Background::The potential impact of β cell function and insulin sensitivity on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) remains uncertain. We aimed to investigate the association between β cell dysfunction, insulin resistance, and the composite adverse pregnancy outcomes.Methods::This observational study included 482 women diagnosed with GDM during pregnancy. Quantitative metrics on β cell function and insulin sensitivity during pregnancy were calculated using traditional equations. The association of β cell dysfunction and insulin resistance with the risk of the composite adverse pregnancy outcomes was investigated using multivariable-adjusted logistic regression models.Results::Multivariable-adjusted odds ratios (ORs) of adverse pregnancy outcomes across quartiles of homeostatic model assessment for insulin resistance (HOMA-IR) were 1.00, 0.95, 1.34, and 2.25, respectively ( P for trend = 0.011). When HOMA-IR was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 1.34 (95% confidence interval 1.16-1.56) for each 1-unit increase in HOMA-IR. Multivariable-adjusted ORs of adverse pregnancy outcomes across quartiles of homeostatic model assessment for β cell function (HOMA-β) were 1.00, 0.51, 0.60, and 0.53, respectively ( P for trend = 0.068). When HOMA-β was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 0.57 (95% CI 0.24-0.90) for each 1-unit increase in HOMA-β. However, other quantitative metrics were not associated with the composite adverse pregnancy outcomes. Conclusions::We demonstrated a significant association of β cell function and insulin sensitivity with the risk of adverse pregnancy outcomes. We have provided additional evidence on the early identification of adverse pregnancy outcomes besides the glycemic values.

Objective To observe the clinical effects of cardiac resynchronization therapy (CRT)in patients with chronic heart failure,and compare the clinical characteristics and outcome between responders and non-responders to define factors related to the efficacy of CRT.Methods We retrospectively analyzed the data of patients underwent CRT-P/D implantation from January 2006 to December 2012 in our Hospital.All patients received long-term follow-up including NYHA classification,left ventricular ejection fraction (LVEF) and left ventricular internal dimension at end diastole (LVIDd).Results A total of 204 patients were included (130 males,mean age (64.8 ± 11.9) years).The total response rate of CRT was 61.3％.Women,QRS duration ≥150 ms,and left bundle branch block (LBBB) were related with better response after CRT (all P ＜ 0.05).Multivariate regression analysis showed that QRS duration was an independent determinant for CRT response.All-cause mortality rate was significantly lower in responder group than in non-responder group (P ＜ 0.001).Conclusions In patients with chronic heart failure,women,QRS duration ≥ 150 ms,and LBBB are related with better CRT response rate post CRT.QRS duration ≥ 150 ms is an independent predictor of CRT response,and positive response is associated with lower all-cause mortality in this oatient cohort.