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Objective: To investigate the relationship of different types of gestational diabetes mellitus (GDM) and pregnancy outcomes., Methods: A total of 4090 cases, who received prenatal examination and delivered in Peking University First Hospital and performed a 75 g oral glucose tolerance test (75 g OGTT) at 24-28 gestational weeks, from January. 1(st), 2011 to Jul 31(st), 2012 , were divided into 2 groups. Normal blood glucose group:the result of OGTT (fasting plasma glucose, 1 hour glucose and 2 hour glucose ) was normal; Gestational diabetes mellitus group (GDM group): the result of OGTT was abnormal at any time point. GDM group were separated into A, B and C. GDM A means fasting plasma glucose annormal but others were normal, GDM B:fasting plasma glucose, 1 hour and/or 2 hour glucose abnormal, GDM C:fasting plasma glucose normal. To analyse the effect of different number of abnormal result of OGTT on pregnancy outcomes, GDM group were divided into I, II and III.GDMI means one abnormal blood glucose of OGTT result, GDM II: two abnormal blood glucose and GDM III:three abnormal blood glucose. We analyzed the pregnant outcomes of each group., Results: (1) Among the 4090 cases, 858 cases (21.98%) were diagnosed as GDM (GDM group), and 82 cases (9.6%, 82/858) were treated with insulin.other 3232 cases with normal blood glucose (normal blood glucose group). In GDM group, the rate of cesarean section (51.9%, 445/858), premature delivery (8.4%, 72/858) and LGA (5.9%, 51/858) were respectively significantly higher than those of normal blood glucose group [ (43.5%, 1406/3232), (5.8%, 189/3232) and(4.2%, 137/3232)] (P < 0.05). But, there was no statistically significant differences for the rate of macrosomia (P > 0.05) between the GDM group(6.8%, 58/858) and normal blood glucose group (6.2%, 199/3232) . (2) In the GDM group, GDM A was 317 cases (36.9%), GDM B 239 cases (27.8%), GDM C 302 cases (35.2%). The incidence of Macrosomia and LGA in GDM B was significantly higher than that in GDM C and normal blood glucose group (P < 0.05). Comparing with GDM A , there was no statistically significance in GDM B and GDM C (P > 0.05). (3) In GDM group, GDMIwas 521 cases (60.7%), GDM II203 cases (15.6%), GDM III 134 cases (23.7%). Compared with the normal blood glucose group, GDM III had a significantly higher incidence of macrosomia and LGA and cesarean section(P < 0.01);and GDM IIhad only a significantly higher incidence of cesarean section(P < 0.01). (4) Among the 4090 cases, there were 1118 patients (27.3%) whose fasting blood glucose was below 4.4 mmol/L, of which 55 cases were diagnosed as GDM. There were 4 premature infants and 1 macrosomia., Conclusions: The GDM group with more than FBG ≥ 5.1 mmol/L had a higher incidence of adverse pregnancy outcomes, it suggested that we should pay more attention and take actively intervented; the pregnant woman is not recommended for 75g OGTT detection when fasting blood glucose was below 4.4 mmol/L because of the low rate of GDM and adverse pregnancy outcomes among them.

Objective: To investigate the long-term effects of intrauterine mild hyperglycemia exposure and postnatal high fat diet on the body weight and metabolism of offspring through a pregnant rat model of intrauterine mild hyperglycemia., Methods: Twenty-one pregnant Wistar rats were randomly divided into intrauterine hyperglycemia group and control group. Twenty percent streptozotocin (STZ, 25 mg/kg)was given to rats of intrauterine hyperglycemia group by a single intraperitoneal injection to induce intrauterine mild hyperglycemia; control group rats received an equal volume of citric acid-sodium citrate buffer. Off springs were divided into 4 groups: exposed to intrauterine hyperglycemia and fed with normal diet group (group DN) or high fat diet group (group DF); exposed to intrauterine euglycemia and fed with normal diet group (group CN) or high fat diet group (group CF). The blood glucose levels of pregnant rats in two groups and body weights of offsprings in four groups were recorded. At the age of 28 weeks, the mesenteric fat amount, epididymal amount, perirenal fat amount, total triglyceride (TG) and high density 1ipoprotein-cholestrol (HDL-C) were measured in all four groups., Results: (1)The average blood glucose level of intrauterine hyperglycemia group [(16.6 ± 3.4) mmol/L] was significantly higher than that of the control group [(5.8 ± 1.1) mmol/L, P < 0.01]. (2) On the birth day, 3 weeks and 4 weeks, the body weight of group DN[(7.4 ± 0.6), (44.1 ± 5.9), (79.6 ± 7.4) g] and group DF [(7.4 ± 0.2), (43.9 ± 6.9), (76.1 ± 5.8) g] were remarkably increased compared with group CN [(6.6 ± 0.5),(35.6 ± 4.4),(71.5 ± 6.8) g, P < 0.05]; but the body weight in group CF [(6.7 ± 0.5),(33.0 ± 6.5),(66.1 ± 10.2) g] had no statistical difference compared with group CN (P > 0.05). (3)From then on, the body weights of the offsprings in four groups presented an increasing trend, but there was no statistical difference until 28 weeks (P > 0.05). (4) The perirenal fat amount of group DN, group CF and group DF [(13.8 ± 3.3), (14.3 ± 3.2), (18.4 ± 1.3) g] were remarkably increased compared with group CN[(9.7 ± 3.5) g, P < 0.05]; the epididymal fat amount of group CF and group DF were also significantly increased compared to group CN (P < 0.05); the mesenteric fat amount in four groups had no statistical difference (P > 0.05). (5) The TG level of group DN, group CF and group DF [(0.52 ± 0.14), (0.52 ± 0.09), (0.54 ± 0.17) mmol/L] were significantly higher compared to group CN [(0.41 ± 0.09) mmol/L, P < 0.05], but there was no statistical difference within the first three groups (P > 0.05); the HDL-C level in four groups had no statistical difference (P > 0.05)., Conclusions: In intrauterine mild hyperglycemia environment, there were some evidently metabolic changes observed in the offspring, including body weight increasing on birth day and early postnatal period, visceral fat amount increasing and lipid metabolism disorders, which could be aggravated by postnatal high fat diet.

Objective: To explore the normal range of serum glycated albumin (GA) during the second trimester in non-gestational diabetes mellitus (GDM) population and the value of serum GA in the blood glucose monitoring during pregnancy., Methods: The GA was measured in 101 healthy gravida during the second trimester and 80 gravida with GDM and diabetes mellitus who were in treatment at Peking University First Hospital between August 2011 and December 2011, in order to analyze the normal range of GA and the relationship between GA and the level of blood glucose., Results: (1) The normal range of GA during the second trimester was 10.9%-15.3%, which was negatively correlated with body mass index (P < 0.01). (2) Significant correlations were observed between GA and the level of hemoglobin A1c (HbA1c), preprandial, postprandial and mean plasma glucose in gravida with GDM and diabetes mellitus (r:0.361, 0.252, 0.338, 0.310;all P < 0.05). (3) When the level of GA was 13.97%, the sensitivity and specificity index for glucose control were 78.0% and 74.4%., Conclusions: GA could evaluate the severity of disease in gravida with GDM and diabetes mellitus. 10.9%-15.3% could be suggested as normal range of GA for the gravida at the second trimester.

Objective: To study newborns weight in singleton term births and the association between newborns birth weight and mode of delivery in 3 hospitals., Methods: From Jan. 2005 to Dec. 2009, 13 963 singleton term live neonates born in the Department of Obstetrics and Gynecology of Peking University First Hospital (PU group), 6519 neonates in Affiliated Hospital of Binzhou Medical College (BMC group,) and 8725 neonates in Miyun Hospital Affiliated to Capital Medical University, Yanjing Medical College (MYC group) were enrolled in this retrospective study. The newborns weight and the rate of macrosomia was calculated and compared. Those newborns from PU group and MYC group were divided into 2288 neonates at macrosomia group and 20 400 neonates at non-macrosomia group, their mode of deliveries were analyzed., Results: (1) The mean neonatal birth weight were (3386 ± 414) g at PU group, (3389 ± 446) g at BMC group and (3445 ± 449) g at MYC group. Neonates born weight in MYC was significantly higher than those from in PU group and BMC group (P = 0.000). Neonates born weight in BMC showed higher than those in PU group, which did not reached statistical difference (P = 0.638). (2) The incidence of macrosomia were 7.935% (1108/13 963) in PU group, 9.802% (639/6519) in BMU group and 13.524% (1180/8725) in MYU group. The incidence of macrosomia in MYC group was higher than those in PU and BMC group, the incidence of macrosomia in BMC group was higher than that in PU group, which reached statistically difference (P = 0.000). (3)The proportion of cesarean delivery were 75.306% (1723/2288) at macrosomia group, 50.765% (10 356/20 400) at non-macrosomia group, which showed statistical difference (P = 0.000)., Conclusions: (1) The difference of newborns birth weight existed in different administrative level hospital. (2) The risk of cesarean delivery due to macrosomia is higher than that of non-macrosomia. (3) Obstetricians should pay more attention to nutrition in gestation period to lessen the incidence of macrosomia and cesarean section.

Objective: To establish and assess the high-birth-weight offspring model of the diabetic rat induced by stueptozotocin, and the long-term metabolic impact of maternal hyperglycemia of those offsprings., Methods: Streptozotocin (STZ, 25 mg/kg) was given to Wistar rats (G group, n = 14) once intraperitoneally to induce maternal hyperglycemia model (blood glucose between 10 - 20 mmol/L), and there still had a number of rats defined as severe hyperglycemia model group (SG group, n = 5). The Control group (C group, n = 7) were given the same volume citrate buffer solution. The body weight and blood glucose were recorded, and the lavaging glucose tolerance test (LGTT) was performed by a glucose meter in the gestation. The offsprings were corresponding allocated into 2 groups, and the birth weight were recorded. All the offsprings were observated body weight, blood glucose blood pressure (male rats only), and so on., Results: (1) The blood glucose of G group (16.8 ± 5.4 mmol/L) and SG group (20.5 ± 5.6 mmol/L) were increased significantly as compared with C group (7.0 ± 1.4 mmol/L) 5 days after the model was established (P < 0.01); and the average blood glucose of G group (16.6 ± 3.4 mmol/L) and SG group (23.8 ± 1.5 mmol/L) increased too as comparede with C group (5.8 ± 1.1 mmol/L), the difference was significance according to statistics (P < 0.01). (2) According to the LGTT result, which operationed on generation day 4 and day 10, the blood glucose of every time point of G group were increased significantly as compared with C group (P < 0.01). (3) The male and female birth weight of G group was remarkably higher than the C group and the SG group (P < 0.05), and the blood glucose of SG/G/C group was (6.5 ± 1.2) mmol/L, (4.1 ± 0.8) mmol/L, (4.1 ± 0.8) mmol/L respectively, according to the statistics results, the difference between SG group and G/C group respectively both remarkable (P < 0.05). (4) The body weight, Lee's index, fat weight, and the fat weight of mass ratio in C group mother rats after lactation presented dressed compared with the SG group (P < 0.05), and so as to the G group compared with the SG group (P < 0.05). (5) In the female offsprings of G group, the birth weight was remarkably increased compared with the C group (P < 0.05); the body weight of the female offsprings presented an increased trend compared with the C group since the 12 weeks, but had no statistical significance; there were significant differences of body weight between G group and C group since 15 weeks (P < 0.05), and the trend kept up until 26 weeks; in the male offsprings of G group, the body weight on birth day and 4 weeks had a marked rise compared with the C group (P < 0.05); and from then on, the body weight of the male offsprings presented an increased trend compared with the C group, but had no statistical significance until 26 weeks (P > 0.05). (6) In G group, the blood glucose on 30 min and 60 min of LGTT in female offsprings were increased than the C group since 20 weeks (P < 0.05); the blood glucose of LGTT (30 min) still had a marked rise until 24 weeks (P < 0.05); in G group, the blood glucose on 30 min of LGTT in male offsprings was remarkably increased than the C group since 16 weeks (P < 0.05) ; the blood glucose of LGTT (30 min) still had a marked rise until 24 weeks (P < 0.05). (7) The blood pressure of male offsprings in G group had a marked rise on 12 weeks compared with the C group (P < 0.05); from then on the blood pressure of G group kept up a rise trend until 26 weeks, but had no statistical significance (P > 0.05)., Conclusion: The diabetic high-birth-weight rat model could be duplicated with STZ (25 mg/kg) once intrapertoneally on the first day of gestation, which were observed some evidently metabolic changes in weight, glucose tolerance and blood pressure. These results could represent an forward step in the clinical study of human gestational diabetes mellitus and their macrosomia babies, which may suffer some metabolic disease in their later life.

Objective: To study whether the current Institute of Medicine (IOM) pregnancy weight gain recommendations vary by pre-pregnancy body mass index (BMI) was suitable to Chinese people., Methods: A 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/m(2), n = 465), normal body mass group (BMI 18.5 - 24.9 kg/m(2), n = 3549), over body mass group (BMI ≥ 25 kg/m(2), 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., Conclusion: The current IOM pregnancy weight gain recommendations vary by pre-pregnancy BMI may be suitable to Chinese people.

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 3(rd) 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 tail vein 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 3(rd) 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 3(rd) 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 study the value of cervical length (CL) by transvaginal sonography in the mid-trimester and late-trimester for the prediction of preterm delivery., Methods: The CL was measured by transvaginal sonography for 5277 pregnant women between 22 - 24 weeks and 28 - 32 weeks gestation, who were prenatal cared and delivered at the First Hospital of Peking University from June 2008 to November 2009. The pregnancy outcomes were followed, and the relationship between CL and preterm delivery and preterm premature rupture of membrane was studied., Results: (1) The incidence of preterm delivery was 5.4% (289/5370) total, among of them the incidence of therapeutic preterm delivery was 1.7% (93/5370), spontaneously preterm delivery was 1.2% (62/5370), and preterm premature rupture of membrane was 2.5% (134/5370). There are 4 cases (4/5370) who occured late abortion. (2) Excluding the 93 women who had therapeutic preterm delivery, the mean CL of 22 - 24 weeks was (38.8 ± 4.0) mm. The relative risk for preterm delivery when the CL < 30 mm was 5.2, when CL < 25 mm, the relative risk was 11.1, and when CL < 15 mm the relative risk for preterm delivery was 13.8. The average CL during 28-32 weeks of gestation was (34.6 ± 4.8) mm, was significantly shorter than that of 22 - 24 weeks (P < 0.05). During this period the relative risk for preterm delivery when the CL < 30 mm was 6.9, when CL < 25 mm, the relative risk was 11.1, and when CL < 15 mm the relative risk for preterm delivery was 20.0. (3) A CL < 30 mm as the cut-off value for predicting preterm delivery during 22 - 24 weeks of gestation has only a 3% sensitivity and 19% positive predictive value, but had a 99% specificity and 96% negative predictive value. The sensitivity, positive predictive value, specificity and negative predictive value for a CL < 30 mm as the cut-off value for predicting preterm delivery during 28 - 32 weeks of gestation was 33%, 21%, 95% and 97% respectively. (4) The total number of preterm premature rupture of membrane pregnant women was 134 (2.5%), who had a mean CL of (38.4 ± 4.7) mm during 22 - 24 weeks of gestation, was similar with the women without preterm premature rupture of membrane (PPROM), but during 28 - 32 weeks of gestation the women who occured PPROM had a mean cervical length of (30.6 ± 8.1) mm, and was significantly shorter than that of women without PPROM (34.7 ± 4.6) mm., Conclusions: (1) CL in 28 - 32 weeks of gestation is significantly shorter than that of in the mid-gestation, but more than 90% of women has a CL ≥ 30 mm. (2) The shorter the CL is, the greater the relative risk of preterm delivery. According to different CL for clinical consulting objective relative risk could be provide. (3) The CL during 28 - 32 weeks of gestation can also predict preterm delivery, the sensitivity is obviously better than that of 22 - 24 weeks of gestation. (4) The CL during 28 - 32 weeks of gestation is valuable for predicting of PPROM.

Objective: To investigate the relationship between gestational hyperglycemia and adverse pregnancy outcomes and find out the optimum diagnostic criteria of gestational diabetes mellitus in China., Methods: A retrospective population-based study of 14 593 pregnant women, who delivered between Jan.2005 and Dec.2009 and accepted the gestational diabetes mellitus (GDM) screening and diagnosis was performed. The prevalence of gestational hyperglycemia according to different criteria was calculated, and the incidence of adverse pregnant outcomes relation to gestational hyperglycemia according to different criteria was analyzed., Results: (1) According to National Diabetes Data Group (NDDG) criteria and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the prevalence of gestational hyperglycemia that intervention required was 8.9% (1293/14 593) and 14.7% (2138/14 593) respectively; the prevalence of gestational hyperglycemia differed significantly between NDDG and IADPSG criteria (P < 0.05). (2) The prevalence of macrosomia, large for gestational ages (LGA), cesarean section, preterm birth and neonatal hypoglycemia etc would increase in gestational glucose metabolic disorders according to any criteria. The prevalence of the complications in gestational hyperglycemia according to NDDG criteria, IADPSG criteria and the patients with normal glucose metabolism is as follows, macrosomia: 8.4% (108/1293), 11.3% (241/2138) and 6.7% (835/12 403); LGA: 9.7% (125/1293), 11.7% (250/2138) and 5.5% (687/12 403); cesarean section: 59.0% (763/1293), 60.4% (1291/2138) and 51.6% (6397/12 403); preterm birth: 11.4% (147/1293), 9.5% (203/2138) and 6.3% (777/12 403); neonatal hypoglycemia: 2.6% (33/1293), 2.2% (46/2138) and 0.7% (89/12 403).(3) About 71.3% (922/1293) of the gestational hyperglycemia according to NDDG criteria could be well control only by diet control., Conclusion: The prevalence of perinatal complications would increase in gestational hyperglycemia that achieved IADPSG criteria without intervention, so IADPSG criteria is reasonable in China.

Objective: Study the effects of early overfeeding in the adult offspring of mother with severely hyperglycaemia in pregnancy to islet development and insulin resistance., Methods: Thirty healthy female Wistar rats were mated with 10 male Wistar rats and the morning on which sperm were found in three different visual fields of the vaginal smear was designated pregnancy day 1. The pregnant rats were intraperitoneally administered with Streptozotocin (STZ, 50 mg/L) on 5th day of pregnancy, and blood glucose exceeded 20 mmol/L to induce severely gestational diabetes mellitus (SDM) model. The pregnant Wistar rats were assigned to two experimental groups: SDM (n = 16) and control (n = 8). Litter size reduction in the lactation period induced early postnatal overfeeding model. Offspring were divided into three groups according to the level of blood glucose in pregnancy and feeding patterns in lactation: (1) control group (CG): euglycemia in pregnancy, eight pups in lactation; (2) severely gestational diabetes mellitus-normal feeding (SDM-N): severely gestational diabetes mellitus, eight pups in lactation; (3) severely gestational diabetes mellitus-overfeeding (SDM-O): severely gestational diabetes mellitus, four pups lactation. At the end of the lactation period, all pups were fed standard laboratory chow adlibitum until the date of the experiments. Offspring body weight was measured weekly after ablactation. Serum insulin was measured by enzyme-linked immunosorbent assay (ELISA) and pancreatic islet morphology was analyzed by immunohistochemistry (IHC) in all three groups at 26 weeks of age., Results: (1) Blood glucose of pregnant Wistar rats: SDM (28.3 ± 5.1) mmol/L was statistically higher than control (6.3 ± 1.4) mmol/L (P < 0.05). (2) Growth rates of body weight in 3-7 weeks and 3-9 weeks: SDM-N: (4.6 ± 1.3)% and (6.8 ± 2.5)%, SDM-O: (3.2 ± 0.7)% and (4.6 ± 1.2)%, CG: (2.9 ± 0.6)% and (4.1 ± 0.8)%. The growth rates of body weight in SDM-N and SDM-O were both significantly higher than those in CG (P < 0.05). (3) Body weight at 26 weeks: CG: (486 ± 132) g, SDM-N: (387 ± 115) g, SDM-O: (382 ± 122) g. There was no statistical difference among the three groups (P > 0.05). (4) Fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model of insulin resistance (HOMA-IR) and insulin sensitivity index (ISI): at 26 weeks, the SDM-offspring has normal FPG, but more insulin was needed to keep it normal. The insulin level of SDM-O [(12.6 ± 3.3) mU/L] was statistically higher than those of SDM-N [(10.9 ± 3.3) mU/L] and CG [(8.6 ± 0.8) mU/L] (P < 0.05). The ISI of SDM-O (0.020 ± 0.006) was significantly smaller than its HOMA-IR (2.40 ± 0.62, P < 0.05). (5) The morphological change of pancreatic islet: The islets of CG and SDM-N were round or ellipse and have clear boundary between endocrine and exocrine parts and the β cells distributed equally. However, SDM-O islets were not of uniform size and most of islets were hyperplasia and hypertrophy. (6) Relative β cell area of pancreas, β-cell area and islet size: SDM-O: (1.81 ± 0.31)%, (57.1 ± 3.2)% and (39,067 ± 3308) µm(2); SDM-N:(1.34 ± 0.43)%, (60.9 ± 0.6)% and (30,570 ± 4824) µm(2); CG: (1.11 ± 0.26)%, (63.7 ± 2.7)% and (26,443 ± 4431) µm(2). SDM-O has significantly increasing β-cell mass, hypertrophic islet size and slightly decreasing β-cell percentage compared with other two groups (P < 0.05)., Conclusions: The exposure of severely hyperglycemia in pregnancy induces low weight infant and postnatal catch-up growth leading to the possibility of insulin resistance (IR) in adult and early postnatal overfeeding will accelerate such course. Islet morphology of SDM-N has no significant change, indicating that maternal diabetes mainly affected β-cell function but not islet morphological features. SDM overfeeding results in early impairment of islet morphology and function, indicating that the compensation ability of islets has already been impaired and the risk of further development of impaired glucose tolerance (IGT) and diabetes. In conclusion, the nutritional environment in early life (duration of pregnancy and lactation) participate in the metabolic programming in adulthood.

Objective: To investigate the influencing factors of neonatal birth body mass in women with abnormal glucose metabolism during pregnancy., Methods: A study was conducted on 1157 singleton gravidas, who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology, First Hospital, Peking University from January 2005 to December 2009, by reviewing the medical records. Based on the pre-pregnant body mass index, the selected cases were divided into 4 groups: low body mass group [body mass index (BMI) < 18.5 kg/m(2), n = 53], ideal body mass group (BMI 18.5-23.9 kg/m(2), n = 647), over body mass group (BMI 24.0-27.9 kg/m(2), n = 323), and obese group (BMI ≥ 28.0 kg/m(2), n = 134). 1157 newborns were divided by birth body mass into 3 groups: normal birth body mass group (body mass 2500-4000 g, n = 987), of which 545 cases of birth body mass 3000-3500 g for the appropriate newborns, macrosomia group (body mass ≥ 4000 g, n = 112); low birth body mass group (body mass < 2500 g, n = 58). The following information was collected, including pre-pregnancy body mass, height, gestational age of diagnosis and body mass gain after diagnosis, maternal serum level of cholesterol, history of adverse pregnancy, and family history of diabetes, gestational age, delivering body mass, neonatal birth body mass. The influence of pre-pregnant BMI, body mass gain during pregnancy, gestational age of diagnosis, body mass gain after diagnosis, maternal serum level of cholesterol, family history of diabetes on the newborns' birth body mass was analyzed. The appropriate ranges of gestational body mass gain were calculated in women with abnormal glucose metabolism., Results: (1) The average neonatal birth body mass for each group respectively were (3142 ± 333) g for low body mass group, (3339 ± 476) g for the ideal body mass group, (3381 ± 581) g for over body mass group, and (3368 ± 644) g for obese group. The neonatal birth body mass was increasing with maternal pre-pregnant BMI, and average birth body mass of the newborns in low body mass group was lower than other 3 groups, respectively, the difference was statistically significant (P < 0.05). The difference was not statistically significant (P > 0.05), when it was compared among the obese group, ideal weight group and over body mass group. (2) The body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for each group respectively were (13.5 ± 4.5) and (17.1 ± 5.4) kg for the ideal body mass group, (11.6 ± 4.9) and (15.3 ± 6.4) kg for the over body mass group, (10.3 ± 5.0) and (14.7 ± 7.4) kg for the obese group. The difference was statistically significant in 3 groups (P < 0.05). The difference of body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (3) The gestational age of diagnosis in women who delivered normal birth weight newborn and macrosomia for the ideal body mass group respectively were (27.8 ± 5.8) and (29.8 ± 5.3) weeks, the difference was statistically significant (P < 0.05). The gestational age of diagnosis in gravidas who delivered normal birth weight newborn and macrosomia for the over body mass group respectively were (26.7 ± 6.8) and (30.2 ± 4.1) weeks, the difference was statistically significant (P < 0.05). The gestational age of diagnosis in women who delivered normal birth weight newborn for obese group was (26.2 ± 7.5) weeks, less than that of pregnant women who delivered macrosomia [(25.7 ± 9.3) weeks], but the difference was not statistically significant (P > 0.05). The difference of the diagnosed gestational age for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (4) The serum triglyceride (TG) levels of pregnant women who delivered macrosomia was (3.1 ± 1.5) mmol/L, higher than that of pregnant women who delivered normal birth weight newborn [(2.7 ± 1.2) mmol/L], and the difference was statistically significant (P < 0.01). The serum high density lipoprotein cholesterol (HDL-C) levels of pregnant women who delivered macrosomia was (1.4 ± 0.3) mmol/L, lower than that of pregnant women who delivered normal birth weight newborn [(1.7 ± 0.9) mmol/L], and the difference was statistically significant (P < 0.01). The serum low-density lipoprotein cholesterol (LDL-C) and cholesterol level of pregnant women who delivered macrosomia respectively was (2.8 ± 0.8) and (5.4 ± 1.1) mmol/L, less than those of pregnant women who delivered normal birth weight newborn [(3.0 ± 0.9) mmol/L and (5.6 ± 1.1) mmol/L], but the difference was not statistically significant (P > 0.05). (5) The final regression model of variables into the top three were pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C, when analyzing the related factors of affecting neonatal birth body mass with multiple logistic regression analysis such as age, history of adverse pregnancy, family history of diabetes, pre-pregnancy BMI, body mass gain during pregnancy and after diagnosis of abnormal glucose metabolism, maternal serum level of cholesterol, abnormal glucose metabolism categories, gestational age and other factors (P < 0.01)., Conclusion: Pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C may affect the neonatal birth body mass whose mothers were complicated with abnormal glucose metabolism during pregnancy.

Objective: To investigate the incidence and relevant information of preterm birth and the outcomes of preterm infants delivered at various gestational weeks and for different causes., Methods: Totally 955 women, who ended their pregnancies before term, and 1066 neonates of the previous mothers were enrolled in this survey, among 15,197 deliveries at Peking University First Hospital, Beijing Gynecological and Obstetric Hospital, Women's and Children's Hospital of Haidian District and Peking University Third Hospital, respectively, from December 1(st), 2006 to May 31(st), 2007., Results: (1) Incidence of preterm birth: the overall incidence of preterm birth of the 4 hospitals was 6.3% (955/15 197), and it was 8.1% (125/1549) in Peking University First Hospital, 13.1% (150/1142), which was the highest (P < 0.01), in Peking University Third Hospital, 5.5% (369/6656) in Beijing Gynecological and Obstetric Hospital and 34.0% (311/5850) in Women's and Children's Hospital of Haidian District. The preterm birth rate at the two comprehensive hospitals was significantly higher than that of the two specialized hospitals [10.2% (275/2691) vs 5.4% (680/12 506), P < 0.01]. (2) Gestational weeks at delivery: the incidence of preterm birth before 34 weeks was 28.5% (272/954) and the number changed to 71.5% (682/954) for those preterm deliveries after 34 weeks. However, this number varied among the 4 hospitals. Peking University First Hospital had the highest incidence of preterm birth before 34 weeks (P < 0.05), and the lowest was found in Women's and Children's Hospital of Haidian District (P < 0.01), but no difference was found between Peking University Third Hospital and Beijing Gynecological and Obstetric Hospital. (3) Etiology of preterm birth: preterm premature rupture of membranes (PPROM) accounted for the most proportion of all preterm birth cases, followed by iatrogenic preterm birth and spontaneous preterm birth. But the causes of preterm birth in the 4 hospitals were different. Peking University Third Hospital had a higher incidence of iatrogenic preterm birth than the others (P < 0.01), and Peking University First Hospital had a higher incidence of preterm birth caused by PPROM and lower incidence of spontaneous preterm birth. The first four reasons of iatrogenic preterm birth were preeclampsia (143, 42.0%), fetal distress (58, 17.1%), placenta previa (43, 12.6%) and placenta abruption (33, 9.7%). (4) Neonatal outcomes in different hospitals: the neonatal outcomes were quite different among the 4 hospitals due to different causes and different delivery weeks. The highest neonatal mortality rate was found in Beijing Gynecological and Obstetric Hospital (5.4%, 22/408) compared to that in Women's and Children's Hospital of Haidian District (1.3%, 4/320) and Peking University Third Hospital (0.6%, 1/170) (P < 0.01), but without any difference when compared to that in Peking University First Hospital (2.4%, 3/124) (P > 0.05). (5) Neonatal outcomes at different gestational age: the recovery rate of preterm infants delivered at < 32 weeks was lower than those delivered > or = 32 weeks (P < 0.01), and this number rose to 99.6% in those delivered > or = 34 weeks. More infants delivered < 32 weeks were given up for treatment or died during the perinatal period than those delivered > or = 32 weeks, with the neonatal mortality rate of 22.1% for those delivered at < 32 weeks and only 0.3% for those delivered at > or = 34 weeks (P < 0.01). (6) Neonatal outcomes for various causes: the premature neonatal mortality rate for iatrogenic preterm births was higher than that of PPROM (4.9% vs 1.6%, P < 0.05). But the neonatal recovery rates were similar among the PPROM, spontaneous and iatrogenic preterm birth group (P > 0.05)., Conclusions: Preterm birth is associated with high perinatal mortality rate, especially for those delivered before 32 weeks which would be highlighted in prevention. Reduction of the iatrogenic preterm birth, combined with proper prevention of PPROM, is an important issue in decreasing the prevalence of preterm birth.

Objective: To study the sensitivity of the real-time polymerase chain reaction (RT-PCR) in detecting group B streptococcus (GBS) in late pregnant women and the influence of vaginal/rectal GBS colonization on maternal and neonatal outcomes., Methods: Microbiological culture and RT-PCR for GBS were both performed for each sample taken from the vagina and rectus in 617 gravidas at 35-37 weeks of gestation, with an average age of 30.1, among which 80 aged over 35. Forty-one out of the 617 women were multiparous and 576 primiparous. The laboratory results were collected and the pregnant outcomes were followed., Results: (1) Out of the 617 gravidas, 21 (3.4%) were GBS positive by culture (all positive in RT-PCR) and 57 (9.2%) were GBS positive by RT-PCR. Thirty-six cases with PCR positive but culture negative results were analyzed by sequencing, and 34 showed GBS positive and 2 negative. (2) The sensitivity and specificity of RT-PCR was 100% (55/55) and 99.6% (560/562) respectively. (3) The average age of GBS positive gravidas was 30 ± 4, without significant difference compared with that of GBS negative women (31 ± 4), P > 0.05. The GBS positive rates were also similar between the primiparas and the multiparous [7.3% (3/41) vs. 9.4% (54/576)], between elderly women and those under the age of 35, and between those women who had abortions over and less than 3 times (all P > 0.05). (4) No significant difference was found in the cesarean section rate between the GBS positive and negative group [54.4% (31/57) vs. 44.6% (250/560), P > 0.05]. (5) Compared with the GBS negative group, the GBS positive group had higher incidence of intrauterine infection [6.6% (37/560) vs. 15.8% (9/57)], postpartum hemorrhage (2.9% vs. 10.5%) and fetal distress (25.9% vs. 38.6%) all P < 0.05, but had similar incidence of premature rupture of membranes [25.0% (140/560) vs. 33.3% (19/57)], preterm birth and meconium-stained amniotic fluid. (6) The neonatal infection rate in the GBS positive group was significantly higher than that of the GBS negative group [29.8% (17/57) vs. 13.2% (77/560), P < 0.05]. One neonate in the GBS positive group developed early-onset severe GBS infection and achieved better outcome under proper treatment., Conclusions: Maternal GBS carrier at 35-37 weeks of gestation can lead to adverse pregnant outcomes by increasing the incidences of intrauterine infection and neonatal infections. However, RT-PCR could be a routine method to detect GBS status in late pregnant women with its higher sensitivity and specificity.

Objective: To study the effect of intrauterine hyperglycemia on leptin level and offspring development in rats., Methods: Female and male adult Wistar rats were mated, streptozotocin (STZ, 50 mg/kg) was administered intraperitoneally on 5th day of gestation to induce diabetic model, diabetic pups (DP) were exposed to intrauterine hyperglycemia; control pups (CP) were exposed to controls, which was injected with citrate buffer, 8 pups were choosed from each group. Weight gain between 3 - 10 weeks were recorded. Plasma leptin was detected by enzyme-linked immunosorbent assay (ELISA) when the rats were 11 weeks old, and the expression of leptin receptor in hypothalamus was measured at protein level by histomorphology and mRNA level measured by realtime PCR [expressed with integral absorbance (IA)] in 11 weeks in order to discuss the relation of leptin and offspring development., Results: The fasting blood glucose level was significantly higher in diabetic mother compared with the controls [(28.3 +/- 5.1) mmol/L vs. (6.3 +/- 1.4) mmol/L, P < 0.05]. However, there was no difference between the fasting blood glucose level in DP group and CP group [(5.1 +/- 0.8) mmol/L vs. (5.3 +/- 0.6) mmol/L, P > 0.05]. The growth rate between 3-10 weeks was significantly higher in DP group 649.7% than CP group 479.2%, P < 0.05. The base insulin level was lower in DP group [(0.76 +/- 0.37) microg/L vs. (1.06 +/- 0.14) microg/L, P < 0.05]; while there was no difference in plasma leptin and the expression of leptin receptor in hypothalamus [(113 +/- 37) microg/L vs. (128 +/- 40) microg/L, P > 0.05]. The growth rate was not associated with plasma leptin in DP group (r = -0.501, P = 0.311) but associated in CP group (r = -0.553, P = 0.001). The protein level of DP group (4125 +/- 414) did not significantly differ from that of CP group (4244 +/- 511). The median of mRNA of leptin receptor in hypothalamus in DP group did not altered significantly compared with that of CP group (1.25 vs 1.80, P > 0.05)., Conclusions: Intrauterine hyperglycemia accelerated growth rate of offsprings between 3 and 10 weeks, however, plasma leptin was not discreased, which indicated leptin resistance. Intrauterine hyperglycemia did not influence the expression of leptin receptor in hypopthalamus in offsprings, this suggested the leptin resistance may be not caused by the quantity of leptin receptors.

Objective: To discuss the diagnosis and treatment strategy of cesarean scar pregnancy (CSP)., Methods: Forty-two cases of CSP admitted to Peking University First Hospital from Jan. 2003 to Dec. 2008 were analyzed retrospectively, and the clinical characteristics, pelvic Doppler ultrasonography report, management including methotrexate (MTX) therapy, bilateral uterine artery embolism (UAE), curettage and hysterectomy of these 42 women were reviewed. The percentage of human chorionic gonadochopin (hCG) reduction, menstrual period after the treatment of her CSP and recurrent pregnant outcome were also followed., Results: Among the 42 CSP women, 24 (57%) presented with vaginal bleeding, 3 (7%) with lower abdominal pain. The interval between CSP and the last cesarean scar (CS) was 0.5 - 18.0 years and the average duration of gestation was (60 +/- 18) days. Fourteen cases (33%) were finally diagnosed as CSP in our hospital followed by failure of abortion due to misdiagnosed as early uterine pregnancy in other hospitals; one (2%) was finally diagnosed after hysterectomy due to excessive bleeding during curettage because of suspected hydatidiform mole under color sonography; one was diagnosed by MRI after color sonography; the rest 25 women (60%) were all confirmed by color sonography before management. Treatment of these cases included curettage after UAE (17 cases), curettage after UAE and MTX (13 cases), curettage after MTX only (4 cases), MTX only (4 cases) and others (4 cases). No significant difference was found in the average duration of pregnancy, average reduction of serum level of hCG and the operation time for curettage between the first two management group (P > 0.05). All of the 42 cases fully recovered before discharge and the recovery time of menses was averagely (32 +/- 10) days (10 - 60 days) after curettage and 5 reported reduced menstrual blood volume. Three out of the 42 women were pregnant again during follow-up and 1 delivered by CS at 39 weeks of gestation one year after without any complications or CSP., Conclusions: CSP is not common and can be easily misdiagnosed and color ultrasound scan is important in its early diagnosis. UAE combined with MTX followed by curettage is an effective treatment of CSP.

Objective: To find out the bacterial species in the vagina of postpartum women and the possible influencing factors on colonization., Methods: From Jun. 2007 to Oct. 2007, 560 postpartum women from 7 hospitals in China were enrolled. Questionnaire survey, gynecological examination and Nugent score of vaginal smear and microbial spectrum study of the vaginal flora were completed., Results: (1) According to the Nugent score, 48 out of the 560 women were normal (8.6%), 337 at the borderline (60.2%) and 175 (31.2%) were complicated with bacterial vaginosis (BV). Among the 560 women, Bacterium lacticum were identified in 74 cases (13.2%), but not in the rest 486 cases (86.8%). Gardnerella and bacteroids were detected in 322 women (57.5%) and small flectobacillus in 214 women (38.2%) out of the 560 subjects. (2) Influencing factors on vaginal microflora: among the 266 women who had normal vaginal delivery, 25 (9.4%) showed normal vaginal microflora, 148 (55.6%) at borderline and BV was diagnosed in 93 women (35.0%). The corresponding figures among the 294 women who underwent cesarean section were 23 (7.8%), 189 (64.3%) and 82 (27.9%), respectively. However, the incidence of BV had no statistical difference between these two groups (P = 0.204). In the 233 women who received episiotomy, 22 (9.4%) showed normal vaginal microflora, 135 (57.9%) at borderline and 76 presented with BV (32.6%), the corresponding figures among the 327 women without episiotomy were 26 (8.0%), 202 (61.8%) and 99 (30.2%), respectively. The incidence of BV did not show any statistical difference between the above two groups (P = 0.790). (3) Prenatal vaginitis were reported in 46 women, among which 5 (10.9%) with normal vaginal flora, 26 (56.5%) at borderline and 15 (32.6%) with BV, and again in the 514 women without prenatal vaginits, the above figures changed to 43 (8.4%), 311 (60.5%) and 160 (31.1%). No significant difference was found in the incidence of BV between the two groups (P = 0.962). The rate of BV in women without sex, with sex occasionally and with sex frequently during pregnancy was 27.5% (78/284), 35.6% (96/270) and 1/6, respectively (P = 0.185), and the numbers in women who had breast-feeding, bottle feeding and mixed feeding were 31.0% (67/216), 39.3% (35/89) and 28.6% (73/255), respectively (P = 0.573)., Conclusions: The amount of Lactobacillus in vagina of postpartum women is greatly reduced leading to dysbacteria. The incidence of BV is not affected by vaginal delivery, episiotomy, vaginitis, prenatal intercourse and the way of feeding, but is higher in postpartum women.

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 positions 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 discuss the serum endoglin expression in severe pre-eclampsia and eclampsia women and their relationships., Methods: Forty-two severe pre-eclamptic patients and 4 eclamptic patients in Peking University First Hospital from Dec. 2005 to Dec. 2007 were enrolled in the study group, with the mean gestational week of 35 +/- 4, the mean age of 29.3 +/- 5.7 and the mean BMI (30.1 +/- 4.1) kg/m(2). This group included 25 cases of early onset pre-eclampsia, 21 cases of late onset pre-eclampsia, 8 cases of fetal growth restriction and 5 cases of HELLP syndrome. The control group included 29 cases of normal pregnant women during the same period, with the mean gestational week of 33 +/- 4, the mean age of 30.7 +/- 3.4 and the mean BMI (27.2 +/- 2.2) kg/m(2). Peripheral serum endoglin was determined by ELISA in these two groups., Results: (1) There is positive correlation between serum soluble endoglin level and the gestational weeks during 27 to 37 gestational weeks in the control group (r = 0.79, P < 0.05), but there is no distinct relationship in the study group (r = 0.31, P > 0.05). (2) Serum endoglin level of severe pre-eclampsia group was higher than the normal group [(14.2 +/- 5.6) microg/L vs. (10.9 +/- 4.2) microg/L, P < 0.05]. (3) Serum endoglin level of early onset group did not differ from late onset group [(14.3 +/- 5.7) microg/L vs. (13.6 +/- 5.0) microg/L, P > 0.05]. (4) No difference of serum endoglin between HELLP group and non-HELLP group was found [(10.1 +/- 2.9) microg/L vs. (14.4 +/- 5.4) microg/L, P > 0.05]. (5) Serum endoglin level of FGR sub group was higher than non-FGR sub group [(17.3 +/- 6.1) microg/L vs. (13.0 +/- 4.8) microg/L, P < 0.05] in the stady group., Conclusion: The elevated peripheral serum endoglin level may contributes to the pathogenesis of severe pre-eclampsia and FGR, but not the week of the onset of the disease.

Objective: To investigate the incidence of glucose metabolism disorder during pregnancy and establish the diagnosis criteria for gestational diabetes mellitus (GDM) among Chinese patients., Method: A prospective population-based study of 16 286 pregnant women, who received 50 g glucose challenge test (GCT) for the first time between Apr 1, 2006 and Sept 30, 2006, was performed throughout 18 cities in China., Results: According to national diabetes data group (NDDG) criteria, the overall incidence of GDM and glucose impaired glucose tolerance (GIGT) was 2.763% (450/16 286) and 3.862% (629/16 286), respectively; it changed to 5.078% (827/16 286) and 5.268% (858/16 286) when using American diabetes association (ADA) criteria. If the women who had 2 or more abnormal oral glucose tolerance test (OGTT) values meeting or exceeding ADA criteria was classified as group 1, and the women who had one or more meeting or exceeding NDDG criteria was group 2, the ratio of women who met both the criteria of ADA and NDDG in group 1 was 94.2%. The 95%CI of normal glucose when using ADA criteria were fasting glucose 5.3 mmol/L, 1 hour 10.4 mmol/L, 2 hour 8.7 mmol/L, 3 hour 7.7 mmol/L, which is close to ADA criteria., Conclusions: ADA criterion is more suitable for Chinese patients. According to NDDG criteria, it is reasonable to treat the patient with 1 or more abnormal OGTT values, and if choosing ADA criteria, 2 or more abnormal OGTT values is more reasonable.

Objective: Alport syndrome (AS) is a progressive renal disease characterized by hematuria and progressive renal failure. X-linked dominance is the major inheritance form of the syndrome, accounting for almost 80% of the cases, caused by mutations in COL4A5 genes. There is currently no effective treatment that has been shown to favorably affect the outcome of AS, so early diagnosis and even prenatal diagnosis is very important., Methods: In this study mutation of COL4A5 was detected by amplifying the entire coding sequence mRNA of peripheral blood lymphocytes using nested PCR in two Chinese X-linked dominant Alport syndrome (XLAS) families, then the first prenatal diagnosis of XLAS in China was performed. Mutation analysis of the fetus was performed on both cDNA-based level and DNA-based level of amniocytes. Fetus sex was determined by PCR amplification of SRY as well as karyotypes analysis. Maternal cells contamination was excluded by linkage analysis., Results: There was a deletion mutation in the proband of the first family, 2696 - 2705 del gtatgatggg in the 32 exon of COL4A5, but the mother did not carry the mutation (de novo). There was a G to A substitution at position 4271 in exon 46 of COL4A5 gene (c.G4271A) in the second family, the mother also carried this mutation. After genetic counselling, only the second family accepted prenatal diagnosis. Both amniocytes cDNA level and amniocytes genomic DNA level based prenatal diagnosis showed that the fetus did not carry the same mutation as the mother. PCR amplification of SRY and karyotypes analysis showed a male fetus. Linkage analysis of X chromosome polymorphic microsatellite markers showed that there was no MCC in amniocytes., Conclusion: Both cDNA level and DNA level analysis could enhance the accuracy and reliability of prenatal diagnosis. PCR amplification of SRY was faster than karyotypes analysis in the fetal sex determination. Linkage analysis was useful in the detection of maternal cells contamination in amniocytes.

Objective: To analyze the pregnant outcome of women with chronic hypertension, and to investigate the high risk factors associated with harmful maternal and perinatal prognosis., Methods: Of the 14 127 deliveries in Peking University First Hospital from Jan 2001 to Dec 2005, 121 pregnant women with chronic hypertension were identified and divided into two groups: chronic hypertension with and without preeclampsia (group PE, 64 cases; group N-PE, 57 cases). The maternal and perinatal outcomes of the two groups and the high risk factors for adverse maternal and perinatal prognosis were analyzed., Results: (1) The incidence of pregnancy with chronic hypertension was 0.86% (121/14 127). (2) The incidences of placental abruption, pulmonary edema and retinopathy in groups PE and N-PE were 16% (10/64) vs 2% (1/57), 11% (7/64) vs 0 and 41% (26/64) vs 16% (9/57, P < 0.05). (3) Preterm birth rate and preterm birth rate before 32 weeks in groups PE and N-PE were 55% (35/64) vs 16% (9/57) and 27% (17/64) vs 2% (1/57, P < 0.01). (4) The rate of small for gestational age in groups PE and N-PE was 31% (20/64) vs 7% (4/57, P < 0.01). (5) The perinatal mortality and newborn intensive care unit (NICU) admission rate in groups PE and N-PE were 11% (7/64) vs 0 and 33% (21/64) vs 5% (3/57, P < 0.01). (6) Chronic hypertension history > or = 4 years, no systemic therapy, irregular perinatal care and preeclampsia history were high risk factors of preeclampsia superimposed on chronic hypertension (P < 0.05). Chronic hypertension history > or = 4 years was the only independent risk factor by multiple factors logistic regression analysis (P < 0.05)., Conclusions: Maternal and perinatal morbidity and mortality are higher in chronic hypertension with preeclampsia than without preeclampsia. Hypertension history for at least 4 years is an independent risk factor.

Objective: To understand the incidence of abnormal glucose metabolism during pregnancy and the maternal and neonatal outcomes after standard management., Methods: A retrospective study of maternal and neonatal outcomes was conducted in 1490 pregnant women who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology of First Hospital of Peking University from Jan 1995 to Dec 2004 by reviewing the medical records. The selected cases consisted of 79 women with diabetes mellitus (DM group), 777 with gestational diabetes mellitus (GDM group), including 355 cases of A1, 316 with A2 and 106 cases unclassified, and 634 with gestational impaired glucose test (GIGT group). Maternal and fetal outcomes were analysed in comparison with the controls of 19 013 pregnant women with normal glucose metabolism who delivered during the same period., Results: (1) The total incidence of gestational abnormal glucose metabolism was 7.3% and increased gradually from 1995 to 2004. The first stage, from Jan 1995 to Dec 1999, saw a slow increase in the incidence [4.3% (376/8739)]; the second stage, from Jan 2000 to Dec 2001, showed a fast increasing trend. The average incidence was 10.8% (445/4133). The incidence in the third stage kept stable at 8.9% (678/7640) from Jan 2002 to Dec 2004. (2) The incidence of macrosomia, preeclampsia and preterm birth were 12.1% (180/1490), 9.5% (141/1490) and 9.4% (140/1490), which were significantly higher than those women with normal glucose metabolism (P < 0.01). A significant difference was found in the incidence of preeclampsia, preterm birth, intrauterine infection, polyhydramnios and ketonuria among the three groups (P < 0.05), but not in the incidence of macrosomia (P > 0.05). (3) The perinatal mortality rate (PMR) of abnormal glucose metabolism group was 1.19% (18/1513) which was significantly higher in the DM group (4.93%) than GDM (1.14%) and GIGT groups (0.78%, P < 0.01), while the incidence of neonatal asphyxia, hypoglycemia, malformation and admission to NICU in the DM group were all higher than GDM and GIGT groups (P < 0.01). (4) NRDS was found in 9 cases among 1505 neonates (0.6%) and all were delivered preterm., Conclusions: (1) The incidence of gestational abnormal glucose metabolism is increasing and the screening and diagnosis of diabetes in pregnancy should be strengthened. (2) Macrosomia, preeclampsia and preterm birth remain the first three common complications even after standardized glycemic management, but the maternal and neonatal complications are reduced in the GIGT group except for macrosomia. Those women in the DM group has a higher rate of maternal and neonatal complications than those in GDM and GIGT groups, so management in these patients should be strengthened. (3) NRDS is no longer a primary neonatal complication provided proper management is performed.

Objective: To evaluate whether incidence of 50 g glucose challenge test (GCT) and 75 g oral glucose tolerance test (OGTT) is higher in pregnant women with vulvovaginal candidiasis (VVC)., Methods: A retrospective study of pregnant women with IGGT or GDM who delivered at Peking University First Hospital from Jan 1, 2004 to June 30, 2005 was conducted. The prevalence of VVC and re-infected vulvovaginal candidiasis (RVVC) were determined, and blood glucose concentrations of GGT and OGTT in VVC, RVVC and NVVC groups were compared., Results: Four hundred and one pregnant women were recruited, of whom 51 had VVC, and 16 had RVVC. The prevalence of VVC was greater among GDM women than among IGGT women (P = 0.014). Glucose concentrations were higher in VVC cases than in NVVC cases at GCT [(9.6 +/- 2.0) vs (9.3 +/- 1.6) mmol/L], OGTT 0 hour [(5.4 +/- 1.1) vs (5.3 +/- 0.9) mmol/L], 1 hour [(11.1 +/- 1.7) vs (11.0 +/- 1.5) mmol/L], 2 hours [(9.4 +/- 1.8) vs (9.2 +/- 1.6) mmol/L], however, there were no statistical differences (P > 0.05). Glucose concentrations were higher in RVVC cases than in NVVC cases at GCT [(10.4 +/- 1.2) vs (9.3 +/- 1.6) mmol/L]; OGTT 0 hour [(5.3 +/- 0.6) vs (5.3 +/- 0.9) mmol/L], 1 hour [(11.4 +/- 1.0) vs (11.0 +/- 1.5) mmol/L]; 2 hours [(9.4 +/- 1.4) vs (9.2 +/- 1.6) mmol/L], but there were no statistical differences (P > 0.05)., Conclusion: The incidence of VVC is higher in pregnant women with GDM than in pregnant women with GIGT, however, GCT, and OGTT show no statistical differences between women with VVC and those without VVC.

Objective: To investigate the incidence, treatment and pregnant outcomes of women with hypothyroidism during pregnancy., Methods: A retrospective analysis was conducted on the perinatal care, treatment and pregnant outcomes of 31 pregnant women with hypothyroidism from Jan.1995 to May.2006 in our hospital. All subjects were received in the high risk clinic, and the thyroid function was monitored every 1.0 - 1.5 months. The dosage of LT4 was adjusted to maintain the normal level of thyroid function., Results: The incidence of maternal hypothyroidism during the study period was 1.27 per thousand (31/24 327) [0.19 per thousand (1/5251) - 2.32 per thousand (15/6456)]. The average LT4 dosage in pre-gestation, the first, second, third trimester and postpartum was (33 +/- 35), (51 +/- 36), (68 +/- 42), (76 +/- 42) and (38 +/- 34) microg/d, respectively. Compared with the pre-gestational period, the dosage in the first trimester or postpartum was higher although the difference was not significant (P>0.05). The required dose of LT4 during the second and third trimester was respectively, remarkably increased compared to pre-gestational period (P<0.05). The average increase of the dose of LT4 required during the pregnancies was about 35%. All of 31 women had uneventful pregnancies. No perinatal mortality or congenital hypothyroidism occurred. The incidence of abnormal glucose metabolism was up to 16.1%., Conclusions: The incidence of maternal hypothyroidism is increasing yearly. It is of great value in improving the pregnant outcome through adjusting the LT4 dose during pregnancy and close monitoring of maternal and fetal status.

Objective: To investigate the relationship between the polymorphism of site rs228648 in urotensin II gene and the genetic susceptibility to gestational diabetes mellitus in northern Chinese women., Methods: Genotyping was conducted to investigate the polymorphism of site rs228648 (G-A) in urotensin II gene among 70 unrelated gestational diabetes mellitus (GDM) subjects and 70 normal controls. DNA samples isolated from leucocyte of the control and study groups were analyzed for single-nucleotide polymorphisms of the urotensin II gene at positions rs228648 using polymerase chain reaction and restriction analysis., Results: (1) The distribution of genotype frequencies of site rs228648 accorded with Hardy-Weinberg's equation law, being colony representative. (2) The frequency of G allele of site rs228648 was 70.7% in GDM group, significantly higher than that in the control group (57.9%, P < 0.05); and the frequency of A allele of site rs228648 was 29.3% in GDM group, significantly lower than that in the control group (42.1%, P < 0.05). There was no significant difference in the frequency of G/G genotype between GDM group and control group (52.9% vs 41.4%, P > 0.05). (3) Women in control group were more likely to be homozygous for the allele A of site rs228648 than women with GDM. The frequency of A/A genotype of rs228648 was negatively correlated with GDM group. By the logistic procedure, after adjustment by age and gestational weeks, the odds ratio was 0.312, and Wald Confidence Limites were 0.108 to 0.900 (P = 0.031)., Conclusion: Urotensin II gene may contribute to the genetic susceptibility to gestational diabetes mellitus in northern Chinese population. G allele of site rs228648 is related to GDM possibly, and that homozygosis A of site rs228648 is likely to be an important protecting factor for GDM.

Objective: Severe preeclampsia, and hemolysis, elevated liver enzymes, and low platelet syndrome (HELLP) are serious complications of pregnancy, and evidence suggests a genetic basis for these conditions. A G1528C mutation in the alpha-subunit of the mitochondrial trifunctional protein (MTP) gene has been identified in association with these conditions. The aim of this study is to explore the carrier rate of the G1528C mutation in the MTP gene in pregnant women with severe preeclampsia, HELLP syndrome and in their newborns, as well as in a normal pregnant population, so as to determine its association with maternal liver disease among women in Beijing., Methods: A multicenter, prospective, case control study was carried out. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to screen the G1528C mutations in the MTP gene. One hundred and forty cord blood samples from cases with severe preeclampsia (n = 130) and HELLP syndrome (n = 10) were collected. Ninety maternal peripheral blood samples among them (84 from severe preeclampsia and 6 from HELLP syndrome) were also collected for screening the common disease-causing mutation in Caucasians. Five hundred and sixty cord blood samples and 90 maternal peripheral blood samples obtained from normal pregnant women served as controls., Results: The G1528C mutations in the MTP gene were not found in samples from women with severe preeclampsia and their newborns, from women with HELLP syndrome and their new borns, as well as in samples from the normal pregnant women and their new borns., Conclusions: The common disease-causing mutation of G1528C in MTP gene in Caucasians is probably not a common mutation in Chinese Han people in Beijing. Further study is needed to expand the sample size among HELLP syndrome and maternal liver diseases in Chinese population.

Objective: To evaluate the risk factors for gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT)., Methods: A prospective case-control study was performed in 85 women with GDM, 63 cases with GIGT and 125 cases as control recruited from Feb 2004 to Aug 2004 in Peking University First Hospital. Univariate analysis and multivariate logistic regression were used to identify risk factors of GDM and GIGT., Results: (1) The mean age, and body mass index (BMI) before pregnancy and larger maternal weight gains during pregnancy were significantly different between GDM/GIGT and control group (P < 0.05). (2) More intakes of fruits and carbohydrate per day increased the incidence of GDM and GIGT (P < 0.05). (3) There was a higher proportion of women with family history of diabetes among the GDM (42.2%) and GIGT (36.5%) compared with control group (19.2%). Irregular menses (16.5%, 23.8%), and polycystic ovary syndrome (PCOS) (5.9%, 3.2%) were more prevalent in the GDM, GIGT groups versus control subjects (6.4%, 0). The incidence of vulvovaginal candidiasis (VVC) was significantly higher in pregnant women with GDM and GIGT (15.3% and 17.4%) than in control group (7.2%). (4) Multivariate logistic regression showed that age, irregular menses, BMI before pregnancy, history of spontaneous abortion, educational level and VVC all were independent factors for GDM or GIGT., Conclusions: Maternal age, irregular menses, obesity before gestation, rapid weight gains during pregnancy, history of spontaneous abortion as well as VVC are independent risk factors for GDM or GIGT. PCOS and family history of diabetes increase the incidence of GDM and GIGT but these are not independent risk factors for GDM and GIGT.

Objective: To investigate the incidence and associated factors of pre-eclampsia in women with abnormal glucose metabolism in pregnancy., Methods: A retrospective study was conducted on 1202 pregnant women with abnormal glucose metabolism who delivered their babies in our hospital between 1981-2003. All women were divided into 2 groups: group I included 151 women with pre-eclampsia; group II consisted of 1050 women without pre-eclampsia. The risk factors of pre-eclampsia were analyzed., Results: (1) The incidence of pre-eclampsia was 12.6% as a whole and was 34.8% (39/112), 11.8% (89/753) and 6.8% (23/337) in diabetes mellitus (DM), gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) groups, respectively (P < 0.01). (2) The average pre-pregnant body mass index (BMI), the gestational age at the presence of elevated blood glucose and the parity in group I were significantly different from that of group II [(31 +/- 4) kg/m(2) vs (29 +/- 4) kg/m(2), P = 0.027; (27 +/- 11) weeks vs (30 +/- 7) weeks, P = 0.001; (1.0 +/- 0.6) vs (0.8 +/- 0.6), P = 0.01]. No difference was shown in these two groups in maternal age and gravida. (3) The incidence of pre-eclampsia was increased in women who had poor obstetric history and chronic hypertension (18.5% vs 11.6%, 41.9% vs 11.5%, P = 0.03, 0.000). (4) In group I, the glucose level of glucose challenge test (GCT), oral glucose tolerance test (OGTT, fasting, 2 hr and 3 hr) and the hemoglobin A(1)c (HbA(1)c) value were all higher than those of group II (P = 0.002, 0.000, 0.009, 0.001, 0.004, respectively). (5) Those with insulin treatment had a rate of 15.6% of pre-eclampsia, which was higher than those with diet control (9.9%, P = 0.009), and the glucose not well controlled women had a higher rate of pre-eclampsia than the well controlled ones (17.0% vs 10.0%, P = 0.000). (6) Logistic regression analysis showed that the independent risk factors of pre-eclampsia were pregnant women with chronic hypertension and the level of HbA(1)c., Conclusions: Types of abnormal glucose metabolism have significant effect on the incidence of pre-eclampsia. The occurrence of pre-eclampsia in these women is closely related to the plasma glucose level at GDM diagnosis and how well the maternal glucose level is controlled.

Objective: To investigate the influence of combined spinal-epidural analgesia (CSEA) and epidural analgesia (EA) and patient-controlled epidural analgesia (PCEA) on labor progress., Methods: The partograms of 722 healthy vaginal delivery nulliparas were retrospectively analyzed in Department of Obstetric and Gynecology, First Hospital of Peking University. Three groups were divided among all subjects: CSEA group (259 cases) receiving CSEA + PCEA, EA group (215 cases) receiving EA + PCEA and control group (248 cases) without any analgesia method., Results: The duration of active phase in the first stage and the second stage in the CSEA group [(272 +/- 127) min and (57 +/- 36) min] and in the EA group [(305 +/- 133) min and (59 +/- 39) min] were significantly longer than that of control group [(188 +/- 110) min and (45 +/- 32) min]. No significant difference was found in the three groups in the duration of the third stage [CSEA: (9 +/- 6) min; EA: (8 +/- 6) min;, Control: (9 +/- 6) min. P > 0.05]. The dilatation curve of the cervix in CSEA group and EA group was plotted on the right side of the Friedman curve while that of the control group on the left, reflecting a slower progress in the former two groups than the control during the active phase. The average speed of cervical dilatation in CSEA and EA groups (1.5 cm and 1.4 cm) was significantly slower than that of the control (1.8 cm) in the active phase (P < 0.01)., Conclusions: CSEA + PCEA or EA + PCEA during labor might slow down the progress of the active phase and lead to a prolonged labor in the end. Therefore, the management of these parturients may vary based on Friedman partogram.

Objective: To study the maternal blood glucose management of gestational diabetes mellitus during the labor and relationship of maternal blood glucose in labor and neonatal blood sugar., Methods: A prospective study on maternal blood glucose monitoring and control during labor was carried in 40 pregnant women with abnormal glucose metabolism. We adjusted maternal blood glucose by low-dosage constant insulin drop during labor., Results: Maternal blood glucose in labor arranged between 3.8 approximately 11.2 mmol/L, and low-dosage constant insulin drop was used in 17 cases (42.5%). The neonatal blood glucose was (4.0 +/- 1.5) mmol/L following delivery and (3.9 +/- 1.0) mmol/L at 24-hour postpartum. There were 2 cases with neonatal hypoglycemia. The neonatal blood glucose of the rest 23 cases was (4.2 +/- 1.5) mmol/L, and (3.9 +/- 1.0) mmol/L at 24-hour postpartum, and 1 case with neonatal hypoglycemia. There was no the difference of the blood glucose level of newborns between mothers with abnormal glucose metabolism and the normal pregnant women., Conclusion: It is necessary to monitor and control the blood glucose level by low dose constant insulin during labor in pregnant women with abnormal glucose metabolism.

Objective: To study the cutoff value, the appropriate time of the 50 g oral glucose challenge test (GCT) to screen the gestational diabetes mellitus (GDM) and to study the importance of the maternal age and body weight of GDM., Methods: The clinical data of 8 665 pregnant women who underwent the GCT from January 1995 to March 2001 in the Department of Obstetrics and Gynecology of the First Hospital of Beijing University were collected, and a retrospective study was made., Results: (1) The 1 h average plasma glucose level of the GCT is (6.8 +/- 1.7) mmol/L. The abnormal rate of GCT was 25.2% using 7.8 mmol/L as the cutoff, 5.3% (17/321) of GDM were misdiagnosed. When the cutoff is 7.2 mmol/L, the abnormal rate is increased to 36.5%, and 2.8% (9/321) of GDM were more diagnosed. If a value of 8.3 mmol/L as threshold, there would be 15.9% (51/321) of GDM to misdiagnose. (2) When 1 h blood glucose is >or= 11.2 mmol/L, the incidence of GDM is 55.8% (92/165). Among them, 62.0% (57/92) GDM could be diagnosed according to the fasting blood glucose. (3) There were no difference in the rate of abnormal GCT when GCT underwent between 24 and 36 weeks of gestation. (4) The rate of abnormal GCT and the incidence of the GDM are obviously different among the different age groups. The incidence of GDM among the women younger than 25 years old without high risk factors is only 0.3%, obviously lower than the other groups. (5) The average body mass index (BMI) of the women between 26 to 28 weeks of gestation is (24.9 +/- 2.9) kg/m(2). When the BMI is >or= 27.8 (x +/- s), the rate of abnormal GCT and the incidence of the GDM were obviously higher than the other women., Conclusions: (1) 7.8 mmol/L as the cutoff of the GCT for the screening of GDM is appropriate. When the 1 h blood glucose level is >or= 11.2 mmol/L, fasting blood glucose should first be done to diagnose GDM. (2) It is necessary to screen GDM as soon as possible after 24 weeks of gestation, but for the women with obviously high risk factors GCT should be done before 24 weeks of gestation. (3) Age and obesity are the important risk factors for the GDM. It is not necessary to screen GDM among the pregnant women younger than 25 years old without high risk factors.