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Gestational diabetes mellitus(GDM) is defined as glucose intolerance that is first detected during pregnancy, its incidence rate is about8%to14%, and has increased year by year. It is a common perinatal complication and harm to maternal and child, leads to energy metabolism disorders in pregnant women. It is association with a variety of adverse pregnancy outcomes, such as macrosomia, polyhydramnios, spontaneous abortion, fetal malformation, fetal distress, stillbirth, neonatal hypoglycemia, hypocalcemia, and hyperbilirubinemia, maternal ketoacidosis. Its pathogenesis is indefinite. At present, the traditional viewpoint is GDM and type2diabetes (T2DM) have a similar pathogenesis that there are insulin resistance (IR) and insulin secretion insufficiency on the basis of genetic defects, in which IR plays a major role. IR means that a certain amount of insulin concentration can not affect the metabolism of expected nutrients and biological response in target tissues (mainly muscle, fat, liver). During normal pregnancy, the most important metabolic change is that insulin resistance is increased, and sensitivity to insulin in liver, muscle and adipose tissue is decreased, especially in third trimester, sensitivity to insulin decreased by45%to80%. During pregnancy can be viewed as a normal physiological state of IR, when the body can not produce enough insulin to compensate abnormal increase of IR, that GDM is occurred. Previous view is that elevated placental lactogen, oxytocin, progesterone and glucocorticoid, which result in nsulin resistance, is the main reason for the incidence of GDM. In recent years, adipokines and their secreted factors, mediating the incidence of IR, has got our attention. Weight gain during pregnancy is the fastest accumulation of fat in women’s life. Socholars widely considered that synthesis and secretion of adipocytokines are increased as the growth of the placenta and maternal accumulation of fat during normal pregnancy and play the role in the regulation of energy metabolism and regulating insulin activity. At the same time, synthesis, secretion and receptor expression of adipocytokines between GDM and normal pregnant women are different. This is association with insulin resistance, suggesting that imbalance of adipocytokines network play the role in the development of GDM.Human adipose tissue is one of the most important endocrine organ, synthesize and secrete a variety of adipocytokines, including leptin, adiponectin, tumor necrosis factor-a (TNF-a), interleukin-6(IL-6) and resistin, visfatin, apelin, fasting-induced adipose factor (FIAF), retinol-binding4(RBP4), Chemerin and so on. Chemerin in the body’s adipose tissue, adrenal gland, liver, lung, pancreas, placenta, ovary, skin, etc. are expressed, which is mainly expressed in white adipose tissue, liver and lung, and has anti-inflammatory effects, in obtaining immunity and natural immunity froma certain role, and through autocrine and paracrine pathways to promote the decomposition of fat cells, increased lipolysis and enhanced sensitivity of fat cells to insulin, insulin resistance plays an important role. Many literature suggests changes in Chemerin serum concentrations associated with a variety of metabolic diseases, such as obesity, type2diabetes, insulin resistance, high blood pressure and chronic inflammation of the increase in the concentration of blood Chemerin.. The role of Chemrin in GDM is not clear, research on the relationship between Chemerin and lipids is rare. To explore the correlation between Chemerin with GDM, We studied serum Chemerin in patients with GDM and normal pregnant women at prepartum and the relationship of Chemerin and BMI, lipids, blood glucose.Objective:To explore the correlation between Chemerin with GDM and IR, this study measured Chemerin in patients with GDM and normal pregnant women at prepartum and the relationship of Chemerin and BMI, lipids, blood glucose.Methods:Choose pregnant women who did regularly prenatal examination in maternity clinic and delivered in inpatient department of Women’s Hospital School of Medicine Zhejiang University during May2010to August201130pregnant women were diagnosed GDM according to the diagnostic criteria IADPSG. At the same period,30normal pregnant women, with normal blood glucose or OGTT screening, and age, gestational age, prepregnant BMI are match with the experimental group, were chose as a control group. The pregnant women of two groups delivered in inpatient department at37-42weeks gestation. Made a detailed record of maternal age, height, prepregnant weight and weight gain during pregnancy after admission. Fasting plasma glucose (FPG), insulin (Fins), HemoglobinA1c (HbA1c),Total Cholesterole (TC), Triglyceride (TG) were measured in two groups. Then we calculated insulin resistance index (HOMA-IR). Chemerin were measured in blood samples of two groups by enzyme-linked immunosorbent assay (ELISA) at prenatal. Results:(1) Weight gain, BMI in GDM group was significantly higher than the control (36.57±4.67kg,31.25±1.18and30.63±3.59kg,29.67±1.10, respectively, both P<0.001).(2) Serum Chemerin levels in GDM group were significantly higher than the control at prenatal (199.7±41.37ng/ml,174.2±26.28ng/ml, respectively, P <0.001); FPG, Fins, TG, HbA1c and HOMA-IR in GDM group were higher than control (5.22±0.28mmol/L,18.5±3.42mu/L,4.96±0.52mmol/L,5.88±0.42%,3.66±0.32and4.43±0.38mmol/L,13.2±3.26mu/L,4.57±0.58mmol/L,5.18±0.38%,3.27±0.27, respectively, all P<0.001), while there is no significant difference in TC levels between the two groups (4.24±0.58mmol/L,4.2±0.46mmol/L, respectively, P>0.05).(3) Correlation analysis:Chemerin were negatively correlated with FPG, HOMA-IR, TG in normal control group at prenatal (r=-0.47,-0.40,-0.55, respectively, all P<0.05), There is no correlation between visfatin and these indicators in GDM group at prenatal. But there are positively correlation between Chemerin and weight gain, BMI in GDM group (R=0.59,0.54, respectively, both P<0.001).Conclusion:(1) The levels of Chemerin in GDM group at prenatal were significantly higher than the control, but also were correlated with weight gain and BMI. The result suggested that weight gain during pregnancy and Chemerin are related with GDM. (2) Chemerin were negatively correlated with the index of blood glucose, lipids metabolism in normal control group at prenatal, suggested that Chemerin participate in lipid metabolism to maintain blood glucose and lipids at normal levels during normal pregnancy.(3) Disorders of Chemerin, blood glucose and lipid metabolism in GDM group might be one of the factors involved in the pathogenesis of GDM.
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