Insulin resistance and pregnancy outcomes in gestational diabetes mellitus gravida complicated by chronic hypertension

Q4 Medicine

中华围产医学杂志 Pub Date : 2020-02-16 DOI:10.3760/CMA.J.ISSN.1007-9408.2020.02.004

J. Juan, Yiying Sun, C. Ye, Huixia Yang

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Abstract

Objective To analyze insulin resistance (IR) level and pregnancy outcomes in women with gestational diabetes mellitus (GDM) complicated by chronic hypertension (CHT). Methods This is a retrospective case-control study involving 2 457 singleton pregnant women complicated by GDM who received regular prenatal examinations and participated in the one-day-care clinic of GDM in Peking University First Hospital from January 1, 2014 to December 31, 2016. Clinical data were collected and homeostasis model assessment insulin resistance (HOMA-IR) was calculated. All subjects were divided into two groups: GDM with CHT group (CHT group, n=47) and GDM without CHT group (non-CHT group, n=2 410). Based on their pre-pregnancy body mass index (BMI), they were also grouped into normal pre-pregnancy BMI group (n=1 590) and overweight and obese group (n=863). Two-sample independent t test and Chi-square test were used to compared the age, HOMA-IR, pre-pregnancy BMI, weight gain during pregnancy and glucose levels between groups, and logistic regression model was used to analyze the effects of HOMA-IR on pregnancy outcomes. Results HOMA-IR (3.5±1.8 vs 2.6±1.5, t=-3.290), fasting plasma glucose [(5.4±0.5) vs (5.2±0.5) mmol/L, t=-3.005], pre-pregnancy BMI [(26.7±4.7) vs (23.3±3.4) kg/m2, t=-4.842] and the incidence of preeclampsia [14.9% (7/47) vs 2.5% (61/2 410), χ2=21.790] were significantly higher in GDM women with CHT than those without (all P 0.05). For pregnant women with normal pre-pregnancy BMI, HOMA-IR (3.0±1.5 vs 2.3±1.2, t=-2.217), fasting plasma glucose [(5.4±0.5) vs (5.1±0.5) mmol/L, t=-2.299] and the incidence of preeclampsia [2/14 vs 1.6% (26/1 576), χ2=6.545] were higher in the CHT group than the non-CHT group (all P 0.05). After adjusting for age, fasting plasma glucose, pre-pregnancy BMI and weight gain during pregnancy, the elevated HOMA-IR level increased the risk of preterm birth (OR=1.223, 95%CI: 1.093-1.369, P<0.001) in GDM women without CHT. Conclusions GDM gravida complicated by CHT have severe insulin resistance and a higher incidence of preeclampsia, but the risk of other pregnancy outcomes are not increased. Key words: Diabetes, gestational; Hypertension; Insulin resistance; Pregnancy outcome

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妊娠期糖尿病合并慢性高血压患者的胰岛素抵抗与妊娠结局

目的分析妊娠期糖尿病(GDM)合并慢性高血压(CHT)患者胰岛素抵抗(IR)水平与妊娠结局的关系。方法对2014年1月1日至2016年12月31日在北京大学第一医院GDM一日门诊接受常规产前检查并合并GDM的2 457例单胎孕妇进行回顾性病例对照研究。收集临床资料，计算胰岛素抵抗稳态模型(HOMA-IR)。所有受试者分为两组:GDM合并CHT组(n =47)和GDM不合并CHT组(n = 2410)。根据孕妇孕前体重指数(BMI)分为孕前体重指数正常组(n= 1590)和超重肥胖组(n=863)。采用两样本独立t检验和卡方检验比较各组年龄、HOMA-IR、孕前BMI、孕期体重增加及血糖水平，采用logistic回归模型分析HOMA-IR对妊娠结局的影响。结果GDM合并CHT组HOMA-IR(3.5±1.8 vs 2.6±1.5,t=-3.290)、空腹血糖[(5.4±0.5)vs(5.2±0.5)mmol/L, t=-3.005]、孕前BMI[(26.7±4.7)vs(23.3±3.4)kg/m2, t=-4.842]、先兆子痫发生率[14.9% (7/47)vs 2.5% (61/2 410)， χ2=21.790]均显著高于未合并CHT组(P均为0.05)。孕前BMI正常的孕妇，CHT组HOMA-IR(3.0±1.5 vs 2.3±1.2,t=-2.217)、空腹血糖[(5.4±0.5)vs(5.1±0.5)mmol/L, t=-2.299]、先兆子痫发生率[2/14 vs 1.6% (26/1 576)， χ2=6.545]均高于非CHT组(P均为0.05)。在调整了年龄、空腹血糖、孕前BMI和孕期体重增加等因素后，在没有CHT的GDM女性中，HOMA-IR水平升高增加了早产的风险(OR=1.223, 95%CI: 1.093-1.369, P<0.001)。结论GDM妊娠合并CHT患者胰岛素抵抗严重，子痫前期发生率较高，但其他妊娠结局风险未增加。关键词:糖尿病;妊娠期;高血压;胰岛素抵抗;怀孕的结果

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来源期刊

中华围产医学杂志 Medicine-Obstetrics and Gynecology

CiteScore

0.70

自引率

0.00%

发文量

4446

期刊介绍： Chinese Journal of Perinatal Medicine was founded in May 1998. It is one of the journals of the Chinese Medical Association, which is supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by Peking University First Hospital. Perinatal medicine is a new discipline jointly studied by obstetrics and neonatology. The purpose of this journal is to "prenatal and postnatal care, improve the quality of the newborn population, and ensure the safety and health of mothers and infants". It reflects the new theories, new technologies, and new progress in perinatal medicine in related disciplines such as basic, clinical and preventive medicine, genetics, and sociology. It aims to provide a window and platform for academic exchanges, information transmission, and understanding of the development trends of domestic and foreign perinatal medicine for the majority of perinatal medicine workers in my country.