|
妊娠期糖尿病脂代谢异常研究进展
|
Abstract:
妊娠期糖尿病(gestational diabetes mellitus, GDM)是指在妊娠期首次发生或发现的糖代谢异常,是最常见的妊娠期内分泌疾病之一。根据2019年国际糖尿病联盟全球糖尿病地图报告,全球妊娠期高血糖疾病患病率为15.8%,其中81%被诊断为GDM。脂代谢作为三大基础代谢之一,在妊娠期中的变化对母儿健康有着十分重要的影响,随着研究的深入,人们越来越认识到孕期血脂管理的重要性。本文章将从妊娠期糖尿病合并脂代谢异常机制及治疗方法展开综述。
Gestational diabetes mellitus (GDM) refers to the first occurrence or detection of abnormal glucose metabolism during pregnancy and is one of the most common endocrine disorders during preg-nancy. According to the 2019 International Diabetes Federation Global Diabetes Atlas report, the global prevalence of hyperglycemia in pregnancy is 15.8%, with 81% of cases diagnosed as GDM. Li-pid metabolism, as one of the three major metabolic processes, has a significant impact on the health of both the mother and the baby during pregnancy, has highlighted the importance of lipid management during pregnancy. This review will provide an overview of the mechanisms and treatment methods for the coexistence of gestational diabetes and lipid metabolism abnormalities.
[1] | Saeedi, P., Petersohn, I., Salpea, P., et al. (2019) Global and Regional Diabetes Prevalence Estimates for 2019 and Pro-jections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th Edition. Diabetes Re-search and Clinical Practice, 157, Article ID: 107843. https://doi.org/10.1016/j.diabres.2019.107843 |
[2] | 李瑞, 梁葵香. 妊娠期脂代谢异常的研究进展[J]. 医学综述, 2019, 25(7): 1348-1352. |
[3] | Wang, Y., Chen, Z. and Zhang, F. (2022) Association between Maternal Lipid Levels during Pregnancy and Delivery of Small for Gestational Age: A Systematic Review and Meta-Analysis. Frontiers in Pediatrics, 10, Article 934505.
https://doi.org/10.3389/fped.2022.934505 |
[4] | Mirabelli, M., Chiefari, E., Tocci, V., Greco, E., Foti, D. and Bru-netti, A. (2021) Gestational Diabetes: Implications for Fetal Growth, Intervention Timing, and Treatment Options. Cur-rent Opinion in Pharmacology, 60, 1-10.
https://doi.org/10.1016/j.coph.2021.06.003 |
[5] | Hernandez, T.L., Friedman, J.E. and Barbour, L.A. (2018) Insulin Resistance in Pregnancy: Implications for Mother and Offspring. In: Zeitler, P. and Nadeau, K.J., Eds., Insulin Resistance, Humana, Cham, 67-94.
https://doi.org/10.1007/978-3-030-25057-7_5 |
[6] | Emet, T., üstüner, I., Güven, S.G., Bal?k, G., Ural, ü.M., Tekin, Y.B. and Av?ar, A.F. (2013) Plasma Lipids and Lipoproteins during Pregnancy and Related Pregnancy Outcomes. Ar-chives of Gynecology and Obstetrics, 288, 49-55.
https://doi.org/10.1007/s00404-013-2750-y |
[7] | Cibickova, L., Schovanek, J. and Karasek, D. (2021) Changes in Serum Lipid Levels during Pregnancy in Women with Gestational Diabetes. A Narrative Review. Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, 165, 8-12. https://doi.org/10.5507/bp.2021.009 |
[8] | Shi, P., Tang, J. and Yin, X. (2023) Association between Second- and Third-Trimester Maternal Lipid Profiles and Adverse Perinatal Outcomes among Women with GDM and Non-GDM: A Retrospective Cohort Study. BMC Pregnancy Child-birth, 23, Article No. 318. https://doi.org/10.1186/s12884-023-05630-5 |
[9] | Powe, C.E., Huston Presley, L.P., Locascio, J.J. and Catalano, P.M. (2019) Augmented Insulin Secretory Response in Early Pregnancy. Diabetologia, 62, 1445-1452. https://doi.org/10.1007/s00125-019-4881-6 |
[10] | Sonagra, A.D., Biradar, S.M., Dattatreya, K. and Ds, J.M. (2014) Normal Pregnancy—A State of Insulin Resistance. Journal of Clinical and Diagnostic Research, 8, CC01-CC03. https://doi.org/10.7860/JCDR/2014/10068.5081 |
[11] | Huhtala, M., R?nnemaa, T. and Tertti, K. (2023) Insulin Resistance Is Associated with an Unfavorable Serum Lipoprotein Lipid Profile in Women with Newly Diagnosed Gestational Diabetes. Biomolecules, 13, Article 470.
https://doi.org/10.3390/biom13030470 |
[12] | Herrera, E. and Desoye, G. (2016) Maternal and Fetal Lipid Metabo-lism under Normal and Gestational Diabetic Conditions. Hormone Molecular Biology and Clinical Investigation, 26, 109-127.
https://doi.org/10.1515/hmbci-2015-0025 |
[13] | Heerwagen, M.J.R., Gumina, D.L., Hernandez, T.L., et al. (2018) Placental Lipoprotein Lipase Activity Is Positively Associated with Newborn Adiposity. Placenta, 64, 53-60. https://doi.org/10.1016/j.placenta.2018.03.001 |
[14] | Layton, J., Powe, C., Allard, C., et al. (2019) Maternal Lipid Profile Differs by Gestational Diabetes Physiologic Subtype. Metabolism, 91, 39-42. https://doi.org/10.1016/j.metabol.2018.11.008 |
[15] | Plows, J.F., Stanley, J.L., Baker, P.N., Reynolds, C.M. and Vickers, M.H. (2018) The Pathophysiology of Gestational Diabetes Mellitus. International Journal of Molecular Sci-ences, 19, Article 3342.
https://doi.org/10.3390/ijms19113342 |
[16] | 郑凯, 袁晶. 脂肪因子与妊娠期糖尿病及糖脂代谢[J]. 国际生殖健康/计划生育杂志, 2021, 40(5): 431-435. |
[17] | Helman, A., Avrahami, D., Klochendler, A., Glaser, B., Kaestner, K.H., Ben-Porath, I. and Dor, Y. (2016) Effects of Ageing and Senescence on Pancreatic β-Cell Function. Diabetes, Obesity and Metabolism, 18, 58-62.
https://doi.org/10.1111/dom.12719 |
[18] | Catalano, P.M. and Shankar, K. (2017) Obesity and Pregnancy: Mecha-nisms of Short Term and Long Term Adverse Consequences for Mother and Child. BMJ, 356, j1. https://doi.org/10.1136/bmj.j1 |
[19] | 张瑾, 池晶晶, 张蕊, 等. 孕前肥胖及超重女性的孕期管理模式探讨及肥胖相关胎盘因子分析[J]. 首都医科大学学报, 2022, 43(5): 774-781. |
[20] | Xu, H., Ma, Y., Zhang, L., Liang, Z. and Chen, D. (2021) Impact of Pre-Pregnancy Body Mass Index, Weight Gain and Blood Lipid Level during Pregnancy on Pregnancy Outcome in Patients with Gestational Diabetes Mellitus. Journal of Zhejiang University. Medical Sciences, 50, 320-328. https://doi.org/10.3724/zdxbyxb-2021-0185 |
[21] | Tan, B., Ma, Y., Zhang, L., Li, N. and Zhang, J. (2020) The Application of Metabolomics Analysis in the Research of Gestational Diabetes Mellitus and Preeclampsia. Journal of Obstetrics and Gynaecology Research, 46, 1310-1318.
https://doi.org/10.1111/jog.14304 |
[22] | 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会. 妊娠期高血糖诊治指南(2022) [第一部分] [J]. 中华妇产科杂志, 2022, 57(1): 3-12. |
[23] | Yan, J. and Yang, H. (2014) Gestational Diabetes Mellitus, Programing and Epigenetics. The Journal of Maternal-Fetal & Neonatal Medicine, 27, 1266-1269. https://doi.org/10.3109/14767058.2013.853733 |
[24] | Cui, M., Li, X., Yang, C., Wang, L., Lu, L., Zhao, S., Guo, Q. and Liu, P. (2022) Effect of Carbohydrate-Restricted Dietary Pattern on Insulin Treatment Rate, Lipid Metabolism and Nutritional Status in Pregnant Women with Gestational Diabetes in Beijing, China. Nutrients, 14, Article 359. https://doi.org/10.3390/nu14020359 |
[25] | Zhang, D., Wei, Y., Huang, Q., et al. (2022) Important Hormones Regulating Lipid Metabolism. Molecules, 27, Article 7052. https://doi.org/10.3390/molecules27207052 |
[26] | LaMoia, T.E. and Shulman, G.I. (2021) Cellular and Molecular Mechanisms of Metformin Action. Endocrine Reviews, 42, 77-96. https://doi.org/10.1210/endrev/bnaa023 |
[27] | Brand, K.M.G., Saarelainen, L., Sonajalg, J., et al. (2022) Metformin in Pregnancy and Risk of Adverse Long-Term Outcomes: A Register-Based Cohort Study. BMJ Open Diabetes Re-search & Care, 10, e002363.
https://doi.org/10.1136/bmjdrc-2021-002363 |
[28] | Tosti, G., Barberio, A., Tartaglione, L., Rizzi, A., Di Leo, M., Viti, L., Sirico, A., De Carolis, S., Pontecorvi, A., Lanzone, A. and Pitocco, D. (2023) Lights and Shadows on the Use of Metformin in Pregnancy: From the Preconception Phase to Breastfeeding and Beyond. Frontiers in Endocrinology, 14, Article 1176623.
https://doi.org/10.3389/fendo.2023.1176623 |
[29] | Huang, L., Yue, P., Wu, X., et al. (2018) Combined Intervention of Swimming plus Metformin Ameliorates the Insulin Resistance and Impaired Lipid Metabolism in Murine Gestational Diabetes Mellitus. PLOS ONE, 13, e0195609.
https://doi.org/10.1371/journal.pone.0195609 |
[30] | Dienstmann, G., Nascimento, I.B.D., Sales, W.B., et al. (2020) No Effect of a Low Dose of Metformin on the Lipid Profile, Body Mass Index and Weight Gain in Pregnant Women with Obesity: A Randomized Trial. Obesity Research & Clinical Practice, 14, 561-565. https://doi.org/10.1016/j.orcp.2020.09.005 |
[31] | Mach, F., Baigent, C., Catapano, A.L., et al. (2020) 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Athero-sclerosis Society (EAS). European Heart Journal, 41, 111-188. https://doi.org/10.1093/eurheartj/ehz455 |
[32] | 王朦朦, 陈赵静, 王颖, 等. 维生素D补充对妊娠期糖尿病血脂水平及新生儿结局影响Meta分析[J]. 中国医学科学院学报, 2021, 43(1): 82-91. |