title: [Sex hormone-binding globulin of gestational diabetes mellitus pregnant women with well-controlled glucose and pregnancy outcomes].
abstract: OBJECTIVE
  To explore the relationship between sex hormone-binding globulin (SHBG) of gestational diabetes mellitus (GDM) pregnant women with well-controlled glucose and pregnancy outcomes.
  
  
  METHODS
  Two hundred and fifty-one GDM pregnant women of 24 - 28 weeks in Shengjing Hospital of China Medical University were recruited from Mar. 2005 to Mar. 2010. Two hundred and sixteen cases of GDM with well-controlled glucose were defined as glycemic satisfied group, and they were treated by diet therapy (169 cases) or insulin therapy (47 cases). Thirty-five cases with unsatisfied glucose were defined as glycemic unsatisfied group. One hundred and ninety-two healthy pregnant women of 24 - 28 weeks were defined as healthy control group. Serum SHBG and homeostasis model analysis of insulin resistance (HOMA-IR) at 24 - 28 weeks and above 36 weeks were measured. GDM was diagnosed by "two-step" method according to the National Diabetes Data Group (NDDG) criteria. The pregnancy outcomes and complications of the three groups were recorded.
  
  
  RESULTS
  (1) Comparison of pregnancy outcomes and complications:glycemic satisfied group was less likely to develop hypertensive disorders in pregnancy (10.6%), premature birth (8.3%), large for gestational age (LGA) (8.8%), neonatal asphyxia (3.7%) and neonatal hypoglycemia (2.3%) compared to glycemic unsatisfied group (42.9%, 34.3%, 31.4%, 22.9% and 11.4%, respectively). And the difference was statistically significant (P < 0.05 or P < 0.01). There was no significant difference for incidence of polyhydramnios, pueperal infection, postpartum hemorrhage, neonatal hyperbilirubinemia between the two groups (P > 0.05). When compared to healthy control group (7.3%, 2.1%, 4.2%, 2.1% and 1.6%), no significant difference was found for incidence of premature birth (8.3%), pueperal infection (3.2%), postpartum hemorrhage (5.1%), neonatal asphyxia (3.7%) and neonatal hypoglycemia (2.3%, P > 0.05). (2) Comparison of results of 24 - 28 weeks and above 36 weeks: serum SHBG of glycemic satisfied group [(384 ± 88), (457 ± 48) nmol/L] was significantly higher than that of glycemic unsatisfied group [(313 ± 45), (401 ± 73) nmol/L]; HOMA-IR of glycemic satisfied group (5.3 ± 1.1, 5.5 ± 1.1) was significantly lower than that of glycemic unsatisfied group (7.0 ± 1.3, 7.6 ± 1.7; P < 0.01). Serum SHBG of glycemic satisfied group was significantly lower than that of healthy control group [(492 ± 95), (565 ± 40) nmol/L]; and HOMA-IR of glycemic satisfied group (5.3 ± 1.1, 5.5 ± 1.1) was significantly higher than that of healthy control group (3.6 ± 0.6, 3.9 ± 0.5; P < 0.01). FPG of glycemic satisfied group [(5.84 ± 0.28), (5.16 ± 0.13) mmol/L] was significantly lower than that of glycemic unsatisfied group [(6.13 ± 0.16), (5.68 ± 1.14) mmol/L;P < 0.01]. FINS of glycemic satisfied group [(20.4 ± 2.1), (24.1 ± 4.2) mmol/L] was significantly lower than that of glycemic unsatisfied group [(24.7 ± 4.5), (29.9 ± 2.7) mmol/L; P < 0.01]. (3) Correlation analysis. Between 24-28 weeks, SHBG was negatively correlated with HOMA-IR in the three groups (r = -0.952, P < 0.01); and SHBG was negatively correlated with HOMA-IR in glycemic satisfied group (r = -0.903, P < 0.01).
  
  
  CONCLUSIONS
  Well-controlled glucose can not completely improve maternal and fetal outcomes of GDM pregnant women. High insulin resistance and low serum SHBG can influence pregnancy outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, China. jinzhen66@yahoo.com.cn
authors.forename: Zhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Xin-shu
authors.initials: XS
authors.lastname: Chi
authors.forename: Wei-ping
authors.initials: WP
authors.lastname: Teng
authors.forename: Xiao-yan
authors.initials: XY
authors.lastname: Wang
authors.forename: Qi-wei
authors.initials: QW
authors.lastname: Xu
authors.forename: Ping-ting
authors.initials: PT
authors.lastname: Wang
authors.forename: Wan-ting
authors.initials: WT
authors.lastname: Ai
authors.forename: Si-yu
authors.initials: SY
authors.lastname: Lian
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000097:blood / Q000378:metabolism* / Q000628:therapy; D005260:Female; D005865:Gestational Age; D005951:Glucose Tolerance Test; D006801:Humans; D006946:Hyperinsulinism; D007328:Insulin / Q000097:blood / Q000627:therapeutic use; D007333:Insulin Resistance; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*
chemical_list: D001786:Blood Glucose; D007328:Insulin; D012738:Sex Hormone-Binding Globulin