8):578-81.
-
Zhonghua er ke za zhi. Chinese journal of pediatrics 06/2011; 49(6):477-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Preeclampsia (PE) is a severe hypertensive disorder associated with pregnancy; despite substantial research effort in the past several years, the etiology of PE is still unclear. The role of epigenetic factors in the etiology of PE, including DNA methylation, has been poorly characterized. In the present study, we investigated global DNA methylation as well as DNA methylation of the paternally imprinted H19 gene in preeclamptic placentas. Using 5-methylcytosine immunohistochemistry and Alu and LINE-1 repeat pyrosequencing, we found that the global DNA methylation level and the DNA (cytosine-5) methyltransferase 1 mRNA level were significantly higher in the early-onset preeclamptic placentas when compared with the normal controls. Data from methylation-sensitive high resolution melting demonstrated hypermethylation of the promoter region of the H19 gene, and results of real-time PCR showed decreased mRNA expression of H19 gene in the early-onset preeclamptic placentas as compared with the normal controls. Our results suggest that abnormal DNA methylation during placentation might be involved in the pathophysiology of PE, especially early-onset preeclampsia.
Hypertension Research 02/2011; 34(5):655-61. · 2.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study investigated the prevalence of fecal incontinence (FI) and urinary incontinence (UI) in primiparous postpartum Chinese women.
Questionnaires about FI and UI symptoms were completed via telephone interviews conducted within 6 months postpartum.
A total of 1889 primiparous postpartum women were asked to participate in this investigation. Only 13 (0.69%) of them had FI within 6 months after parturition, including loss of flatus in six women (0.32%), loss of solid stool in one (0.05%), loss of liquid stool in two (0.11%) and fecal urgency in four (0.21%). Bivariate logistic regression analysis showed that FI was significantly associated with forceps delivery OR=37.91 (95% CI 4.20-342.18, P=0.001) and medio-lateral episiotomy OR=11.79 (95% CI 1.47-94.46, P=0.02). The prevalence of UI, stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI) was 9.9% (186), 8.0% (151), 1.0% (18) and 0.9% (17), respectively. Multinomial logistic regression analysis found that SUI prevalence was related to age OR=1.08 (95% CI 1.04-1.12, P=0.000), maternal weight OR=1.04 (95% CI 1.02-1.06, P=0.001), neonate head circumference OR=1.17 (95% CI 1.01-1.36, P=0.043), spontaneous labor OR=5.42 (95% CI 2.60-11.32, P=0.000), forceps delivery OR=7.0 (95% CI 2.40-20.41, P=0.000), and medio-lateral episiotomy OR=5.24 (95% CI 3.15-8.72, P=0.000).
1. FI and UI prevalence was lower in our department than reported in previous studies in other areas. 2. Vaginal delivery has a risk impact on women's FI and UI, especially forceps delivery and medio-lateral episiotomy. 3. Maternal age, weight, newborn head circumference, spontaneous vaginal delivery, forceps delivery, and medio-lateral episiotomy increase the risk of UI.
European journal of obstetrics, gynecology, and reproductive biology 10/2010; 152(2):214-7. · 1.97 Impact Factor
-
Zhonghua fu chan ke za zhi 09/2010; 45(9):641-3.
-
Zhonghua fu chan ke za zhi 09/2010; 45(9):644-5.
-
Xue-Lian Gao,
Yu-Mei Wei, Hui-Xia Yang,
Xian-Ming Xu,
Ling Fan,
Jing He,
Ning Liu,
San-Cun Zhao,
Ya-Li Hu,
Zi Yang,
Yun-Ping Zhang,
Xing-Hui Liu,
Xu Chen,
Jian-Ping Zhang,
Wen-Li Gou,
Mei Xiao,
Hai-Rong Wu,
Mei-Hua Zhang
[show abstract]
[hide abstract]
ABSTRACT: The possibility of the 2 h oral glucose tolerance test (OGTT) as an alternative to the 3 h OGTT was investigated based on data from a national survey on pregnancy-associated diabetes. Data were retrieved from 4179 pregnant women who had OGTT performed after an abnormal 50 g glucose challenge test (GCT). All of the 4 glucose levels during their OGTT were collected and analyzed. According to American Diabetes Association (ADA) gestational diabetes mellitus (GDM) diagnostic criteria, among the 4179 pregnant women who required OGTT, 3429 (82.1%) were normal and 750 (17.9%) were diagnosed as GDM. If the 3rd h glucose levels were omitted from OGTT, 79 cases of GDM (10.5%) would be overlooked. No trend was shown where women with more risk factors were more likely to be overlooked if the 3rd h test was omitted (χ2 for trend=0.038, P>0.05). No significant differences were found in the rate of cesarean section (CS), preterm births or macrosomia between the 79 cases and those with normal OGTT results and in the gestational weeks when OGTT was performed. It shows that in order to diagnose one woman with GDM, another 52 pregnant women would have an innocent 3rd h glucose test. Omission of the 3rd h glucose test in OGTT might be reasonable due to its convenience, better compliance and a small number of possibly miss-diagnosed cases, and their pregnancy outcomes have no significant difference from those of normal pregnant women.
Frontiers of Medicine in China 09/2010; 4(3):303-7.
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the influencing factors of neonatal birth body mass in women with abnormal glucose metabolism during pregnancy.
A study was conducted on 1157 singleton gravidas, who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology, First Hospital, Peking University from January 2005 to December 2009, by reviewing the medical records. Based on the pre-pregnant body mass index, the selected cases were divided into 4 groups: low body mass group [body mass index (BMI) < 18.5 kg/m(2), n = 53], ideal body mass group (BMI 18.5-23.9 kg/m(2), n = 647), over body mass group (BMI 24.0-27.9 kg/m(2), n = 323), and obese group (BMI ≥ 28.0 kg/m(2), n = 134). 1157 newborns were divided by birth body mass into 3 groups: normal birth body mass group (body mass 2500-4000 g, n = 987), of which 545 cases of birth body mass 3000-3500 g for the appropriate newborns, macrosomia group (body mass ≥ 4000 g, n = 112); low birth body mass group (body mass < 2500 g, n = 58). The following information was collected, including pre-pregnancy body mass, height, gestational age of diagnosis and body mass gain after diagnosis, maternal serum level of cholesterol, history of adverse pregnancy, and family history of diabetes, gestational age, delivering body mass, neonatal birth body mass. The influence of pre-pregnant BMI, body mass gain during pregnancy, gestational age of diagnosis, body mass gain after diagnosis, maternal serum level of cholesterol, family history of diabetes on the newborns' birth body mass was analyzed. The appropriate ranges of gestational body mass gain were calculated in women with abnormal glucose metabolism.
(1) The average neonatal birth body mass for each group respectively were (3142 ± 333) g for low body mass group, (3339 ± 476) g for the ideal body mass group, (3381 ± 581) g for over body mass group, and (3368 ± 644) g for obese group. The neonatal birth body mass was increasing with maternal pre-pregnant BMI, and average birth body mass of the newborns in low body mass group was lower than other 3 groups, respectively, the difference was statistically significant (P < 0.05). The difference was not statistically significant (P > 0.05), when it was compared among the obese group, ideal weight group and over body mass group. (2) The body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for each group respectively were (13.5 ± 4.5) and (17.1 ± 5.4) kg for the ideal body mass group, (11.6 ± 4.9) and (15.3 ± 6.4) kg for the over body mass group, (10.3 ± 5.0) and (14.7 ± 7.4) kg for the obese group. The difference was statistically significant in 3 groups (P < 0.05). The difference of body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (3) The gestational age of diagnosis in women who delivered normal birth weight newborn and macrosomia for the ideal body mass group respectively were (27.8 ± 5.8) and (29.8 ± 5.3) weeks, the difference was statistically significant (P < 0.05). The gestational age of diagnosis in gravidas who delivered normal birth weight newborn and macrosomia for the over body mass group respectively were (26.7 ± 6.8) and (30.2 ± 4.1) weeks, the difference was statistically significant (P < 0.05). The gestational age of diagnosis in women who delivered normal birth weight newborn for obese group was (26.2 ± 7.5) weeks, less than that of pregnant women who delivered macrosomia [(25.7 ± 9.3) weeks], but the difference was not statistically significant (P > 0.05). The difference of the diagnosed gestational age for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (4) The serum triglyceride (TG) levels of pregnant women who delivered macrosomia was (3.1 ± 1.5) mmol/L, higher than that of pregnant women who delivered normal birth weight newborn [(2.7 ± 1.2) mmol/L], and the difference was statistically significant (P < 0.01). The serum high density lipoprotein cholesterol (HDL-C) levels of pregnant women who delivered macrosomia was (1.4 ± 0.3) mmol/L, lower than that of pregnant women who delivered normal birth weight newborn [(1.7 ± 0.9) mmol/L], and the difference was statistically significant (P < 0.01). The serum low-density lipoprotein cholesterol (LDL-C) and cholesterol level of pregnant women who delivered macrosomia respectively was (2.8 ± 0.8) and (5.4 ± 1.1) mmol/L, less than those of pregnant women who delivered normal birth weight newborn [(3.0 ± 0.9) mmol/L and (5.6 ± 1.1) mmol/L], but the difference was not statistically significant (P > 0.05). (5) The final regression model of variables into the top three were pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C, when analyzing the related factors of affecting neonatal birth body mass with multiple logistic regression analysis such as age, history of adverse pregnancy, family history of diabetes, pre-pregnancy BMI, body mass gain during pregnancy and after diagnosis of abnormal glucose metabolism, maternal serum level of cholesterol, abnormal glucose metabolism categories, gestational age and other factors (P < 0.01).
Pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C may affect the neonatal birth body mass whose mothers were complicated with abnormal glucose metabolism during pregnancy.
Zhonghua fu chan ke za zhi 09/2010; 45(9):646-51.
-
[show abstract]
[hide abstract]
ABSTRACT: Study the effects of early overfeeding in the adult offspring of mother with severely hyperglycaemia in pregnancy to islet development and insulin resistance.
Thirty healthy female Wistar rats were mated with 10 male Wistar rats and the morning on which sperm were found in three different visual fields of the vaginal smear was designated pregnancy day 1. The pregnant rats were intraperitoneally administered with Streptozotocin (STZ, 50 mg/L) on 5th day of pregnancy, and blood glucose exceeded 20 mmol/L to induce severely gestational diabetes mellitus (SDM) model. The pregnant Wistar rats were assigned to two experimental groups: SDM (n = 16) and control (n = 8). Litter size reduction in the lactation period induced early postnatal overfeeding model. Offspring were divided into three groups according to the level of blood glucose in pregnancy and feeding patterns in lactation: (1) control group (CG): euglycemia in pregnancy, eight pups in lactation; (2) severely gestational diabetes mellitus-normal feeding (SDM-N): severely gestational diabetes mellitus, eight pups in lactation; (3) severely gestational diabetes mellitus-overfeeding (SDM-O): severely gestational diabetes mellitus, four pups lactation. At the end of the lactation period, all pups were fed standard laboratory chow adlibitum until the date of the experiments. Offspring body weight was measured weekly after ablactation. Serum insulin was measured by enzyme-linked immunosorbent assay (ELISA) and pancreatic islet morphology was analyzed by immunohistochemistry (IHC) in all three groups at 26 weeks of age.
(1) Blood glucose of pregnant Wistar rats: SDM (28.3 ± 5.1) mmol/L was statistically higher than control (6.3 ± 1.4) mmol/L (P < 0.05). (2) Growth rates of body weight in 3-7 weeks and 3-9 weeks: SDM-N: (4.6 ± 1.3)% and (6.8 ± 2.5)%, SDM-O: (3.2 ± 0.7)% and (4.6 ± 1.2)%, CG: (2.9 ± 0.6)% and (4.1 ± 0.8)%. The growth rates of body weight in SDM-N and SDM-O were both significantly higher than those in CG (P < 0.05). (3) Body weight at 26 weeks: CG: (486 ± 132) g, SDM-N: (387 ± 115) g, SDM-O: (382 ± 122) g. There was no statistical difference among the three groups (P > 0.05). (4) Fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model of insulin resistance (HOMA-IR) and insulin sensitivity index (ISI): at 26 weeks, the SDM-offspring has normal FPG, but more insulin was needed to keep it normal. The insulin level of SDM-O [(12.6 ± 3.3) mU/L] was statistically higher than those of SDM-N [(10.9 ± 3.3) mU/L] and CG [(8.6 ± 0.8) mU/L] (P < 0.05). The ISI of SDM-O (0.020 ± 0.006) was significantly smaller than its HOMA-IR (2.40 ± 0.62, P < 0.05). (5) The morphological change of pancreatic islet: The islets of CG and SDM-N were round or ellipse and have clear boundary between endocrine and exocrine parts and the β cells distributed equally. However, SDM-O islets were not of uniform size and most of islets were hyperplasia and hypertrophy. (6) Relative β cell area of pancreas, β-cell area and islet size: SDM-O: (1.81 ± 0.31)%, (57.1 ± 3.2)% and (39,067 ± 3308) µm(2); SDM-N:(1.34 ± 0.43)%, (60.9 ± 0.6)% and (30,570 ± 4824) µm(2); CG: (1.11 ± 0.26)%, (63.7 ± 2.7)% and (26,443 ± 4431) µm(2). SDM-O has significantly increasing β-cell mass, hypertrophic islet size and slightly decreasing β-cell percentage compared with other two groups (P < 0.05).
The exposure of severely hyperglycemia in pregnancy induces low weight infant and postnatal catch-up growth leading to the possibility of insulin resistance (IR) in adult and early postnatal overfeeding will accelerate such course. Islet morphology of SDM-N has no significant change, indicating that maternal diabetes mainly affected β-cell function but not islet morphological features. SDM overfeeding results in early impairment of islet morphology and function, indicating that the compensation ability of islets has already been impaired and the risk of further development of impaired glucose tolerance (IGT) and diabetes. In conclusion, the nutritional environment in early life (duration of pregnancy and lactation) participate in the metabolic programming in adulthood.
Zhonghua fu chan ke za zhi 09/2010; 45(9):658-63.
