Scholl T O, Stein T P, Smith W K
Departments of Obstetrics and Gynecology and of Surgery, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, Stratford, NJ 08084, USA.
Am J Clin Nutr. 2000 Dec;72(6):1542-7. doi: 10.1093/ajcn/72.6.1542.
Maternal growth on the basis of knee height occurs in nearly 50% of pregnant teenagers and is associated with greater gestational weight gain and accrual of subcutaneous fat in the mother but lower fetal growth compared with nongrowing teenagers and mature pregnant women.
The objective of this study was to determine whether leptin is a biomarker for continued maternal growth.
Leptin concentrations were measured in 162 growing and nongrowing teenage gravidas (aged </=18 y) and in mature gravidas (aged 19-29 y) from the Camden Study at 2 time points during pregnancy and 1 time point postpartum.
Growing teenagers had leptin concentrations that increased with gestation and were higher at 28 wk gestation and postpartum than in nongrowing teenagers and mature gravidas. The differences were related to a leptin surge between entry into the study (16.9 wk) and week 28, primarily in still-growing gravidas. Leptin-surge quartiles were associated with higher knee-height velocity and weight gain, increased skinfold thicknesses in late pregnancy (28 wk) and early postpartum (4-6 wk), and changes in postpartum weight and body mass index. For the highest quartile, low birth weight increased >5-fold, fetal growth restriction increased >6-fold, and infant birth weight decreased by approximately 200 g. Gravidas who developed pregnancy-induced hypertension showed a different pattern-higher leptin concentrations at entry and week 28, no difference in the leptin surge, and no postpartum difference in leptin concentration.
A leptin surge by week 28 appears to mark reduced mobilization of maternal fat stores that is associated with maternal growth on the basis of knee height during adolescent pregnancy.
近50%的怀孕青少年会出现基于膝高的母体生长，这与母亲孕期体重增加更多、皮下脂肪积累有关，但与未生长的青少年及成熟孕妇相比，胎儿生长较慢。
本研究的目的是确定瘦素是否为母体持续生长的生物标志物。
在卡姆登研究中，对162名生长中和未生长的青少年孕妇（年龄≤18岁）以及成熟孕妇（年龄19 - 29岁）在孕期的2个时间点和产后1个时间点测量瘦素浓度。
生长中的青少年瘦素浓度随孕周增加，在孕28周和产后高于未生长的青少年及成熟孕妇。这些差异与研究入组时（16.9周）至第28周期间的瘦素激增有关，主要发生在仍在生长的孕妇中。瘦素激增四分位数与更高的膝高增长速度和体重增加、孕晚期（28周）及产后早期（4 - 6周）皮褶厚度增加以及产后体重和体重指数变化相关。对于最高四分位数，低出生体重增加超过5倍，胎儿生长受限增加超过6倍，婴儿出生体重下降约200克。发生妊娠期高血压的孕妇呈现不同模式——入组时和第28周瘦素浓度较高，瘦素激增无差异，产后瘦素浓度无差异。
到28周时的瘦素激增似乎标志着母体脂肪储备动员减少，这与青春期妊娠期间基于膝高的母体生长有关。
