Objective:To investigate the relationship between serum homocysteine (Hcy), mannose-binding lectin (MBL), triglyceride glucose (TyG) index and homeostasis model assessment-insulinresistance (HOMA-IR) and adverse pregnancy outcomes in patients with second-trimester gestational diabetes mellitus (GDM).Methods:Ninety-eight patients with GDM in the second trimester of pregnancy admitted to the Obstetrics Department of Zhongshan People′s Hospital from April 2020 to June 2022 were retrospectively selected. Serum Hcy and MBL were detected by enzyme-linked immunosorbent assay before intervention, HOMA-IR was evaluated according to homeostasis model, and fasting blood glucose (FBG) was detected by oxidase method. The level of triglyceride (TG) was detected by automatic chemiluminescence immunoassay and TyG index was calculated. The patients were given health education, dietary guidance, insulin and other treatment, followed up until delivery and pregnancy outcomes were recorded. The patients were divided into adverse pregnancy outcome group and no adverse pregnancy outcome group based on pregnancy outcomes. The factors influencing adverse pregnancy outcomes in GDM patients in the second trimester were analyzed, and the predictive value of blood glucose control, serum Hcy, MBL and TyG index on adverse pregnancy outcomes in GDM patients in the second trimester was analyzed by receiver operating characteristics (ROC) curve.Results:After intervention, there were 24 cases (24.49%) of adverse pregnancy outcomes in GDM patients in the second trimester, including 2 cases of polyhydramnios, postpartum hemorrhage, neonatal hypoglycemia, 4 cases of premature membranes breaking, 4 cases of premature delivery, 6 cases of fetal macrosomia, 3 cases of low birth weight, and 1 case of neonatal hyperbilirubinemia. There were statistically significant differences in the proportion of poor glycemic control, Hcy level, TyG index, HOMA-IR and MBL level between the GDM group with adverse pregnancy outcome and the GDM group without adverse pregnancy outcome (all P<0.05). By binary logistic regression analysis, Hcy, TyG index, HOMA-IR and poor glycemic control during pregnancy were risk factors for adverse pregnancy outcomes in GDM patients in the second trimester, and MBL was protective factor for adverse pregnancy outcomes in GDM patients in the second trimester (all P<0.05). The sensitivity of poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR alone and in combination to predict adverse pregnancy outcomes of GDM patients in the second trimester were 75.00%, 79.17%, 70.83%, 75.00%, 66.67% and 91.67%, respectively. The specificity was 74.32%, 78.38%, 71.62%, 75.68%, 71.62% and 91.89%, respectively. Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR combined to predict adverse pregnancy outcomes in GDM patients during the second trimester were of high value (all P<0.05). Pearson correlation analysis showed that Hcy and TyG were positively correlated with HOMA-IR ( r=0.712, P<0.001, r=0.649, P=0.023), while MBL was negatively correlated with HOMA-IR ( r=-0.682, P=0.006). Conclusions:Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR are associated with adverse pregnancy outcomes in patients with GDM in the second trimester. Combined detection can predict adverse pregnancy outcomes in patients with GDM in the second trimester early.

Objective:To investigate the relationship between serum homocysteine (Hcy), mannose-binding lectin (MBL), triglyceride glucose (TyG) index and homeostasis model assessment-insulinresistance (HOMA-IR) and adverse pregnancy outcomes in patients with second-trimester gestational diabetes mellitus (GDM).Methods:Ninety-eight patients with GDM in the second trimester of pregnancy admitted to the Obstetrics Department of Zhongshan People′s Hospital from April 2020 to June 2022 were retrospectively selected. Serum Hcy and MBL were detected by enzyme-linked immunosorbent assay before intervention, HOMA-IR was evaluated according to homeostasis model, and fasting blood glucose (FBG) was detected by oxidase method. The level of triglyceride (TG) was detected by automatic chemiluminescence immunoassay and TyG index was calculated. The patients were given health education, dietary guidance, insulin and other treatment, followed up until delivery and pregnancy outcomes were recorded. The patients were divided into adverse pregnancy outcome group and no adverse pregnancy outcome group based on pregnancy outcomes. The factors influencing adverse pregnancy outcomes in GDM patients in the second trimester were analyzed, and the predictive value of blood glucose control, serum Hcy, MBL and TyG index on adverse pregnancy outcomes in GDM patients in the second trimester was analyzed by receiver operating characteristics (ROC) curve.Results:After intervention, there were 24 cases (24.49%) of adverse pregnancy outcomes in GDM patients in the second trimester, including 2 cases of polyhydramnios, postpartum hemorrhage, neonatal hypoglycemia, 4 cases of premature membranes breaking, 4 cases of premature delivery, 6 cases of fetal macrosomia, 3 cases of low birth weight, and 1 case of neonatal hyperbilirubinemia. There were statistically significant differences in the proportion of poor glycemic control, Hcy level, TyG index, HOMA-IR and MBL level between the GDM group with adverse pregnancy outcome and the GDM group without adverse pregnancy outcome (all P<0.05). By binary logistic regression analysis, Hcy, TyG index, HOMA-IR and poor glycemic control during pregnancy were risk factors for adverse pregnancy outcomes in GDM patients in the second trimester, and MBL was protective factor for adverse pregnancy outcomes in GDM patients in the second trimester (all P<0.05). The sensitivity of poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR alone and in combination to predict adverse pregnancy outcomes of GDM patients in the second trimester were 75.00%, 79.17%, 70.83%, 75.00%, 66.67% and 91.67%, respectively. The specificity was 74.32%, 78.38%, 71.62%, 75.68%, 71.62% and 91.89%, respectively. Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR combined to predict adverse pregnancy outcomes in GDM patients during the second trimester were of high value (all P<0.05). Pearson correlation analysis showed that Hcy and TyG were positively correlated with HOMA-IR ( r=0.712, P<0.001, r=0.649, P=0.023), while MBL was negatively correlated with HOMA-IR ( r=-0.682, P=0.006). Conclusions:Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR are associated with adverse pregnancy outcomes in patients with GDM in the second trimester. Combined detection can predict adverse pregnancy outcomes in patients with GDM in the second trimester early.

ObjectiveTo counsel the life style from the first trimester based on the fasting hyperglysemia to decrease the rate of GDM and adverse effect of it. MethodsThe pregnancy women with fasting hyperglysemia were recruited. All subjects were divided into two groups, one was counselled the life style from the first trimester but the other not. The pregnant outcome were compared. ResultsIn the study group 1 100 with complete information and 29 were abnormal glucose intolerance, 1 120 of 47 in control. The rate of GDM or GIGT,hypertensive disease,spontaneous abortion,premature dilivery, polyhydramnios, fetal macrosomia, fetal growth restriction, neonatal respiratory distress syndrome and the mean GHbA1c was lower than that in control ( x2 = 8.110,6.124,5.815,4.518,6.355,3.957,5.453,4.619, t = 3.385, all P ＜ 0. 05 ). But the body mass index at labor( t = 0.698 ), infection disease ( x2 =0.082),mean neonatal weight (t = 2.09 )and neonatal hypoglysemia (x2 = 0.035 )of term labor had no significant differences. ( t = 0.698, χ2 = 0.082,t = 2.090, χ2 = 0.035, all P ＞ 0.05 ). ConclusionCounseling the life style from the first trimester based on the fasting hyperglysemia could decrease the rate of GDM or GIGT and improve the pregnancy result.