Abstract：
OBJECTIVE: To elucidate the clinical and pathological characteristics of gestational diabetes mellitus (GDM) with high and low insulin resistance.
METHODS: In total, 1393 GDM and 1001 non-GDM singleton deliveries were included in this study. Insulin resistance subtypes were classified according to the HOMA2-IR value. Clinical data were analyzed using SPSS 26.0. Placenta samples were collected for pathological analysis.
RESULTS: Maternal age and fasting glucose were identified as independent risk factors for GDM with high insulin resistance (p < 0.01), while fasting glucose was the sole risk factor for GDM with low insulin resistance (p < 0.001). Fetal distress was associated with both of GDM subtypes (both p < 0.01), while anemia, fetal growth restriction, large for gestational age and intrahepatic cholestasis in pregnancy were related to specific GDM insulin resistance subtype. In addition, GDM with high insulin resistance showed an increase of syncytial knots with down-regulation of PI3K/AKT signaling, while GDM with low insulin resistance showed normal syncytial knot counts and up-regulation of PI3K/AKT signaling.
CONCLUSIONS: Our findings provide novel perspectives to the clinical and pathological comprehensions of GDM with high and low insulin resistance, which might facilitate the mechanism study of GDM and its precision pregnancy management.
METHODS: In total, 1393 GDM and 1001 non-GDM singleton deliveries were included in this study. Insulin resistance subtypes were classified according to the HOMA2-IR value. Clinical data were analyzed using SPSS 26.0. Placenta samples were collected for pathological analysis.
RESULTS: Maternal age and fasting glucose were identified as independent risk factors for GDM with high insulin resistance (p < 0.01), while fasting glucose was the sole risk factor for GDM with low insulin resistance (p < 0.001). Fetal distress was associated with both of GDM subtypes (both p < 0.01), while anemia, fetal growth restriction, large for gestational age and intrahepatic cholestasis in pregnancy were related to specific GDM insulin resistance subtype. In addition, GDM with high insulin resistance showed an increase of syncytial knots with down-regulation of PI3K/AKT signaling, while GDM with low insulin resistance showed normal syncytial knot counts and up-regulation of PI3K/AKT signaling.
CONCLUSIONS: Our findings provide novel perspectives to the clinical and pathological comprehensions of GDM with high and low insulin resistance, which might facilitate the mechanism study of GDM and its precision pregnancy management.
摘要：
目的：阐明妊娠期糖尿病(GDM)合并高、低胰岛素抵抗的临床病理特征。
方法：总共，本研究包括1393例GDM和1001例非GDM单例分娩。根据HOMA2-IR值对胰岛素抵抗亚型进行分类。临床资料采用SPSS26.0进行分析。收集胎盘样品进行病理分析。
结果：孕妇年龄和空腹血糖被确定为高胰岛素抵抗的GDM的独立危险因素（p<0.01）。而空腹血糖是GDM低胰岛素抵抗的唯一危险因素(p<0.001)。胎儿窘迫与两种GDM亚型相关(均P<0.01),而贫血,胎儿生长受限,孕龄大和妊娠期肝内胆汁淤积与特定GDM胰岛素抵抗亚型相关.此外,高胰岛素抵抗的GDM显示合胞体结节增加，PI3K/AKT信号下调，而低胰岛素抵抗的GDM表现出正常的合胞结数和PI3K/AKT信号上调。
结论：我们的发现为高胰岛素抵抗和低胰岛素抵抗的GDM的临床和病理理解提供了新的观点。这可能有助于GDM的机制研究及其精确妊娠管理。
方法：总共，本研究包括1393例GDM和1001例非GDM单例分娩。根据HOMA2-IR值对胰岛素抵抗亚型进行分类。临床资料采用SPSS26.0进行分析。收集胎盘样品进行病理分析。
结果：孕妇年龄和空腹血糖被确定为高胰岛素抵抗的GDM的独立危险因素（p<0.01）。而空腹血糖是GDM低胰岛素抵抗的唯一危险因素(p<0.001)。胎儿窘迫与两种GDM亚型相关(均P<0.01),而贫血,胎儿生长受限,孕龄大和妊娠期肝内胆汁淤积与特定GDM胰岛素抵抗亚型相关.此外,高胰岛素抵抗的GDM显示合胞体结节增加，PI3K/AKT信号下调，而低胰岛素抵抗的GDM表现出正常的合胞结数和PI3K/AKT信号上调。
结论：我们的发现为高胰岛素抵抗和低胰岛素抵抗的GDM的临床和病理理解提供了新的观点。这可能有助于GDM的机制研究及其精确妊娠管理。
