关键词: 糖尿病, 妊娠；分娩后期；脂类代谢；高脂血症；影响因素分析

Abstract: Background　Patients with gestational diabetes mellitus（GDM） may have glucose and lipid metabolic disorder during pregnancy，and this metabolic abnormality will continue after delivery and even affect the offspring's healthy in the long term.The incidence of metabolic diseases such as postpartum diabetes and hyperlipemia in patients with GDM increases significantly.Objective　To understand the prognosis of postpartum lipid metabolism，and to analyze the risk factors and predictive indicators of abnormal prognosis of postpartum lipid metabolism in patients with GDM.Methods　A total of 512 GDM patients were selected from the Outpatient Department of Endocrinology and Metabolism in Beijing Obstetrics and Gynecology Hospital，Capital Medical University from 2016 to 2017，who received routine examination，delivery and follow-up.According to postpartum blood lipid levels at 6 to 12 weeks after delivery，the subjects were divided into normal lipid group（n=244） and hyperlipidemia group（n=268）.Basic data of patients were collected.We tested total cholesterol（TC），triglyceride（TG），high density lipoprotein（HDL），low density lipoprotein（LDL） in first trimester（<14 weeks），second trimester（14-28 weeks），third trimester（>28 weeks），adiponectin in third trimester，and 6-12 weeks after delivery，fasting blood glucose（FBG） in first trimester，and third trimester，oral glucose tolerance test（OGTT） in second trimester and 6 to 12 weeks after delivery，and 1 h postprandial glucose（PG），2 hPG，fasting insulin（FINS），1 h insulin（INS），and 2 hINS.The insulin resistance index（HOMA-IR） of third trimester and after delivery were calculated.Results　Among 268 patients with postpartum hyperlipidemia，151 patients had hypercholesterolemia，58 patients had hypertriglyceridemia，54 patients had mixed hyperlipidemia，and 30 patients had low high-density lipoproteinemia.Maternal age，the number of birth and the proportion of insulin treatment in hyperlipidemia group were higher than those in normal lipid group，and TG，TC and LDL in first trimester，second trimester，and third trimester and FBG after delivery were higher in hyperlipidemia group compared with those in normal lipid group（P<0.05）.The results of multivariate Logistic regression analysis showed that elevated TC 〔OR=2.018，95%CI（1.161，3.509），P<0.05〕 in first trimester were independent predictors of hyperlipidemia in GDM patients.The results of path analysis showed that “TC in first trimester→postpartum TC”“TG in first trimester→postpartum TG”“LDL in first trimester→postpartum LDL” had significant mediating effects（β=0.38，β=0.20，β=0.31，P<0.05）；“TC in second trimester→postpartum TC”“LDL in second trimester→postpartum LDL”（β=0.21，β=0.23，P<0.05）；“TG in third trimester→postpartum TG”（β=0.13，P<0.05） had significant mediating effects；“TC in first trimester →postpartum hyperlipidemia”“TG in first trimester→hyperlipidemia”“LDL in first trimester→postpartum hyperlipidemia” had significant mediating effects（β=0.28，β=0.14，β=0.17，P<0.05）.Conclusion　Patients with GDM during pregnancy are more likely to have hyperlipidemia at 6-12 weeks after delivery.The risk factors for the postpartum hyperlipidemia in patients with GDM is elevated TC in first trimester of pregnancy.Blood lipid levels in early pregnancy can affect the occurrence of postpartum hyperlipidemia.

Key words: Diabetes, gestational；Postpartum period；Lipid metabolism；Hyperlipidemias；Root cause analysis