الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Pregnancy is associated with profound alterations in hormonal metabolism. These changes include hyperinsulinemia and insulin resistance together with large increase in the concentrations of cortisol, estrogen, progesterone and human placental lactogen. The first two trimesters of pregnancy are considered to be predominantly anabolic, and pregnant women normally deposit a certain amount of fat stores. The last trimester of pregnancy is characterized by increased catabolism, increased lipolysis, elevations of the concentrations of free fatty acids, minimal or no fat deposition, and significant increases in triglyceride concentrations.
Gestational diabetes mellitus, defined as a carbohydrate intolerance of varying severity, is the most frequent metabolic disorder of pregnancy, affecting 2-3% of all pregnancies. Although most of the women with GDM return to normal glucose tolerance after delivery, they have increased risk of developing diabetes, mainly type 2 diabetes mellitus, later on, with an incidence ranging from 6-62%, depending on the population examined and the length of the follow up considered. The offsprings of women with GDM are prone to adverse side effects such as macrosomia, which is strongly associated with fetal death, prematurity, birth trauma and respiratory distress syndrome and equally important, these offspring have a high risk of developing obesity, impaired glucose tolerance and type 2 diabetes in adulthood.
Cytokines, through their ability to interfere with insulin signaling, have been implicated in insulin resistance in GDM.
So adipokines secreted by adipose tissue are required for a number of physiological and metabolic processes. Despite the potential importance of these agents as mediators of metabolic disorders, they have been implicated in GDM and macrosomia.
Adiponctin is adipocytokine produced by adipose tissue and also the placenta, could play a role in complicated interactions involving the regulation of appetite and fat metabolism in human pregnancy. Adiponctin level has been reported to be decreased.
The aim of this study was to assess the relation of early pregnancy serum adiponectin, triglycerides and HDL-cholesterol levels and the risk of GDM.
The study was conducted upon 115 pregnant women from anti natal clinic at El Shatby maternity university.
All patients were subjected to:
• Informed consent then complete history taking and Complete examination (general and local).
• Ultrasound: which was done at 11-14 weeks of gestation.
• CBC, FBS, serum adiponectin and serum HDL-cholesterol levels was measured at first visit.
• Measuring BMI.
• Excluding pregestational diabetes.
• All cases were followed till 24-30 weeks of gestation, measuring GCT for assessment of GDM cases (n=28) and controls (n=87).
The results of this study showed that:
75.5% (n=87) of the cases were GCT<140 while 24.3% (n=28) had GCT>140. adiponectin was statistically significantly different between the two groups (p<0.01). Based on this significance, the researchers used ROC analysis to estimate a cut-off point for serum adiponectin, TG and HDL-cholesterol level.
This research found that adiponectin level <5.5 μg/ml, triglycerides concentrations >155 mg /ml and HDL concentration < 68 ng /ml measured, on average, 11-14 weeks pregnancy were associated with a 3.4-fold increased risk of developing GDM with 96.43% sensitivity and 98.85% specificity positive prediction (AUC=0.985, p<0.001).
In conclusion: We found adiponectin levels have been shown to be lower in cases with high triglycerides level and lower HDL level and these all are associated with increased risk of GDM.
Recommendations: we recommend to measure serum adiponectin , triglycerides level and HDL _cholesterol in early pregnancy as an early screening for GDM