당뇨병이 합병된 임신에서의 모체 및 주산기 합병증의 발생에 대한 임상적 연구

백은정(Eun Jeong Baik),김사진(Sa Jin Kim),이귀세라(Gui Se Ra Lee),신종철(Jong Chul Shin),김은중(Eun Jung Kim),김수평(Soo Pyung Kim),노승혜(Seung Hye Rho),이해남(Hae Nam Lee),강병채(Byung Chae Kang),심상인(Sang In Shim),이초희(Cho Hee 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.12

Objectives: The aim of the current paper is to analyze maternal and neonatal complication of pregestational diabetes mellitus and gestational diabetes mellitus, and to compare with the outcome Method: The study included 108 pregnancies with diabetes mellitus among 8,495 admitted to the Department of Obstetrics and Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January 1, 1995 to December 31, 1998. The pregnancies were divided into pregestational diabetes mellitus group and gestational diabetes mellitus group. The data were analyzed and reviewed retrospectively based on medical records Results: 1) Incidence of maternal complication in gestational diabetes mellitus was 7% of pregnancy induced hypertension, 3% of pyelonephritis, 1% of retinopathy and 1% of chronic hypertension. In case of pregestational diabetes mellitus, 18% of pregnancy induced hypertension, 5% of nephropathy, 9% of retinopathy and 14% of pyelonephritis. 2) Incidence of neonatal complication in gestational diabetes mellitus was 1% of congenital malformation, 1% of shoulder dystorcia, 7.3% of polyhydramnios, 17.7% of hyperbilirubinemia, 40.6% of hypoglycemia and 1% of FDIU. In case of pregestaional diabetes mellitus, 1% of congenital malformation, 18.2% of polyhydramnios, 22.7% of hyperbilirubinemia, 27.3% of hypoglycemia, 18.6% of RDS and 4.6% of FDIU. 3) The outcomes of the treatment of pregestational diabetes; There was no significant difference in the maternal weight gain, neonatal birth wight but the incidence rates of neonatal complication was lower in case of insulin treatment 4) The outcomes of the treatment of gestational diabetes; There was significant difference in the maternal weight gain, neonatal birth weight and the incidence rates of maternal and neonatal complication was decreased in case of treatment. Conclusion: Incidence of maternal complication and perinatal complication was higher in pregestaional diabetes mellitus compared with gestational diabetes mellitus, so strict control of blood glucose level and education for diabetes mellitus were essential before gestation. And the proper treatment of gestational DM was necessary because maternal weight gain during pregnancy, neonatal birth weight and the maternal and neonatal complication were affected by treatment.

Probiotic supplements alleviate gestational diabetes mellitus by restoring the diversity of gut microbiota: a study based on 16S rRNA sequencing

Zheng Qing-Xiang,Jiang Xiu-Min,Wang Hai-Wei,Ge Li,Lai Yu-Ting,Jiang Xin-Yong,Chen Fan,Huang Ping-Ping 한국미생물학회 2021 The journal of microbiology Vol.59 No.9

Probiotics effectively prevent and improve metabolic diseases such as diabetes by regulating the intestinal microenvironment and gut microbiota. However, the effects of probiotics in gestational diabetes mellitus are not clear. Here, we showed that probiotic supplements significantly improved fasting blood glucose in a gestational diabetes mellitus rat model. To further understand the mechanisms of probiotics in gestational diabetes mellitus, the gut microbiota were analyzed via 16S rRNA sequencing. We found that compared with the normal pregnant group, the gestational diabetes mellitus rats had decreased diversity of gut microbiota. Moreover, probiotic supplementation restored the diversity of the gut microbiota in gestational diabetes mellitus rats, and the gut microbiota structure tended to be similar to that of normal pregnant rats. In particular, compared with gestational diabetes mellitus rats, the abundance of Firmicutes and Actinobacteria was higher after probiotic supplementation. Furthermore, activating carbohydrate metabolism and membrane transport pathways may be involved in the potential mechanisms by which probiotic supplements alleviate gestational diabetes mellitus. Overall, our results suggested that probiotic supplementation might be a novel approach to restore the gut microbiota of gestational diabetes mellitus rats and provided an experimental evidence for the use of probiotic supplements to treat gestational diabetes melitus.

Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus

( Joon Ho Moon ),( Soo Heon Kwak ),( Hak C. Jang ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.1

Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.

Post-discharge coping difficulties and influencing factors of pregnant women with gestational diabetes mellitus: A cross-sectional study

Wen Li,Yan Zhang,Lili Wei 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): To identify coping difficulties after discharge and influencing factors of pregnant women with gestational diabetes mellitus. Method(s): A convenience sampling method was used to select 252 women with gestational diabetes mellitus from four tertiary hospitals in Shandong Peninsula in China as the object of investigation. Using demographic questionnaire, quality of discharge teaching scale, readiness for hospital discharge scale and post-discharge coping difficulty scale to investigate the current status of post-discharge coping difficulties in women with gestational diabetes mellitus. Multiple linear regression analysis was used to explore the factors of coping difficulties after discharge. Result(s): The score of discharge difficulty scale for pregnant women with gestational diabetes mellitus was (5.22±0.97) which is not optimistic. Results of correlation analysis show that there was a strong negative association between quality of discharge teaching and post-discharge coping difficulty (r=-0.840). Readiness for hospital discharge also showed strong negative correlation (r=-0.734) with post-discharge coping difficulty total score. Age, education level, type of birth, parity, quality of discharge teaching and discharge readiness are six factors that significantly influence in post-discharge coping difficulties, which could explain 69.0% of the variation of post-discharge coping difficulty. Conclusion(s): The study showed that difficult situation of women with gestational diabetes mellitus after discharge needs to be solved. Health professionals should focus on advanced age, low level education, primipara and cesarean section puerpera with gestational diabetes mellitus, strengthen health education, improve the quality of discharge teaching and discharge readiness, so as to reduce the level of difficulties after discharge.

Oral Glucose Tolerance Testing Allows Better Prediction of Diabetes in Women with a History of Gestational Diabetes Mellitus

오태정,Yeong Gi Kim,Sunyoung Kang,문준호,곽수헌,최성희,Soo Lim,Kyong Soo Park,Hak C. Jang,Joon-Seok Hong,Nam H. Cho 대한당뇨병학회 2019 Diabetes and Metabolism Journal Vol.43 No.3

Background: We aimed to identify the postpartum metabolic factors that were associated with the development of diabetes in women with a history of gestational diabetes mellitus (GDM). In addition, we examined the role of the oral glucose tolerance test (OGTT) in the prediction of future diabetes. Methods: We conducted a prospective study of 179 subjects who previously had GDM but did not have diabetes at 2 months postpartum. The initial postpartum examination including a 75-g OGTT and the frequently sampled intravenous glucose tolerance test (FSIVGTT) was performed 12 months after delivery, and annual follow-up visits were made thereafter. Results: The insulinogenic index (IGI30) obtained from the OGTT was significantly correlated with the acute insulin response to glucose (AIRg) obtained from the FSIVGTT. The disposition indices obtained from the OGTT and FSIVGTT were also significantly correlated. Women who progressed to diabetes had a lower insulin secretory capacity including IGI30, AIRg, and disposition indices obtained from the FSIVGTT and OGTT compared with those who did not. However, the insulin sensitivity indices obtained from the OGTT and FSIVGTT did not differ between the two groups. Multivariate logistic regression analysis showed that the 2-hour glucose and disposition index obtained from the FSIVGTT were significant postpartum metabolic risk factors for the development of diabetes. Conclusion: We identified a crucial role of β-cell dysfunction in the development of diabetes in Korean women with previous GDM. The 2-hour glucose result from the OGTT is an independent predictor of future diabetes. Therefore, the OGTT is crucial for better prediction of future diabetes in Korean women with previous GDM.

Risk and Risk Factors for Postpartum Type 2 Diabetes Mellitus in Women with Gestational Diabetes: A Korean Nationwide Cohort Study

최미진,최지미,Chae Weon Chung 대한내분비학회 2022 Endocrinology and metabolism Vol.37 No.1

Background: There are differences in risk and risk factor findings of postpartum type 2 diabetes mellitus (T2DM) after gestational diabetes depending on study design and subjects of previous studies. This study aimed to assess these risk and risk factors more accurately through a population-based study to provide basic data for prevention strategies. Methods: This open retrospective cohort included data of 419,101 women with gestational diabetes and matched 1,228,802 control women who delivered between 2004 and 2016 from the South Korea National Health Information Database of the National Health Insurance Service. Following 14 (median 5.9) years of follow-up, the incidence and hazard ratio (HR) of postpartum T2DM were evaluated using Kaplan-Meier curves and Cox proportional regression models. Results: The incidence and HR of postpartum T2DM in women with gestational diabetes (compared to women without gestational diabetes) after the 14-year follow-up was 21.3% and 2.78 (95% confidence interval [CI], 2.74 to 2.82), respectively. Comorbid obesity (body mass index [BMI] ≥25 kg/m2) increased postpartum T2DM risk 7.59 times (95% CI, 7.33 to 7.86). Significant risk factors for postpartum T2DM were fasting glucose level, BMI, age, family history of diabetes, hypertension, and insulin use during pregnancy. Conclusion: This population-based study showed higher postpartum T2DM risk in women with gestational diabetes than in those without, which was further increased by comorbid obesity. BMI and fasting glucose level were important postpartum risk factors. The management of obesity and glycemic control may be important strategies to prevent the incidence of diabetes after delivery.

임신성 당뇨병 선별검사 실태에 대한 설문조사

고경심 ( Kyung-sim Koh ) 한국모자보건학회 1999 한국모자보건학회지 Vol.3 No.1

Gestational diabetes mellitus is defined as carbohydrate intolerance of variable severity first diagnosed during pregnancy. Although gestational diabetes mellitus is associated with serious obstetric and perinatal complications, there has not been an appropriately controlled trial demonstrating the efficacy of widespread screening for gestational diabets mellitus in Korea. Our purpose was to determine how obstetricians are currently implementing screening tests to diagnose and manage gestational diabetes mellitus. Questionnaires were mailed to 85 obstetricians and perinatologists in hospitals with obstetrics and gynecology residency programs. 28(33%) of specialists responded and the results were summarized. Agreement is lacking regarding the methods of screening and diagnostic tests, selection of test subjects, test threshold of screening, glucose solutions, and interpretations. Arguments concerning screening for gestational diabetes are reviewed and some suggestions for future studies in Korea are introduced.

임신성 당뇨병 산모와 일반 산모의 특성 및 주산기 예후의 비교 고찰

강춘화(Choon Hwa Kang),김미란(Mi Ran Kim),최미영(Mi Young Choi),강은주(Eun Joo Kang),김현진(Hyun Jin Kim),서성숙(Sung Suk Seo) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.3

Objective : To compare maternal characteristics and pregnancy outcomes in a group of women with gestational diabetes mellitus(GDM) diagnosed in our hospital with those of women without this disorder. Materials and Method : This is a retrospective study of 402 gestational diabetic women with singleton cephalic presenting pregnancies delivered at Ilsin Christian Hospital during the period January 1, 1997, through December 31, 1999. National Diabetes Data Group thresholds were used to diagnose gestational diabetes. Women in this group were compared with a nondiabetic control group(n=430) randomly selected and effects of confounding variables were analyzed using stratified analysis. Results : Prevalence of GDM was 2.36%. Women with gestational diabetes were significantly older, heavier, of greater parity and more often had the following risk factors for GDM. Hypertension, cesarean delivery, macrosomia, and large for gestational age(LGA) rate were significantly increased. The adequate treatment group diagnosed before 32wks and received glucose control was compared with a inadequate treatment group. And there was no significant difference in maternal characteristics and pregnancy outcomes between the two groups. Within the adequate treatment group, three groups were subdivided by birth weight as SGA(small for gestational age), AGA(appropriate for gestational age) and LGA. The group with LGA had no difference in age, parity, pregnancy-induced hypertension, 2hr mean postprandial glucose level except body mass index and insulin treatment rate. After adjusting these two factors with stratified analysis, there was no general association between birth weight and glucose level(p=0.342). Conclusion : Maternal characteristics of gestational diabetes were significantly different compared with those of nondiabetic women. Pregnancy outcomes of gestational diabetic women were not improved by our conventional management and more intensified but acceptable and compliable treatment should be tried.

A Korean multicenter study of prenatal risk factors for overt diabetes during the postpartum period after gestational diabetes mellitus

Shin, N.R.,Yoon, S.Y.,Cho, G.J.,Choi, S.J.,Kwon, H.S.,Hong, S.C.,Kwon, J.Y.,Oh, S.y. Hoeber Medical Division, Harper Row ; Elsevier Sci 2016 International journal of gynaecology and obstetric Vol.132 No.3

Objective: To identify prenatal risk factors for postpartum diabetes among pregnant women with gestational diabetes mellitus (GDM). Methods: In a retrospective study, baseline characteristics and data from a postpartum 75-g glucose tolerance test (GTT) were reviewed for patients with GDM who had delivered in four Korean tertiary institutions from 2006 to 2012. Clinical characteristics were compared between women with and those without postpartum diabetes. Cutoffs to predict postpartum diabetes and diagnostic values were calculated from receiver operating characteristic (ROC) curves. Results: Of 1637 patients with GDM, 498 (30.4%) underwent a postpartum 75-g GTT. Postpartum diabetes was diagnosed in 40 (8.0%) patients and impaired glucose intolerance in 157 (31.5%). Women with postpartum diabetes had higher glycated hemoglobin (HbA<SUB>1c</SUB>) levels at GDM diagnosis (P=0.008) and higher 100-g GTT values (P<0.05 for all). In ROC curve analysis, optimal cutoffs for predicting postpartum diabetes were 0.058 for HbA<SUB>1c</SUB> level and 5.3mmol/L (fasting), 10.9mmol/L (1h), 10.2mmol/L (2h), and 8.6mmol/L (3h) for 100-g GTT. The highest sensitivity was observed for 3-h 100-g GTT (76.9%) and the highest positive predictive value was for HbA<SUB>1c</SUB> at diagnosis (15.2%). Conclusion: HbA<SUB>1c</SUB> level at GDM diagnosis and 100-g GTT values could be used to identify patients at high risk of postpartum diabetes who should undergo postpartum screening.

임신성 당뇨병의 유전자

곽수헌,장학철,박경수 대한의사협회 2009 대한의사협회지 Vol.52 No.7

Gestational diabetes mellitus (GDM) is defined as abnormal glucose tolerance diagnosed for the first time during pregnancy. The pathogenesis of GDM is characterized by relatively reduced insulin secretion insufficient to meet the increased insulin demand, which is quite similar to that of type 2 diabetes mellitus. Thus GDM is considered to have a common genetic background as type 2 diabetes mellitus. However, only limited information is available for the genetic basis of GDM. In this review article, we will briefly discuss the definition, epidemiologic features, and pathophysiology of GDM. In addition, we will present the data of two recent genetic association studies regarding GDM. Most of the previously proven type 2 diabetes associated single nucleotide polymorphisms were also associated with the risk of GDM. Rapidly increasing knowledge in genetics of GDM will provide us with new insights into the pathophysiology, treatment, and prevention of GDM.