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    Home > Active Ingredient News > Endocrine System > Gestational diabetes can be predicted!

    Gestational diabetes can be predicted!

    • Last Update: 2021-04-19
    • Source: Internet
    • Author: User
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    Tracing back to the source and "strangling" the disease in the cradle Endocrinologists must be no strangers to gestational diabetes (GDM), but do you really understand GDM? Today, Xiaojie will take everyone to comprehensively understand GDM from multiple angles, understand the latest progress in its pathogenesis, and predict the occurrence of GDM.

     Glucose metabolism during pregnancy is special.
    GDM harms the glucose metabolism of mothers and fetuses during pregnancy.
    There is a certain difference between the glucose metabolism of pregnant mothers and non-pregnancy periods.
    This is specifically reflected in the second and third trimesters.
    As hormone levels change, their insulin sensitivity This is down 56% from the normal period.

    Studies have shown that between 12 and 14 weeks of pregnancy, pregnant women will have a certain degree of insulin resistance, and blood sugar after meals will also increase.

     After 2011, according to the diagnostic criteria of the American Diabetes Association (ADA), regardless of whether the patient had diabetes before, GDM can be diagnosed as long as the 75g oral glucose tolerance test obtains the following results: Table 1.
    ADA has been using the new diagnostic criteria for GDM since 2011 People in different regions have different prevalence rates of GDM.

    The prevalence rate of GDM in the European population is 6.
    1%, while the prevalence rate in the Asian population in the Western Pacific is 10.
    3%, and the prevalence rate in Southeast Asia is as high as 15.
    0%.

    According to the results of flow regulation in Minhang District, Shanghai, the incidence of GDM in this area is as high as 18.
    27%, and the proportion of patients whose blood glucose is between the target and diagnostic value of gestational diabetes control reaches 25.
    9%.
    It can be seen that the situation of gestational diabetes management in my country is very severe.
    Can not be ignored.

     And GDM affects both fetuses and pregnant women.

    GDM can affect fetal development, causing problems such as large fetuses, hyperinsulinemia, and delayed lung maturation.
    It can also cause newborn birth injuries, premature birth, neonatal respiratory distress syndrome, and even long-term diabetes.  The short-term harms of GDM aimed at mothers include: pre-eclampsia, cesarean section, childbirth trauma, etc.
    , but long-term problems may lead to diabetes, abnormal heart structure and function.

     Is the pathogenesis of GDM related to the placenta? The pathogenesis of GDM is very complex, involving multiple organs, including the pancreas, brain, skeletal muscle, liver, intestine, placenta, etc.
    Similar to the pathogenesis of type 2 diabetes, the placenta is both The only difference.

    In addition, changes in islet function caused by hormones secreted by the placenta during pregnancy may also be its unique mechanism, so today we focus on the pathogenesis of islet function and placental-related factors.

     The placenta can secrete hormones such as placental prolactin, hepatocyte growth factor, progesterone and estrogen, thereby affecting the proliferation, expansion, apoptosis and glucose-stimulated insulin secretion (GSIS) of pancreatic islet cells.

    Studies have shown that tissue-specific knockout of islet prolactin receptor (PRLR) does not affect blood glucose and body weight during non-pregnancy, but after pregnancy can cause postprandial blood glucose rise, insulin secretion, pancreatic islet size, islet cell proliferation and The weight of pancreatic islet cells has been reduced.

    This change is because PRLR knockout affects the expression of β cell cycle genes and serotonin (5-hydroxytryptamine, which affects islet proliferation and insulin secretion), while reducing the expression of transcription factor MafB.

    Other studies have shown that the adiponectin gene is also related to this.

     On the other hand, similar to non-pregnancy diabetes, GDM is also accompanied by chronic systemic inflammation.
    This is because the placental tissue can secrete inflammatory factors, which makes tumor necrosis factor-α (TNF-α) and interleukin- 6 (IL-6) all increased.

     New research explores more GDM mechanisms and predicts the occurrence of diseases.
    In recent years, Professor Liu Jun from Shanghai Fifth People's Hospital affiliated to Fudan University has also led a team to study the pathogenesis of GDM. A study published in Diabetes in 2020, by comparing women with GDM and women without GDM, found that early neutrophils in GDM patients were significantly increased, and both neutrophils and white blood cells have a certain predictive value for GDM .

     In the first trimester, with the increase of neutrophils, the incidence of GDM gradually increased, and the body mass index (BMI) also gradually increased.

    In other words, in the first trimester, pregnant women with higher inflammation levels are more likely to develop GDM.
    The higher the BMI, the more likely to develop GDM.
    The higher the BMI, the higher the inflammation level, which shows that the weight control is active before or during pregnancy.
    It can also reduce the level of inflammation and help reduce the occurrence of GDM.

     Since neutrophils are closely related to GDM, what is the underlying mechanism? Professor Liu also shared relevant research results.

     Professor Liu’s team found that human neutrophil elastase (NE) (associated with inflammation) is positively correlated with postprandial blood glucose.
    After knocking out the NE gene, the blood glucose of mice decreases, TNF-α, monocyte chemotactic protein- The expression of pro-inflammatory factors such as 1 (MCP-1) was also significantly reduced.

     Figure 1.
    After NE knockout, the expression of pro-inflammatory factors was significantly reduced.
    Professor Liu's team also found that in early pregnancy, when the placenta did not secrete a large amount of hormones, the hemoglobin (Hb) of GDM patients was significantly increased, while the high level of Hb group After a meal, blood glucose levels increased significantly.

     After further analysis, it can be found that with the increase of Hb, the proportion of GDM patients and the proportion of overweight/obese patients before pregnancy increased.
    It can be seen that in the first trimester, even if there is no placental secretion-related hormones, obesity will cause inflammation and iron.
    Problems such as overloading affect the health of pregnant women and increase the risk of GDM.

     Figure 2.
    The situation after grouping according to Hb level In addition, you may also want to know: What is the relationship between GDM and placental tissue? When using neutrophils to predict the risk of GDM, what is the cut-off point? What are the other independent risk factors for GDM? For more exciting content, log in to the doctor's station to view. Search "17 Essential Skills for Endocrine Diagnosis and Treatment" Professor Liu will personally take you to explore "Secretion" ~ Course viewing 1.
    Log in to the medical doctor station (If the medical doctor station is not installed, click the QR code or read the original download) 2.
    Find the "Courses" page 3.
    Enter the name of the course you want to see in the search box.
    4.
    Enter "17 Essential Skills for Endocrine Diagnosis and Treatment" to watch.
    Scan the code to download the Doctor Station App Famous Doctor Class for you to watch for free.
    Read the original text, watch it now ↓↓ ↓↓
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