Loukovaara Mikko, Leinonen Pekka, Teramo Kari, Andersson Sture, Alfthan Henrik, Stenman Ulf-Håkan
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
Obstet Gynecol. 2004 Feb;103(2):240-4. doi: 10.1097/01.AOG.0000110545.64874.49.
Epidermal growth factor is a ubiquitous mitogen that also possesses insulin-like properties. Fetal mal-growth is associated with altered epidermal growth factor levels. Maternal diabetes is frequently complicated by macrosomia, but the effect of maternal diabetes on fetal epidermal growth factor levels is not known. We studied cord serum epidermal growth factor concentrations in pregnancies complicated by diabetes and in normal pregnancies.
Cord serum epidermal growth factor concentrations were measured at birth by a sandwich-type time-resolved immunofluorometric assay in 63 pregnancies complicated by insulin-dependent diabetes mellitus, in 25 pregnancies complicated by insulin-treated gestational diabetes, and in 56 normal pregnancies.
Cord serum epidermal growth factor correlated positively with the duration of pregnancy in diabetic and normal pregnancies. In a subgroup of women at similar gestational ages (38-39 weeks), cord serum epidermal growth factor concentrations were higher in pregnancies complicated by insulin-dependent diabetes mellitus (962 +/- 211 ng/L, P =.047; n = 9) and in pregnancies complicated by gestational diabetes (1133 +/- 115 ng/L, P =.001; n = 9) than in controls (564 +/- 75 ng/L; n = 22). In multiple regression analysis, only umbilical artery hemoglobin in diabetic pregnancies and vaginal delivery in normal pregnancies were associated with cord serum epidermal growth factor.
Epidermal growth factor concentrations are higher than normal in fetuses of diabetic mothers at term. Pregnancy complications, such as hypertensive disorders, fetal hypoxia and fetal malgrowth, may not explain the rise in epidermal growth factor levels. We hypothesize that the rise in epidermal growth factor levels is a metabolic response of the fetoplacental unit to diabetes-related hyperglycemia.
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表皮生长因子是一种普遍存在的促有丝分裂原，也具有胰岛素样特性。胎儿生长不良与表皮生长因子水平改变有关。母亲患糖尿病常并发巨大儿，但母亲糖尿病对胎儿表皮生长因子水平的影响尚不清楚。我们研究了糖尿病合并妊娠和正常妊娠时脐血血清表皮生长因子浓度。
采用夹心型时间分辨免疫荧光分析法，在出生时测定了63例胰岛素依赖型糖尿病合并妊娠、25例胰岛素治疗的妊娠期糖尿病合并妊娠以及56例正常妊娠的脐血血清表皮生长因子浓度。
糖尿病妊娠和正常妊娠中，脐血血清表皮生长因子与妊娠持续时间呈正相关。在孕周相似（38 - 39周）的女性亚组中，胰岛素依赖型糖尿病合并妊娠（962±211 ng/L，P = 0.047；n = 9）和妊娠期糖尿病合并妊娠（1133±115 ng/L，P = 0.001；n = 9）的脐血血清表皮生长因子浓度高于对照组（564±75 ng/L；n = 22）。在多元回归分析中，糖尿病妊娠中的脐动脉血红蛋白和正常妊娠中的阴道分娩与脐血血清表皮生长因子有关。
足月时糖尿病母亲胎儿的表皮生长因子浓度高于正常。妊娠并发症，如高血压疾病、胎儿缺氧和胎儿生长不良，可能无法解释表皮生长因子水平的升高。我们推测表皮生长因子水平升高是胎儿 - 胎盘单位对糖尿病相关高血糖的一种代谢反应。
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