ObjectiveTo study whether the current Institute of Medicine (IOM) pregnancy weight gain recommendationsvarybypre-pregnancybodymassindex(BMI)wassuitabletoChinese people.MethodsA 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/m2,n =465 ),normal body mass group ( BMI 18.5 - 24.9 kg/m2,n =3549),over body mass group ( BMI ≥ 25 kg/m2,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.ConclusionThe current IOM pregnancy weight gain recommendations vary by pre-pregnancy BMI may be suitable to Chinese people.

Objective To assesment the effect of risk factors at gestational diabetes mellitus (GDM).Methods We collected 427 pregnant women who had done 75 g oral glucose tolerance test (OGTT) between September 1st,2012 and April 19th,2013 in Peking University First Hospital,including 74 pregnant women diagnosed as GDM (GDM group) and 353 pregnant women undiagnosed (non-GDM group).Then we conducted a multiple logistic regression to analyze the clinical datas collected from two groups,which included age,pre-pregnancy body weight and body mass index (BMI),body weight during 11-12 weeks pregnancy,body weight during 23-24 weeks pregnancy; and fasting plasma glucose(FPG),triglyceride (TG),total cholesterol (TCH),high density lipoprotein (H DL),low density lipoprotein (LDL),fasting insulin (FINS),homeostasis model assessment of insulin resistance (HOMA-IR) during early pregnancy; and family history of diabetes mellitus.Results (1)There were significant difference in age,pre-pregnancy BMI,and FPG,TG,FINS,HOMA-IR during early pregnancy,and family history of diabetes mellitus between two groups (P ＜ 0.05).(2) The risk factors of GDM that have statistical significance included FPG during early pregnancy (OR:4.03,95 ％ CI:1.62-10.02),family history of diabetes mellitus (OR:3.15,95 ％ CI:1.66-5.99),TG during early pregnancy (OR:2.13,95 ％ CI:1.17-3.87),BMI before pregnancy (OR:1.36,95 ％ CI:1.08-1.70),age ≥ 35 years (OR:1.15,95 ％ CI:1.05-1.26),early pregnancy weight gain (OR:1.20,95％ CI:1.06-1.35),mid pregnancy weight gain (OR:1.28,95％ CI:1.12-1.47),FINS during early pregancy (OR:1.09,95％ CI:1.01-1.17).Conclusions FPG,TG and FINS during early pregnancy,BMI before pregnancy,early and mid pregnancy weight gain,family history of diabetes mellitus and age≥35 years are the indepadent risk factors for GDM.We should pay more attention to FPG and TG during early pregnancy,and put weight management into practise since early pregnancy and try to control pregnancy weight gain within reasonable limits.

Objective To study three single nucleotide polymorphisms (SNP), SNP-43, -19 and - 63 of calpain-10 (CAPN10) gene in pregnant women with glucose metabolism disorders and their relationship with the risk of these disorders. Methods Totally, 270 pregnant women including 156 with an abnormal oral glucose tolerance test (study group) and 114 healthy controls were selected among those delivered at the Department of Obstetrics and Gynecology, Peking University First Hospital from Jan. 2005 to Dec. 2006. The SNP of CAPN10 gene at posifons 43, 19, and 63 were analyzed by primer-introduced restriction analysis-polymerase chain reaction (PIRA-PCR). Results (1) The frequencies CAPN10 SNP-19 2R/2R genotype (26.9% ,42/156) and 2R allele (48.9%, 152/312 ) were higher than those in controls (12.3% ,14/114 and 36.8% ,84/228, respectively; P=0.012, 0.006). (2) Stratified analysis according to family history of diabetes mellitus showed the proportion of the CAPN10 SNP-19 2R/2R+2R/3R genotypes (83% ,47/57) in the study group were significantly higher than that of control group (52%,11/21 ; P=0.009), and the proportion of SNP-63 T/T + T/C genotypes(47% ,27/57) in study group were significantly higher than that of control group (14%, 3/21 ; P=0.026) among those with positive family history. (3) The combined effect of CAPN10 SNP-43, -19 and -63 on glucose metabolism disorders was analyzed by comparing with the other haplotypes and showed that the haplotype 121 distribution in study group was significantly higher than those in controls(P=0.036), and 221 haplotype was significantly lower than controls (P=0.042). Conclusions (1) CAPN10 SNP-19 is associated with glucose metabolism disorders in pregnant women. And 2R allele might be the risk factor. CAPN10 SNP-19 2R/2R +2R/3R and SNP-63 T/T + T/C genotypes might increase the risk of glucose metabolism disorders in women with positive family history. Haplotype 121 might increase the risk of glucose metabolism disorders in pregnant women and 221 be a protective factor.

Objective To investigate the appropriate range of gestational weight gain in pregnant women with abnormal glucose metabolism.Methods A retrospective study was conducted on 661 term singleton pregnant women with gestational abnormal glucose metabolism,who delivered in the Department of Obstetrics and Gynecology of Peking University First Hospital from Jan.2005 to Dec.2007,by reviewing the medical records.All sujects were divided into 4 groups according to their body mass index (BMI) before pregnancy:group Ⅰ (n=40):BMI<18.5;group Ⅱ (n=400):BMI18.5-23.9;group Ⅲ (n=162):BMI 24.0-27.9;group Ⅳ (n=59):BMI≥28.0.The weight gain among different groups and that between women who delivered normal birth weight infant and maerosomia were analyzed.The weight gain of pregnant women who delivered babies weighing 3000～3500 g in each group was determined as the appropriate weight gain for that group.Results The same results were achieved that the weight gain in pregnant women who delivered macrosomia was significantly higher than those who delivered normal birth weight newborns in each group,ie,the weight gains for women who had macrosomia and normal birth weight infants were (17.0±5.2) kg and (14.1±4.7) kg in group Ⅱ,(16.8±7.3) kg and (11.9±5.1) kg in group Ⅲ and (18.3±6.7) kg and (11.2±5.4) kg in group Ⅳ,respectively (P<0.05).The appropriate ranges of weight gain for each group were (15.6±3.3) kg,(14.0-18.0) kg for group Ⅰ,(13.9±4.6) kg,(11.0-16.5) kg for group ]],(11.5±5.2)kg,(9.0-15.0) kgforgroup Ⅲ,(10.1±2.9) kg,(7.0-12.7) kg forgroup Ⅳ.Conclusions Appropriate weight gain based on prepregnant BMI,together with glucose monitoring in women with gestational abnormal glucose metabolism,is helpful for fetal weight control.

Objective To investigate the expression of glucose transporters(GLUTs)in placentas of pregnant women with abnormal glyeometabolism,and to explore its effect on glucose transport between mother and fetus and its relation with the birth weight.Methods Placentas of 41 pregnant women with abnormal glycometabolism(7 cases of DM,10 GDM A1,10 GIGT and 14 GDMA2)and 15 normal pregnant women as control were selected.The expression of GLUT1 and GLUT3was detected by immunohistochemistry.The birth weight was measured at delivery.Results GLUT1 was expressed in the syncytiotrophoblasts and cytotrophoblasts,whereas GLUT3 in some endothelial cells.The expressions of GLUT1 and GLUT3 were significantly different among the five groups(P＜0.01).Positive correlation was shown between the GLUT1 expression and the birth weight(rs=0.532,P＜0.01),but not in GLUT3 expression.Conclusions The expression of GLUT1 and GLUT3 in placentas of pregnancy with abnormal glycometabolism is enhanced,and GLUT1 may play a predominant role in the fetal glucose uptake.

Objective To investigate the effects of gestational diabetes mellitus (GDM) on the growth rate of fetuses.Methods This was a retrospective study.Women who had deliveries in Peking University First Hospital between January 2012 and June 2013 were enrolled.Matched by maternal age,they were divided into four groups with 100 cases in each group:macrosomic fetuses of mothers with GDM (GDM-macrosomia group),normal birth weight infants of mothers with GDM (GDM-non-macrosomia group),macrosomic fetuses of mothers with normal pregnancy (normal-macrosomia group),and normal birth weight infants of mothers with normal pregnancy (normal-non-macrosomia group).The fetal abdominal circumference was measured at 20+1-24,28+1-32,32+1-37 weeks and 37+1 weeks to delivery under prenatal ultrasound.The growth rate of fetal abdominal circumference was calculated (abdominal circumference/gestational weeks).The analysis of variance,the least significant difference-t test and Student's t test were used for statistical analysis.Results At early pregnancy [(9.2±2.6) weeks of gestation] and 20+1-24,28+1-32,32+1-37 weeks and 37+1 weeks to delivery,the weight and body mass index (BMI) of the mothers in GDM-macrosomia group were higher than those in the other three groups (all P＜0.05).The body weight of the mothers increased by (15.5±5.4),(13.5±3.6),(16.4±4.1) and (16.2±4.3) kg,respectively,compared with early pregnancy.At 20+1-24,28+1-32,32+1-37 weeks and 37+1 weeks to delivery,the fetal abdominal circumference of GDM-macrosomia group was (182.0± 13.9),(270.7± 17.7),(335.2±21.3) and (362.3± 18.7) mm,respectively,being higher than that in GDM-non-macrosomia group [(176.8± 13.0),(256.6± 13.5),(313.2± 17.5) and (335.8± 15.5) mm] and normal-nonmacrosomia group [(176.9± 11.8),(260.0± 14.2),(310.6± 21.4) and (334.5 ± 16.1) mm] (all P＜0.05).The fetal abdominal circumference of GDM-macrosomia group was even higher than normal-macrosomia group at 32+1-37 weeks [(335.2±21.3) vs (326.1 ± 19.1) mm,t=4.01,P＜0.05].The changes of the growth rate of fetal abdominal circumference were consistent with the fetal abdominal circumference.Conclusions GDM accelerates fetal growth.

Objective To compare the clinical use of continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG) when monitoring blood glucose level of patients with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (DM) complicated with pregnancy.Methods A total of 99 patients with GDM (n=70) and type 2 DM complicated with pregnancy (n=29) that whether hospitalized or in clinical of Peking University First Hospital were recruited from Aug 2012 to Apr 2013.The CGMS was used to monitor their blood glucose level during the 72-hour time period,while the SMBG was also taken seven times daily.The correlation between these blood glucose levels and their glycosylated hemoglobin (HbA1c) levels were analyzed by comparing the average value,the maximum and the minimum value of blood glucose,and the appeared time of these extremum values in these two monitoring methods,and the amount of insulin usage was recorded as well.Results (1) The maximum,minimum and the average blood glucose value in the GDM group were (8.7± 1.2),(4.5 ±0.6) and (6.3 ± 0.6) mmol/L of SMBG vs.(10.1±1.7),(3.1±0.7),(6.0±0.6) mmol/L of CGMS.These values in DM group were (10.1±2.2),(4.5±1.0),(6.9±1.1) mmol/L of SMBG vs.(12.2±2.6),(2.8±0.8),(6.6±1.1) mmol/L of CGMS.By using the two methods,the maximum and the average value of the two groups showed significant differences (P＜0.01) while the minimum value showed no significant differences (P＞0.05).(2) In the GDM group,the average blood glucose values of CGMS and SMBG were significantly correlated (r=0.864,P＜0.01).The maximum values presented the same result (r=0.734,P＜0.01).Correlation was not found in the minimum values of CGMS and SMBG (r=0.138,P＞0.05).In the DM group,the average valves of two methods were significantly correlated (r=0.962,P＜0.01),the maximum values showed the same result (r=0.831,P＜0.01).It can also be observed in the minimum values (r=0.460,P＜0.05).(3) There was significant correlation between the average value of CGMS and HbA1c level (r=0.400,P＜0.01),and the average value of SMBG and HbA1c level were correlated (r=0.031,P＜0.05) in the GDM group; the average values of CGMS (r=0.695,P＜0.01) and SMBG (r=0.673,P＜0.01) were both significantly correlated with the HbA1c level in the DM group.(4) In the GDM group,37％ (26/70) of the minimum values of SMBG appeared 30 minutes before breakfast,while 34％(24/70) of them appeared 30 minutes before lunch; 86％(60/70) of the maximum values of SMBG were evenly distributed 2 hours after each of the three meals.In the DM group,41％(12/29) of the minimum values of SMBG presented 30 minutes before lunch,while 21％(6/29) and 14％(4/29) of them were showed 30 minutes before breakfast and dinner respectively; about 30％ of the maximum values of SMBG appeared 2 hours after each of the three meals.(5) In the GDM group,23％(16/70) of the minimum values of CGMS occurred between 0:00-2:59 am.,and most of the other minimum values of CGMS were evenly distributed in the rest of the day,except for 3％(2/70) of them were found during 18:00-20:59 pm.43％(30/70) of the maximum values of CGMS appeared during 6:00-8:59 am.,only 1％(1/70) and 3％(2/70) of them presented during 0:00-2:59 am.and 21:00-23:59 pm.,and the rest were evenly distributed for the other times of the day.In the DM group,34％(10/29) of the minimum values of CGMS were found during 0:00-2:59 am.,14％(4/29) of them appeared during 9:00-11:59 am.and 15:00-17:59 pm.,45％(13/29) of the maximum values of the CGMS presented during 6:00-8:59 am.,none was found during 21:00-23:59 pm.,0:00-2:59 am.and 3:00-5:59 am.,and the rest were evenly distributed for the other times of the day.(6) 64％(45/70) of the patients in the GDM group did not require for insulin treatment,while 36％(25/70) of them did.For those patients who received insulin treatment,after CGMS,64％(16/25) of them adjusted the insulin dosage according to their blood glucose levels.In the DM group,14％(4/29) of them did not receive insulin treatment,while for the others who did(86％,25/29); 60％ (15/25) of them adjusted the insulin dosage according to their blood glucose levels after CGMS.Conclusions Both CGMS and SMBG could correctly reflect patients' blood glucose levels.It was more difficult to control the blood glucose levels in patients with type 2 DM complicated with pregnancy than the GDM patients.Compared with SMBG,CGMS could detect postprandial hyperglycemia and nocturnal hypoglycemia more effectively.

Objective To study the roles of advanced glycation end products and its receptor on fetal brain injury of gestational diabetes mellitus (GDM) rats.Methods Twenty one adult pregnant Wistar rats were administered streptozotocin (STZ) intraperitoneally to induce GDM rats model.The fourteen pregnant rats were divided into two groups according to the fasting glucose on the 3rd day of pregnancy:severe GDM group with the fasting glucose ＞ 16.7 mmol/L and mild GDM group with the fasting glucose between 6.7 - 16.7 mmol/L Another seven pregnant rats were chosen as the severe GDM and intervention with micronutrient group,receiving gavage with micronutrient during the whole pregnancy.Five control rats received the same volume of citric acid buffer.All the pregnant rats were tested fasting glucose from the tailvein and their weight on the pregnant day 3,13 and 19.Maternal serum levels of AGE were measured by ELISA and RAGE levels in the embryonic brain tissues were tested by immunohistochemistry.Results ( 1 ) There was no statistically significant difference of pre-pregnancy fasting glucose level among all groups (P ＞ 0.05 ).The fasting glucose levels on the 3rd day and the mean fasting glucouse level of pregnancy in the severe GDM group and the severe GDM and intervention with micronutrient group were higher than those of the control group ( P ＜0.05 ).And there was no significant difference between the severe GDM group and the severe GDM and intervention with micronutrient group (P ＞0.05 ).(2)The serum AGE levels in the severe GDM group and the mild GDM group were( 1037 + 38) ng/L and( 880 ± 34) ng/L respectively,with no significant difference ( P ＞ 0.05 ).The serum AGE levels in the control group and the severe GDM and intervention with micronutrient group were (857 ± 32 ) ng/L and (988 ± 37 ) ng/L,and the difference was statistically significant ( P ＜ 0.05 ).The serum AGE levels in the severe GDM and intervention with micronutrient group and in the mild GDM group had no significant difference ( P ＞ 0.05 ).( 3 ) The serum AGE levels in the severe GDM group,mild GDM group and the control group were positively associated with the mean glucose level of pregnancy ( r =0.603,P ＜ 0.05 ) and the grlucose on the 3rd day of pregnancy (r =0.704,P ＜ 0.05 ).(4)The fetal brain nerve cell number and morphology in the control group were normal.While in the mild GDM group fetal brain nerve cells decreased,the proliferation and swelling of glial cells were seen.In the severe GDM group and the severe GDM and intervention with micronutrient group,the fetal brain cells furtherly reduced,and large vacuole around the cells,deformation and debris of the cells were seen. Glial scar formation was visible in some fetal brain tissues.There was a few RAGE expression in the control fetal brain tissues.In the mild GDM group and the severe GDM group,RAGE expression increased significantly.And the RAGE expression intensity in the severe GDM and intervention with micronutrient group was between the severe and the mild GDM groups.Conclusions( 1 ) Abnormal fetal brain development of GDM rats was associated with the increase of maternal serum AGE and the enhancement of RAGE expression in fetal brain tissues,which suggested that AGE/RAGE pathway may play an important role in the fetal brain injury of GDM rats.(2) Micronutrients can reduce the brain damage of GDM fetuses.

Objective To investigate the varaiation of the incidence of macrosomia and its influencing factors. Methods A population-based study of 25 944 pregnant women,who delivered in Peking University First Hospital in term birth,with singleton,between Jan. 1,2006 and Dec. 31,2013 and accepted the gestational diabetes mellitus(GDM)screening and diagnosis,was performed. The women are grouped according to the different clinical interventions at different period. Women delivered between Jan. 1, 2006 and Dec. 31,2006 was defined as Group 2006,and they were diagnosed with glucose metabolism disorder [gestational impaired glucose tolerance(GIGT)and GDM] and intervened only when meeting National diabetes data group(NDDG)criteria. Women delivered between Jan.1,2007 and Apr. 30,2011 were defined as Group post 2007,and NDDG criteria was also applied in this period. Women delivered between May. 1,2011 and Dec. 31,2013 were defined as Group post 2011,and Ministry of Health(MOH)of China was used for GDM diagnosis in this group. All pregnant women in Group post 2007 accepted the preliminary pregnancy nutrition advice and weight management. All participants met MOH criteria were diagnosed as glucose metabolism disorder in this study,in which women diagnosed and intervened in pregnancy were defined as Group diagnosis and those not being identified during pregnancy were defined as Group missed diagnosis. It was analyzed retrospectively for the incidence of macrosomia and the influencing factor. Results (1)The prevalence of macrosomia and cesarean section was decreased every year from Jan. 2006 to Dec. 2013. The incidence of macrosomia was 9.14%in 2006,reduced to 8.02%in 2007-2011 and 6.79%in 2011-2013. The incidence of cesarean section was 55.22%,reduced to 51.04%in 2007-2011 and 44.15%in 2011-2013. However,there was not remarkable change in the prevalence of small for gestational age(P>0.05).(2)Compared with Group 2006,the incidence of cesarean section was lower in Group post 2007 [51.04%(6 504/12 744)vs 55.22%(1 371/2 483)],and the difference is significantly(P<0.05). Meanwhile,the incidence of cesarean section(44.15%,4 732/10 717)and macrosomia(6.79%,728/10 717) in Group post 2011 was lower significantly than Group 2006 and Group post 2007(P<0.05).(3)The incidence of macrosomia was 7.41%(1 129/15 227)and 6.61%(1 006/15 227)respectively in Group diagnosis and Group missed diagnosis before May 2011,combined 14.02%(2 135/15 227)in total. It was increased significantly in the incidence of GDM 21.41%(2 294/10 717)after May 2011 compared with that before (P<0.05). The incidence of macrosomia was decreased significantly using MOH criteria in GDM women since 2011. It was the downtrend in the incidence of macrosomia since 2007 in non GDM women. However,there was no difference in SGA in different period.(4)In glucose metabolism disorder women, compared with Group 2006 and Group post 2007,the incidence of macrosomia and cesarean section was lower in Group post 2011,and the difference is significantly(P<0.05). However,there was no significant difference in the incidence of macrosomia and cesarean section between Group 2006 and Group post 2007, and there was no difference in SGA in the 3 groups(P>0.05). In non GDM women,the incidence of macrosomia and cesarean section was lower in Group post 2011 than Group 2006(P<0.05);meanwhile,it was the downtrend in the incidence of macrosomia in Group post 2007 compared to Group 2006,and the difference of the incidence of cesarean section was significant(P<0.05). Conclusion The prevalence of macrosomia and cesarean section might be reduced by application of suitable criteria for diagnosis of GDM and education on nutrition during pregnancy.

Objective To analyze the clinical presentation and maternal neonatal outcome of 30 cases with HELLP syndrome and to discuss the diagnosis, treatment and prognosis of the disease. Methods 30 cases of HELLP syndrome were collected retrospectively including 19 cases of complete HELLP syndrome and 11 partial HELLP syndrome. The blood test, clinical presentations, complications and pregnant outcomes were analyzed. Results LDH value in complete HELLP group(CHG) [(622?481)U/L] was significantly higher than that in partial HELLP group(PHG) [( 369?101) U/L, P