简介：AbstractBackground:Gestational weight gain (GWG) is associated with the risk of gestational diabetes mellitus (GDM). However, the effect of weight gain in different trimesters on the risk of GDM is unclear. This study aimed to evaluate the effect of GWG on GDM during different trimesters.Methods:A birth cohort study was conducted from 2017 to 2020 in Shenzhen, China. In total, 51,205 participants were included comprising two models (early pregnancy model and middle pregnancy model). Gestational weight (kg) was measured at each prenatal clinical visit using a standardized weight scale. Logistic regression analysis was used to assess the risk of GDM. Interaction analysis and mediation effect analysis were performed in the middle pregnancy model.Results:In the early pregnancy model, the risk of GDM was 0.858 times lower (95% confidence interval [CI]: 0.786, 0.937) with insufficient GWG (iGWG) and 1.201 times higher (95% CI: 1.097, 1.316) with excessive GWG after adjustment. In the middle pregnancy model, the risk of GDM associated with iGWG increased 1.595 times (95% CI: 1.418, 1.794) after adjustment; for excessive GWG, no significant difference was found (P = 0.223). Interaction analysis showed no interaction between GWG in early pregnancy (GWG-E) and GWG in middle pregnancy (GWG-M) (F = 1.268; P = 0.280). The mediation effect analysis indicated that GWG-M plays a partial mediating role, with an effect proportion of 14.9%.Conclusions:eGWG-E and iGWG-M are associated with an increased risk of GDM. Strict control of weight gain in early pregnancy is needed, and sufficient nutrition should be provided in middle pregnancy.

简介：无

简介：AbstractGestational diabetes mellitus (GDM) is a growing public health problem worldwide that threatens both maternal and fetal health. Identifying individuals at high risk for GDM and diabetes after GDM is particularly useful for early intervention and prevention of disease progression. In the last decades, a number of studies have used metabolomics, genomics, and proteomic approaches to investigate associations between biomolecules and GDM progression. These studies clearly demonstrate that various biomarkers reflect pathological changes in GDM. The established markers have potential use as screening and diagnostic tools in GDM and in postpartum diabetes research. In the present review, we summarize recent studies of metabolites, single-nucleotide polymorphisms, microRNAs, and proteins associated with GDM and its transition to postpartum diabetes, with a focus on their predictive value in screening and diagnosis.

简介：

简介：AbstractBackground:Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.Methods:A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed.Results:In 6204 participants, there are 1002 women (1002/6204, 16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02-1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01-1.61], P = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further.Conclusions:The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.

简介：AbstractThe effects of gestational diabetes mellitus (GDM) on offspring include macrosomia, hypoglycemia, respiratory distress syndrome, cardiovascular disease, neural and mental injury, etc. The effects of GDM on the health status of offspring are sustained although pregnancy has ended. It has been proposed that fetal reprogramming causes long-term consequences to metabolic health in offspring. An intrauterine high-glucose environment may lead to changes in the multi-differentiation proficiency of intracorporal stem cells, showing decreased proliferation and osteogenic ability, increased adipogenic ability, accelerated apoptosis, and occurrence of premature failure. This environment also reduces the mobilization of bone marrow stem cells, whereas it increases that of medullary cells. This results in pro-inflammatory conditions and sustained inflammation in the body, thereby increasing the risk of obesity, cardiovascular and neurological disorders, and metabolic abnormalities. Stem cells derived from the amniotic membrane, umbilical cord, or placenta may be a reliable predictor of the long-term effects of GDM on offspring. The levels of blood glucose during pregnancy should be effectively controlled to reduce harm to the neonate.

简介：AbstractGestational diabetes mellitus (GDM) is a well-established risk factor for fetal macrosomia. A significant number of patients with GDM also suffer from obesity, a factor associated with fetal macrosomia. An important question is whether GDM is independently associated with fetal macrosomia, or whether this relationship is merely the result of maternal obesity acting as a confounder. In this review of the literature, we attempt to further elucidate the relationship between GDM, maternal obesity, and fetal macrosomia.

简介：无

简介：AbstractObjective:To detect the expression of caspase-3, baculoviral inhibitor of apoptosis repeat containing 5 (BIRC-5), vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF), and the concentration of resistin protein in placental of patients with gestational diabetes mellitus (GDM) and normal pregnant women, and to explore its correlation with the pathogenesis of GDM and its significance.Methods:This study includes 30 pregnant women who chose cesarean section at Tongji Hospital of Tongji Medical College during May 2013 to February 2014: 15 GDM patients and 15 normal glucose tolerance patients, 26-36 years old. The expression of caspase-3, VEGF, HIF, and BIRC-5 in placenta of 15 patients with GDM (GDM group) and 15 normal late pregnancy (control group) was detected by real-time fluorescence quantitative polymerase chain reaction. The concentration of resistin protein in the placenta was detected by enzyme-linked immunosorbent assay.Results:Compared with the control group, the expression of caspase-3, HIF, VEGF, resistin in placenta of GDM group increased significantly (P < 0.05); the expression of BIRC-5 in placenta of GDM group decreased significantly (P < 0.05).Conclusion:The expression of caspase-3, BIRC-5, VEGF, HIF, and resistin in placenta of GDM patients and normal pregnant women are significantly different, which may be involved in the pathogenesis of GDM disease.

简介：Theclinicalpresentationsofgestationalchoriocarcinomavarymarkedly,andamisdiagnosiscouldbemadeinatypicalpatientsifsimplyrelyingonclinicalfeatures.Laparoscopicresectionofuterinemasslesionisrarelyusedingestationalchoriocarcinomadiagnosisbecauseofthefearofheavybloodlossanddistantmetastasis.Fivepatientswhowerepreoperativelydiagnosedashavingcornualpregnancyunderwentlaparoscopicresectionofmasslesionandthenprovedtohavegestationalchoriocarcinomabasedonpathologicalexaminations.Chemotherapywasstartedwithintwodaysaftersurgery,andtherateofcompleteremissionwas100%.Themeanfollow-uptimewas29.8±19.1months,andnopatientshowedsignsofrelapse.Laparoscopicresectionofuterinemassfollowedbytimelypostoperativechemotherapymaybeaneffectiveandsafewaytoobtainpathologicresultsinpatientswithsuspectedgestationalchoriocarcinoma.

简介：客观：在单个教材扩大(矿泉)和高密度的oligonucleotideDNA数组的帮助下学习在earliergestational皮肤和老鼠的以后的gestational皮肤之间的基因表示的差别理解scarlesshealing的分子的机制。方法：全部的RNA从疤更少(E15)的胎儿的老鼠皮肤被孤立怀孕期(学期=21.5天)的形成andscar(E18)时期。从更早的gestational皮肤(EGS)和以后的gestational皮肤(LGS)的RNA相对地两个都被抄录到cDNAs，然后为由矿泉方法准备杂交探针用荧光灯的dCTP的加入标记。Themixed探针当时是到包含了5的oligonucleotideDNA数组的hybridized代表5705老鼠基因的705根探针。在高度紧的洗以后，这些DNA数组被扫描因为显示差别的荧光灯的信号表示了在2组skin.Results之间的基因：在5705老鼠基因之中，与差别有53基因(0.93%)在EGS和LGS组，之间的表示层次27基因，包括成纤维细胞生长因素2(FGF2)并且follistatinwere起来调整(0.47%)并且26基因是下面调整的(0.46%)在胎儿的皮肤在scarlessperiod对形成疤的时期期间。在EGS的FGF2和follistatin的更高的表情被RT-PCR方法也比那些inLGS揭示。结论：高密度的oligonucleotideDNA数组为调查微分基因表示在提供了一个强大的工具更早并且latergestational胎儿的皮肤。这种技术验证胎儿的疤更少愈合的机制是很复杂化，许多基因表情的变化与胎儿的疤被联系更少的愈合。

简介：AbstractObjective:This study investigated the prospective associations of circulating levels of sex hormone-binding globulin (SHBG) levels with cardiometabolic biomarkers and risk of gestational diabetes (GDM) during pregnancy. It also examines the longitudinal trajectory of SHBG in women with and without GDM.Methods:We conducted a nested case-control study of 107 incident GDM cases and 214 matched controls within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singleton Cohort. The cohort enrolled non-obese and obese women aged 18-40 years with a singleton pregnancy between 8 and 13 weeks of gestation from 2009 to 2013. GDM was ascertained via medical records review. Blood samples were drawn four times at gestational weeks 10-14, 15-26, 23-31, and 33-39. The prospective associations between SHBG levels and cardiometabolic biomarkers were examined using the Spearman partial correlation among the controls. The longitudinal trajectories of SHBG levels were examined among the cases and the controls. Meta-analysis of prospective studies were performed to examine the association between SHBG levels and GDM risk.Results:SHBG levels at gestational weeks 10-14 were significantly inversely associated with fasting insulin (r= -0.17, P= 0.01) and insulin resistance as measured by HOMA-IR (r= -0.17, P= 0.01) at gestational week 15-26. SHBG at gestational weeks 10-14 and 15-26 was lower in cases than controls (mean ± standard deviation: (204.0±97.6) vs. (220.9±102.5) nmol/L, P= 0.16 and (305.6±124.3) vs. (322.7±105.1) nmol/L, P= 0.14, respectively), yet the differences were not significant. In the meta-analysis, SHBG was 41.5 nmol/L (95% confidence interval: 23.9, 59.1, P < 0.01) significantly lower among women with GDM than without, and each 50 nmol/L increase in SHBG was significantly associated with an odds ratio of 0.85 (95% confidence interval: 0.76-0.95, P= 0.01) for GDM.Conclusion:Lower SHBG levels in early pregnancy were prospectively associated with higher high insulin levels and insulin resistance in mid-pregnancy and subsequent risk of GDM, independent of adiposity. SHBG may serve as a marker for the identification of high-risk pregnancies during early pregnancy.

简介：

简介：无

简介：AbstractObjective:This study aimed to determine: (1) whether recurrent deliveries of a small for gestational age (SGA) neonate are associated with increased obstetrical or neonatal complications; (2) whether the risk factors that can predict small for gestational age (SGA) recurrence.Methods:This study was based on Soroka Medical Center' s Obstetrics electronic database. The database consisted of 109 022 women who had 320 932 deliveries between the year 1988-2014.The study cohort included 6.8% (7 368/109 022) of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery. The study population was divided into two groups according to the outcome of the subsequent delivery: (1) women with sporadic SGA who delivered a non-SGA neonate (n= 5 416); (2) women with recurrent SGA (n = 1 952). SGA defined as birthweight <10th percentile. Maternal and neonatal complications were compared between the two groups. Logistic regression was used to determine independent risk factors for SGA recurrence.Results:The prevalence of birthweight <5th percentile was higher among the recurrent SGA group in the first delivery (P < 0.001). Bedouin ethnicity was more prevalent in the recurrent SGA group (P < 0.001). The rate of preterm delivery was higher in the first delivery of the recurrent SGA group (P = 0.015). The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy (P= 0.017). The rate of severe hypertension (P= 0.005), polyhydramnios, meconium-stained amniotic fluid, nonreassuring fetal heart rate and total perinatal mortality (P < 0.001) were higher in the second delivery of the recurrent SGA group. In a logistic regression model, preterm delivery and birthweight <5th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth (relative risks:1.530, confidence interval: 1.249-1.875; relative risks:1.826, confidence interval: 1.641-2.030, respectively).Conclusion:Women with recurrent SGA neonates have specific clinical characteristics. Among women who deliver an SGA neonate, preterm delivery, and birthweight <5th percentile are independent predictors for its recurrence.

简介：AbstractObjective:This study aimed to determine the likelihood of gestational diabetes mellitus (GDM) in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods:This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018. Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further. Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy, and the characteristics and GDM risk of these groups were compared. A univariate analysis of potential risk factors was performed using the Chi-squared test and/or t-test for qualitative or quantitative variables, respectively. Associations with P values <0.1 were chosen to be included in the multivariate binary logistic regression model.Results:In primary analysis of 6204 women, the incidence of GDM in subsequent pregnancy is 48.9% (490/1002) in women with GDM history and 16.1% (835/5202) in women without GDM history. In a further analysis for 5180 women without GDM at index pregnancy, compared with the non-GDM group, the GDM group had a significantly higher age, prepregnancy body mass index, and blood glucose value at each oral glucose tolerance test (OGTT) timepoint (fasting, 1 h and 2 h) during the index and subsequent pregnancies, as well as higher weight retention during the interval between the two pregnancies (P<0.001). Age above 35 years in subsequent pregnancy (odds ratio (OR)=1.540, 95% confidence interval (CI) = 1.257-1.886, P<0.001), macrosomia in index pregnancy (OR=1.749, 95% CI=1.277-2.395, P=0.001), OGTT blood glucose values in index pregnancy (fasting, OR=2.487, 95% CI=1.883-3.285, P<0.001; 1 h, OR=1.142, 95% CI=1.051-1.241, P=0.002; 2 h, OR=1.290, 95% CI=1.162-1.432, P<0.001) and weight retention (OR=1.052, 95% CI=1.035-1.068, P<0.001) were independent risk factors for GDM in subsequent pregnancy.Conclusion:For women without GDM history, GDM risk factors including age, macrosomia history, OGTT value, and weight retention, these can be evaluated before a subsequent pregnancy. Early warning and interventions are needed for women at high risk.

简介：AbstractBackground:Prenatal evaluation of fetal lung maturity (FLM) is a challenge, and an effective non-invasive method for prenatal assessment of FLM is needed. The study aimed to establish a normal fetal lung gestational age (GA) grading model based on deep learning (DL) algorithms, validate the effectiveness of the model, and explore the potential value of DL algorithms in assessing FLM.Methods:A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41 + 6 weeks were analyzed in this study. There were no pregnancy-related complications that affected fetal lung development, and all infants were born without neonatal respiratory diseases. The images were divided into three classes based on the gestational week: class I: 20 to 29 + 6 weeks, class II: 30 to 36 + 6 weeks, and class III: 37 to 41 + 6 weeks. There were 3323, 2142, and 1548 images in each class, respectively. First, we performed a pre-processing algorithm to remove irrelevant information from each image. Then, a convolutional neural network was designed to identify different categories of fetal lung ultrasound images. Finally, we used ten-fold cross-validation to validate the performance of our model. This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA. This was used to establish a grading model. The performance of the grading model was assessed using accuracy, sensitivity, specificity, and receiver operating characteristic curves.Results:A normal fetal lung GA grading model was established and validated. The sensitivity of each class in the independent test set was 91.7%, 69.8%, and 86.4%, respectively. The specificity of each class in the independent test set was 76.8%, 90.0%, and 83.1%, respectively. The total accuracy was 83.8%. The area under the curve (AUC) of each class was 0.982, 0.907, and 0.960, respectively. The micro-average AUC was 0.957, and the macro-average AUC was 0.949.Conclusions:The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs, which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy. The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.

简介：AbstractObjective:To investigate the association of rs5210 in potassium voltage-gated channel subfamily J member 11 (KCNJ11) with gestational diabetes mellitus (GDM).Methods:Six hundred and thirty-two uncorrelated pregnancy females were recruited in Tongji hospital from October 2017 to June 2018, in which 241 pregnant women were identified as GDM, and 391 were non-GDM. All the pregnant women recruited in this study their peripheral venous blood of 5 mL were withdrawn, and DNA in the blood was extracted. rs5210 in KCNJ11 were genotyped using TaqMan Assays and genotype models were analyzed using logistic regression analyses.Results:After adjusting age and body mass index, the variant genotypes of rs5210 in genotype models were as follows: P for dominant model was 0.945, (odd ratio: 0.987, 95% confidence intervals (CI): 0.681-1.430); P for recessive model: 0.556, (odd ratio: 1.217, 95% CI: 0.633-2.343) and P for addictive model was 0.098 (genotype AA vs. GG), (odds ratio: 1.435, 95% CI: 0.936-2.201). Weight-gain during pregnancy and total cholesterol were significantly different in recessive model (P= 0.015, P= 0.022, respectively) of all participants.Conclusion:No significant association between gene susceptibility of rs5210 in KCNJ11 and GDM occurrence in Chinese pregnant women. But the variant of rs5210 was associated with weight-gain during pregnancy and total cholesterol blood levels. However, more cases are needed in genetic study to check its susceptibility with GDM occurrence in Chinese women.

简介：

简介：AbstractOn April 3, 2020, a 37-year-old woman successfully completed heart valve replacement after cesarean section 67 hours in the First Affiliated Hospital of Harbin Medical University.The woman underwent the mechanical mitral valve replacement in the same hospital 10 years ago. She used low molecular weight heparin instead of warfarin, when she realized her pregnancy. On March 25, 2020 (28+5 weeks of gestation), due to New York Heart Association class IV, severe pneumonia, type I respiratory failure, the patient was admitted to the hospital for treatment. Three days later, she discharged herself from hospital by refusing the cesarean section. The next day she was re-admitted to the ward because of the worsen symptoms and oliguria. Cesarean section was performed 50 hours after admission. The neonate was 1 400 g; Apgar score was 5 in 1 minute, 8 in 5 minutes, transferred to neonatal intensive care unit. Because of the unrecovered heart function, she was confirmed stuck mechanical prosthetic mitral valves. On April 3, 2020, through multi-disciplinary cooperation, the patient was safe without any life-threatening emergency. Eleven days after the replacement, the patient was discharged smoothly, so was the neonate 33 days after delivery.