孕期宫内环境与新生儿出生情况的相关性研究
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摘要
目的:探讨浙江省4个市(永康市、湖州市、宁海市、绍兴市)孕产妇孕前BMI,孕期高龄、吸烟、饮酒等危险因素,家族肥胖、高血压、糖尿病等代谢综合征史,孕期营养情况和孕晚期血生化指标对新生儿出生体重、新生儿脐血生化指标的影响,了解孕期宫内环境对新生儿的影响。
     方法:选取2010年1月1日至2011年4月1日在永康市、湖州市、宁海市及绍兴市妇幼保健院行产前检查并于该院分娩的32-37周孕妇共1325例,对相关家庭背景、孕前BMI、孕期相关危险因素、孕期膳食营养情况、分娩情况、新生儿体重及孕晚期血液及脐血生化指标等数据进行整理及统计分析。
     结果:1325例孕产妇每日摄入的碳水化合物(166.0±61.4)g及蛋白质(52.7±22.2)g明显低于推荐量(P<0.01);每日摄入的脂肪(41.0±24.2)g高于推荐摄入量(P<0.05)。新生儿体重、脐血ApoAl、C肽以及胰岛素水平与母孕前BMI正相关。脐血脂蛋白a高于平均值的孕母脂肪摄入量高(P<0.05);脐血胰岛素及C肽高于平均值的孕母能量及碳水化合物摄入量高(P<0.01)。高出生体重组母血甘油三酯水平、胰岛素水平及脐血胰岛素水平高于低出生体重组及正常出生体重组(P<0.05);低出生体重组脐血ApoAl与HDL水平低于高出生体重组及正常出生体重组(P<0.01)。
     结论:浙江省4个市孕产妇孕期膳食营养不平衡;出生体重与孕前BMI、孕晚期母血甘油三酯、胰岛素水平正相关;低出生体重儿脐血HDL水平偏低,高出生体重儿脐血胰岛素水平偏高。
[Objective]To approach the effcet of puerperants'BMI before pregancy, intrauterine risk factors, such as smoke、 drink、 hypertension、 diabetes mellitus,etc, nutrients intake, family history of overweight、 hypertension、 diabetes mellitus and biochemical indicators of maternal blood on biochemical indicators of cord blood and birth condition, to find how intrauterine enviroment affect fetus'growth.
     [Method]Analysis was made for1325pregnant women conceive from32to37weeks in the maternal and child health hospital in Yongkang、 Huzhou、 Ninghai、 Shaoxing city from January1st2010to April1st2011. They receive prenatal check-up and dilivery in these hospital. Investigations were made on family background, risk factors, biochemical indicator of maternal blood and cord blood.
     [Result] In the1325cases, the maternal daily nutrition intake is unbalanced, which refer to the Chinese Dietary Reference Intakes; Birth weight, cord blood ApoAl, cord blood C-peptide and insulin levels were significantly different in the three groups. The high birth weight group maternal serum triglyceride level, maternal serum insulin level and umbilical blood insulin level was higher than the low birth weight group and normal birth weight group (P <0.05); low birth weight group cord blood ApoAl and HDL level was lower than the high birth weight group and normal birth weight group (P <0.01).
     [Conclusion] In the Zhejiang Province, the maternal pregnancy diet nutrition is imbalance. Maternal serum triglycerides, insulin and C-peptide levels and pre-pregnant BMI were positively correlated with the neonatal birth weight. Low birth weight infants cord blood HDL level is low, high birth weight infants cord blood insulin level is high.
引文
[1]赵欣,戴钟英.近10年新生儿出生体重变化趋势的分析.上海医学,2001,24(6):370-372.
    [2]应玉萍.母亲孕期的体重增长与巨大儿关系的初步研究.中国优生与遗传杂志,1999,7(6):61-62.
    [3]吕淑兰,余淑勤.肥胖妊娠妇女的危害及处理.国外医学·计划生育分册,2002,21(4):242.
    [4]金子还,王淑娟,董丽红等.孕妇产前体重指数对妊娠结局的影响.中国妇幼保健,2008,23(14):1916-1917.
    [5]Cleary Goldman J, Malone FD, Vidaver J, et al. Impact of maternal age on obstetric outcome[J]. Obstet Gynecol, 2005 may, 105(1 Pt 1):983-990.
    [6]全国新生儿生长发育科研协作组.中国12城市新生儿体格发育与父母文化水平之间的关系[J].中国实用儿科杂志,1996,11(3):184.
    [7]Grismtad H, Schei B, Bache B, et al. Anxiety, physical abuse, and low birth weight[J]. Scand Public Health, 1999,27 (4):296.
    [8]韩京秀,甘德坤,石英等.孕期不同阶段被动吸烟对足月产小于胎龄儿影响的病例一对照研究.卫生研究,2006,35(6):788-790.
    [9]于淑娟,李飞.80例妊娠期糖尿病孕妇的新生儿结局临床分析.中国实用医药,2010,5(8):113.
    [10]Koklu E, Akcakus M, Kurtoglu S, et al. Aortic intima-media thickness and lipid profile in macrosomic newborns. Eur J Pediatr. 2007,166 (4):333-338.
    [11]钱丽晶,唐晓武,等.低出生体重影响因素分析.中国儿童保健杂志,2011,26(26):56.
    [12]阴斌霞,王香玲,王玉珍,何谦等.孕妇血脂与新生儿体重关系.中国儿童保健杂志,2002,12(10):389-391.
    [13]Zhang Y. Effects of pre-pregnant overweight, overweight gain during pregnancy on outcome of pregnancy[J]. J Pract Obstet Gynecol, 2006, 22 (8):506-507.
    [14]Li P, Luo LM, Wu QK. Relationship between body mass index and pregnancy complication and results[J]. Shanghai Med, 2004, 27 (11):840-842.
    [15]Yogev Y, Langer O, Xenakis EM, Rosenn B. The association between glucose challenge test, obesity and pregnancy outcome in 6390 non-diabetic women[J]. J Matern Fetal Neonatal Med,2005 Jan,17 (1):29-34.
    [16]Jensen DM, Damm P, Sorensen B, et al. Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women[J]. Am J Obstet Gynecol, 2003 Jul,189 (1):239-244.
    [17]Abrams B, et al. Facrors associated with the patter of maternal weight gain during pregnancy[J]. Obstet Gynecol, 1995,86:170-176.
    [18]Worthington Toberts B. Nutrition and pregnancy. In:Cherry SH, Merlatz IR, eds, Complication of pregnancy: medical, surgi-cal, gynecologic,psychosocial[M].4th ed. Maryland:WillJams & Wilkins, 1991. 42-67.
    [19]熊庆,等.正常孕妇体重增加的监测模式[J].中华妇产科杂志,1998,33(3):142-144.
    [20]陈炳卿,主编.营养与食品卫生学[M].第3版.北京:人民卫生出版社,2000.386-388.
    [21][21]杜丽敏.特大胎儿191例分析[J].中国食用妇科与产科杂志,1997,13(3): 169.
    [22]蔡东联.现代饮食治疗学[M].北京:人民军医出版社,1996.345.
    [23]邢玲玲,曲育红,刘卫红.建科8年LBG219例临床分析.中国优生与遗传杂志,2003,11(1):120—122.
    [24]朱丽萍,秦学伟,钱尚萍.上海地区LBG影响因素调查.中国优生与遗传杂志,2001,6:81.
    [25]乐杰,主编.妇产科学(第5版)[M].人民卫生出版社,2001,148
    [26]Langer O. Fetal macrosomia: etilolgic factor. Clin Obstct Gynecal, 2000,43:283.
    [27]汤丽娟.巨大胎儿相关因素及其对母婴影响的研究.护理研究,2003,17(2):148.
    [28]刘思新,李美菊.巨大胎儿相关因素及预后340例临床分析[J].中国实用妇科与产科杂志,2001,17(2):123.
    [29]徐辉.孕期营养素摄入量对胎儿宫内发育的影响.新疆医科大学学报,2000,23(3):238-239.
    [30]曹华妹,杜文君,陈小鸣.胎儿出生体重与孕期体重指数变化的相关性.实用妇产科杂志.2003,19(4):240-241.
    [31]Mathews F, Yudkin P, Neil A. Influence of maternal nutrition on outcome of pregnancy: prospective cohort study. BMJ, 1999,319:339-343.
    [32]VAN AFA, HOLEMANS K, AERTS L. Fetal growth and consequence for later life[J]. J Perinat Med,1998,26:337-346.
    [33]ONG K, KARTZSCH J, KIESS W, et all. Size at birth and cord blood levels of insulin, insulin-like-growth factor 1, IGF-2, IGF-binding protein-1, IGFBP-3, and the soluble IGF-2/mannose-6-phosphate receptor in term human infants[J]. J Clin Endocrinol Metab,2000,85:4266-4269.
    [34]从克家,王陶陶,刘桂荣,等.妊高症孕妇的脂代谢[J].中华妇产科杂志,1994,29(11):651.
    [35]Desoye G. Correlation of hormones with lipid and lipoprotein levels during normal pregnancy and postpartum[J]. J Clin Endocrinol Metab,1987,64: 704.
    [36]Potter JM. Nestel PJ. The hyperlipidemia of pregnancy in normal and complicated pregnancies[J]. Am J Obstet Gynecol, 19793,13:165.
    [37]卢新梅,严士林,吴艳霞.正常孕妇不同孕期血脂及载脂蛋白的变化[J].中国动脉粥样硬化杂志,1996,4(2):134.
    [38]邱辅佑,胡春霞.妊娠期高血压疾病孕妇血脂水平的临床分析[J].中国妇幼保健,2008,23(30):4266-4267.
    [39]郑其二.不同孕期的孕妇血脂分析的意义[J].中国初级卫生保健,2006,10(6): 30-33.
    [40]谢爱兰,李笑天.160例孕妇血脂水平与胎儿出生体重[J].中国生育健康杂志,2005,6(3):163-164.
    [41]Chiesa C, Osborn JF, Haass C, et al. Ghrelin, Leptin, IGF-1, IGFBP-3, and insulin concentrations at birth: is there a relationship with fetal growth and neonatal anthropometry. Clin Chem, 2008,54:550-558.
    [42]廖艳,等.母血脐血胰岛素、糖脂水平测定及其意义[J].中国儿童保健杂志,2004,12(1):46-48.
    [43]WOLF HJ, EBENBICHLER CF, HUTER O, et al. Fetal leptin and insulin levels only correlate in large-for-gestational age infants[J]. Endocrinology, 2000,142:623-629.
    [44]Frontini MG, Srinivasan SR, Xu J, et al. Low birth weight and longitudinal trends of cardiovascular risk factor variables from childhood to adolescence: The Bogalusa heart study[J]. BMC Pediatr, 2004,4(1):22-25.
    [45]Cianfarani S, Martinez C, Maiorana A, et al. Adiponectin levels are reduced in children born small for gestational age and are inversely related to postnatal catch-up growth[J]. J Clin Endoreinol Metab,2004,89(3):1346-1351.
    [46]郑惠章,高伟玲,刘莎,等.新生儿早期血脂水平的调查.新生儿科杂志。2002,17:69-70.
    [47]国权,林冬云,李介华,等.正常新生儿脐血血脂水平调查.广东医学,2005,26:1419-1420.
    [48]卫红,刘玉洁,寿好长,等.新生儿脐血血脂水平的检测.中华儿科杂志,2003,41:107-109.
    [49]全贞玉,金爱莲,全贞姬.新生儿血脂水平相关性的研究.中国妇幼保健,2009,24:330-332.
    [50]耿玉兰,房桂英,李增宁,等.新生儿脐血血脂水平及胎心率检测析.山东医药,2007,47:17-18.
    [1]Ong KK, Dunger DB. Perinatal growth failure:the mad to obesity, insulin resistance and vascular disease in adults[J]. Best Pmet Res Clin Endocrinol Metab,2002,16(2):1910-2071.
    [2]顾东风,Reynolds K,杨文杰等.中国成年人代谢综合征的患病率.中国糖尿病杂志,2005,13:181—186.
    [3]Rogers I. Birth weight and obesity and fat distribution in later life[J]. Birth Defects Res A Clin Mol Teratol,2005,73(7):485-486.
    [4]BAKER D J, OSMONA C, GOLDING J, et al. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease[J]. BMJ,1989,298(6673):564-567.
    [5]HALES C N, BAKER D J, CLARK P M, et al. Fetal and infant growth and impaired glucose tolerance at age 64[J]. BMJ,1991,303(6809):1019-1022.
    [6]Godfrey K M, Barker DJ. Fetal nutrition and adult disease[J]. Am J Clin Nutr, 2000,71,5 Suppl:1344S-1352S.
    [7]GUPTA M, GUPTA R, PAREEK A, et al. Low birth weight and insulin resistance in mid and late childhood[J]. Indian Pediatr,2007,44(3):177-184.
    [8]Bazaes RA, Alegria A, Pittaluga E, et al. Determinants of insulin sensitivity and secretion in very-low-birth-weight children[J]. Clin Endocrinol Metab,2004,89:1267-1272.
    [9]Yada KK, Gupta R, Gupta A, et al. Insulin levels in low birth weight neonates[J]. India J Med Res,2003,118:197-203.
    [10]Rodrigo A, Bazaes MD, Teresa E, et al. Glucose and lipid age[J]. Am J Pediatr,2003,11:804-809.
    [11]GRUNNET L, VIELWERTH S, VAAG A, POULSEN P. Birth weight is nongenetically associated with glucose intolerance in elderly twins independent of adult obesity [J]. J Intern Med,2007,262(1):96-103.
    [12]Sallout B, Walker M. The fetal origin of adult diseases[J].Obstet Gynaecol.2003; 23(5):555-560.
    [13]Ibanez L, Ong K L, Durlger D B, etal. Early development of adiposity and insulin resistance after catch-up weight gain in small-for-gestational-age children[J]. Clin Endocrinol Hetab.2005:91(6):2153-2158.
    [14]Matharu K, Ozanne S E. The fetal origins of disease and associations with low birthweight[J]. NeoReviews. 2004; 5(12):522-526.
    [15]Petrik J, Reusens B, Arany E, et al. A low protein diet alters the balance of islet cell replication and apoptosis in the fetal and neonatal rat and is associated with a reduced pancreatic expression of insulin-like growth factor-II[J]. Endocrinology,1999,140:4861-4873.
    [16]袁庆新,刘超.胚胎胰腺宫内发育和成年糖尿病.中国糖尿病杂志,2007,15(03):191—192.
    [17]Godfrey K M, Barker DJ. Fetal nutrition and adult disease[J]. Am J Clin Nutr,2000,71,5 Suppl:1344S-1352S.
    [18]Hales C N. Barker D J. The thrifty phenotype hypothesis[J]. Br Med Bull, 2001,60:5-20.
    [19]刘占利,桀琨,贺湘英等.胎儿生长迟缓与新生儿胰岛素敏感性变化的相关性.中国实用儿科杂志,2006,21(5):357-359.
    [20]Lucas A.Programming by early nutrition:an experimental approach[J]. J Nutr,1998,128(2 Suppl):401s-406s.
    [21]Ozanne SE. Metabolic programming in animals[J]. Br Med Bull,2001,60: 143-152.
    [22]Hoet JJ, Hanson MA. Intrauterine nutrition:Its importance during critical periods for cardiovascular and endocrine development[J].J Physiol,1999, 514(Pt 3):617-627.
    [23]Fagerberg B, Bondjers L, Nilsson P. Low birth weight in combination with catch-up growth predicts the occurrence of the metabolic syndrome in men at late middle age:the atherosclerosis and insulin resistance study [J]. Intern Med,2004,256:254-259.
    [24]Rump P, Popp-Snijders C, Heine RJ, et al. Components of the insulin resistance syndrome in seven-year-old children:relations with birth weight and the polyunsaturated fatty acid content of umbilical cord plasma phospholipids[J]. Diabetologia,2002,45:349-355.
    [25]Soto N, Bazaes RA, Pena V, et al. Insulin sensitivity and secretion are related to catch-up growth in small-for-gestational-age infants at age 1 year: results from a prospective cohort[J]. Clin Endocrinol Metab,2003,88:3645-3650.
    [26]Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth hormone releasing acylated peptide from stomach[J]. Nature. 1999,402(6762):656-660.
    [27]Prado GL, Pugh-Bemard AE, Elghazi L, et al. Ghrelin cells replace insulin producing beta cells in two mouse models of pancreas development[J]. Proc Natl Acad Sci USA,2004,101(9):2924-2929.
    [28]Simmon SR. Role of metabolic programming in the pathogenesis of beta-cell failure in postnatal life[J]. Rev Endocr Metab Disord,2007,8(2):95-104.
    [29]Wang XM, Liang Li, Du LZ. The effects of intrauterine under-nutrition on pancreas ghrelin and insulin expression in neonate rats[J].Endocrinol,2007, 194(1):121-129.
    [30]王秀敏,梁黎,杜立中,等.宫内生长迟缓大鼠胰ghrelin和胰岛素表达变化.浙江大学学报(医学版),2008,37(3):226-232.
    [31]MacLennan NK, James SJ, Melnyk S, et al. Uteroplacental insufficiency alters DNA methylation, one-carbon metabolism, and histone acetylation in IUGR rats. Physiol Genomics,2004,18 (1):43-50
    [32]Sachodeva MM, Claiborn KC, Khoo C, et al. PDX-1(MODY4) regulates pancreatic beta cell susceptibility to ER stress[J]. Proc Natl Acad Sci USA, 2009,,16 (45):19090-19095
    [33]Humphrey RK, Yu SM, Flores LE, et al. Glucose regulates steady-state levels of PDX-1 via the reciprocal actions of GSK3 and ATK kinases [J].Biol Chem,2010,825 (5):3406-3416.
    [34]Oliver-Krasinski JM, Kasner MT, Yang J, et al. The diabetes gene PDX-1 regulates the transcriptional network of pancreatic endocrine progenitor cells in mice[J].Clin Invest, 2009,119 (7):1888-1898.
    [35]Lillycrop KA, Phillips ES, Torrens C, et al, Feeding pregnant rats a protein restricted diet persistently alters the methylation of specific cytosines in the hepatic PPAR alpha promoter of the offspring[J].Br J Nutr,2008,100 (2):278-282.
    [36]Burdge GC, Slater-Jefferies J, Torrens C, et al. Dietary protein restriction of pregnant rats in the F0 generation induces altered methylation of hepatic gene promoters in the adult male offspring in the Fl and F2 generations[J]. Br J Nutr,2007,97 (3):435-439.
    [37]Sun L, Yang z. Jin F, et al. The Gly482Ser variant of the PPARGCI gene is associated with Type 2 diabetes mellitus in northern Chinese, especially men[J]. Diabet Med. 2006,23(10):1085-1092.
    [38]Mulder H, Ling C. Mitochondrial dysfunction in pancreatic beta-cells in Type 2 diabetes[J]. Mol Cell Endocrinol. 2009,297(1-2):34-40.
    [39]Ling C, Del Guerra S, Lupi R, et al. Epigenetic regulation of PPARGC1A in human type 2 diabetic islets and effect on insulin secretion. Diabetologia, 2008,51(4):615-622.
    [40]Smith JA, Kohn TA, Chetty AK, et al. CaMK activation during exercise is required for histone hyperacetylation and MEF2A binding at the MEF2 site on the GLUT4 gene. Am J Physiol Endocrinol Metab,2008,295(3):698-704.
    [41]Wu J, Qin Y, Li B, et al. Hypomethylated and hypermethylated profiles of H19DMR are associated with the aberrant imprinting of IGF2 and H19 in human hepatocellular carcinoma[J]. Genomics. 2008,91(5):443-450.
    [42]Delaval K, Wagschal A, Feil R. Epigenetic deregulation of imprinting in congenital diseases of aberrant growth[J]. Biol Essays,2006.28(5):453-459.
    [43]Federici M, Pandolfi A, DeFilippis EA, et al. G972 RIRS-1 variant impairs insulin regulation of endothelial nitricoxide synthase incultured human endothelial cells[J]. Circulation. 2004,109(3):399-405.
    [44]廖艳,黎海芪,邓兵,等.围生期宫内生长迟缓胎鼠的发育及其肝胰岛素信号转导蛋白的表达.北京大学学报,2008,40(5):538-542.
    [45]张良,苏良香,卞晓云,等.巨大儿青少年期血糖、血脂和转氨酶水平的调查研究.检验医学与临床,2010,7(3):211-214.
    [46]张俊清,高妍,郭晓蕙,等.肥胖青少年血清瘦素、胰岛素和胰岛素元水平的变化[J].中华内科杂志,2002,41(4):222-223.
    [47]陈春明.肥胖问题:我国公共卫生的新挑战[J].中华流行病学杂志,2002,23(1):1-2.
    [48]Donma MM. Macrosomia, top of the iceberg: the charm of underlying factors[J]. Pediatri Int,2011,53(1):78-84.
    [49]Hermann GM, Dallas LM, Haskell SE, et al. Neonatal macrosomia is an independent risk factor for adult metabolic syndrome[J]. Neonatology 2010,98(3):238-244.
    [50]ELENI NE, VASILEIOS IG, etc. Prothrombotic State, Cardiovascular, and Metabolic Syndrome Risk Factors in Prepubertal Children Born Large for Gestational Age[J]. Diabetes Care, 2010,33(11):2468-2471.
    [51]Tuya C, Mutch WJ, Broom I, McNeill G. The effect of birth weight on clottable and intact fibrinogen levels:a twin study[J]. Thromb Haemost 2005,3:1143-1148.
    [52]Ijzerman RG, Stehouwer CD, de Geus EJ, Kluft C, Boomsma DI. The association between birth weight and plasma fibrinogen is abolished after the elimination of genetic influences[J]. Thromb Haemost 2003,1:1239-1242.
    [53]Williams MS, Bray PF. Genetics of arterial prothrombotic risk states. Exp Biol Med 2001,226:409-419.
    [54]Jensen RB, Chellakooty M, Vielwerth S, Vaag A, Larsen T, Greisen G, Skakkebaek NE, Scheike T, Juul A. Intrauterine growth retardation and consequences for endocrine and cardiovascular diseases in adult life:does insulin-like growth factor-I play a role? Horm Res 2003,60(Suppl. 3):136-148.

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