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Title: Lipid metabolism indices and other signs of metabolic syndrome in women with gestational diabetes
Abstract:
Gestational diabetes occurs in about 1-14% of pregnant women. It is a reason for 90% of carbohydrate disorders in pregnant women. Gestational diabetes is a serious health hazard for the fetus causing macrosomia and associated peripartum injury, metabolic disorders and developmental defects and it endangers the health of mothers. The purpose of the present study was to evaluate a relationship between 1). lipid disorders observed in women with gestational diabetes and other signs of metabolic syndrome, and control of carbohydrate metabolism 2). lipid disorders and complications of gestational diabetes such as macrosomia in women with gestational diabetes. in pregnant women. The study group consisted of 557 pregnant women receiving treatment at the Out-patient Department for Pregnant Diabetics. Of them 346 women had gestational diabetes treated by diet (group 1), 169 by diet plus insulin (group 2) and 42 women had a positive screening test but the result was not confirmed by 75 gram- glucose challenge test (GCT) (group 3). The mean age of the patients was 30±6 years, mean glucose concentration at 2 hrs 8.2±1.9 mmol/l and mean gestational age was 28.6±5.7 weeks. Apart from the higher, as expected, fasting glycemia and at 2 hrs after GCT and higher HbA1c in group 1 and 2, the study subgroups did not differ with respect to fasting insulinemia and at 2 hrs postprandially, serum ; lipids and fibrinogen concentration. BMI, mean arterial blood pressure and occurrence of hypertension were also similar in all the subgroups. In the whole group there was no correlation between lipid concentration and fasting glycemia and at 2 hrs postprandially. In group 1 there was a correlation between concentrations of triglycerides and fibrinogen and glycemia at 2 hrs after GCT. In group 1 the concentration of triglycerides correlated with fasting insulin levels and at 2 hrs after GCT but in group 2 only with insulin levels after GCT. The concentration of fibrinogen correlated with insulin levels at 2 hrs both in group 1 and 2. In group 3 with the weakest carbohydrate disorders there was no correlation between insulin concentration and serum lipid levels. In group 2 consisting of women receiving insulin there was a negative correlation between glycosylated hemoglobin, HDL cholesterol and a positive correlation between HbA1c and LDL cholesterol. Cesarean section was performed most frequently in group 2, i.e. 42.9% as compared with 27.9% in group 1 and 22.2% in group 3. Macrosomia (LGA) was found in neonates of 12.2% of mothers in group 1, 13.3% in group 2 and 11.1% in group 3. Analysis of LGA neonates was carried out for mothers who delivered term infants. Mothers giving birth to LGA babies were more obese and had higher BMI than mothers delivering normal or small for g ; estational age babies. Weight gain during pregnancy was similar in all the groups of women: with LGA, SGA and normal birth weight. Mean lipid and lipoprotein concentrations were also similar in the subgroups. Women who gained too much weight during pregnancy had a higher rate of LGA than SGA babies, had higher glyocosylated hemoglobin levels and lower fibrinogen concentrations than the remaining groups. To define the relationship between LGA and lipid disorders ROC curve analysis was performed showing that HDL cholesterol (100%) and triglycerides (88.9%) were the most sensitive markers of LGA, but their specificity was low (45% and 38.4%, respectively). These results indicate that LGA but not normal birth weight can be very well predicted on the basis of lipid parameters. Prospective analysis to calculate the odds ratio (OR) of macrosomia showed that a 3-fold increase in the risk of having an LGA baby in the presence of combined lipid disorders. The rate of lipid disorders in pregnancy based on ROC analysis was 62.1% for hypertryglyceridemia and 38.2% for low HDL cholesterol levels. After delivery glucose concentration in GCT, lipids and fibrinogen returned to normal and did not differ among the groups. Mothers delivering LGA babies had higher post-delivery fasting glucose and at 2 hrs after GCT and higher HbA1 than women delivering SGA or normal birth weight babies. The pr ; esent findings indicate that 1). Lipid disorders such as reduced HDL cholesterol and elevated triglycerides are significant predictors of macrosomia. 2). Lipid disorders after delivery occur in a high percentage of women with gestational diabetes: elevated triglycerides in 13.7%, reduced HDL cholesterol in 4.5%, elevated total cholesterol in 46.6%, elevated LDL cholesterol in 69.2% of women. 3). Based on these findings it is recommended: - to follow up women with gestational diabetes and to monitor not only the parameters of carbohydrate metabolism but also serum lipids to prevent cardiovascular disorders and type 2 diabetes mellitus, especially in women with gestational diabetes delivering babies with macrosomia; - to correct lipid profile through overweight reduction and proper diet in women with gestational diabetes to prevent macrosomia and possible metabolic disorders in older children, but further prospective studies are warranted on this subject. The present findings suggest the usefulness of further studies on the relationship between lipid and carbohydrate disorders, neonatal status and obstetric complications in women with gestational diabetes, to protect the health of mothers and the cardiovascular system of children.
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Last modified:
Feb 1, 2023
In our library since:
Nov 21, 2012
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6
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http://dl.cm-uj.krakow.pl:8080/publication/998
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| Edition name | Date |
|---|---|
| ZB-107517 | Feb 1, 2023 |
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