葡萄糖耐量正常孕妇的母体甘油三酯水平与新生儿体重

Maternal triglyceride levels and newborn weight in pregnant women with normal glucose tolerance.

作者信息

Di Cianni G, Miccoli R, Volpe L, Lencioni C, Ghio A, Giovannitti M G, Cuccuru I, Pellegrini G, Chatzianagnostou K, Boldrini A, Del Prato S

机构信息

Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, Azienda Ospedalier Pisana, University of Pisa, Italy.

出版信息

Diabet Med. 2005 Jan;22(1):21-5. doi: 10.1111/j.1464-5491.2004.01336.x.

DOI:10.1111/j.1464-5491.2004.01336.x

PMID:15606686

Abstract

OBJECTIVE

To determine the predictive value of serum triglyceride levels (TG) for neonatal weight in pregnant women with positive diabetic screening but normal glucose tolerance.

RESEARCH DESIGN AND METHODS

We enrolled 180 pregnant Caucasian women with positive diabetic screening. All women underwent a 3-h 100-g oral glucose tolerance test (OGTT) at 27th +/- 4 week of gestation. At the time of OGTT, we measured: fasting plasma glucose, fasting lipids profile and determined ApoE polymorphisms to evaluate the effects on lipid levels. In 83 women with normal glucose tolerance and at term delivery we evaluated the association between maternal serum TG, specific maternal parameters known to affect fetal growth and newborn weight.

RESULTS

Based on OGTT, gestational diabetes mellitus (GDM) was diagnosed in 36 women (20%), impaired glucose tolerance (IGT) in 23 (13%), and normal glucose tolerance (NGT) in 121 (67%). Serum TG concentration was significantly higher in women with GDM (2.47 +/- 0.77 mmol/l) as compared with NGT (1.99 +/- 0.64 mmol/l) or IGT (1.98 +/- 0.81 mmol/l) (P < 0.01). ApoE3 allelic frequency was 86%, ApoE2 and ApoE4 were 5 and 9%, respectively. We found no clear-cut association between apoE genotype and serum TG concentration. Macrosomia and LGA newborns were more frequent in IGT than in GDM or NGT (P < 0.01). In the 83 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of LGA infants was significantly higher in those with TG levels higher than the 75th percentile (> 2.30 mmol/l) (21%) than in mothers who had normal TG levels (4.5%) (P < 0.05). Pre-pregnancy BMI (r(2) = 0.067), weight gain during pregnancy (r(2) = 0.062), fasting serum TG (r(2) = 0.09), and 2-h post-OGTT glucose levels (r(2) = 0.044) were all associated with neonatal body weight (all P < 0.05 or less). However, on a multiple regression analysis, only pre-pregnancy BMI (F-test = 7.26, P < 0.01), and fasting serum TG (F-test = 4.07, P < 0.01) were independently associated with birth weight.

CONCLUSIONS

Pre-pregnancy BMI and fasting maternal serum TG determined in the last trimester of gestation were independently associated with neonatal birth weight in women with normal glucose tolerance, but positive screening test. TG levels measured in the third trimester of pregnancy are independent of the genetic polymorphism of ApoE.

摘要

目的

确定糖尿病筛查阳性但糖耐量正常的孕妇血清甘油三酯水平（TG）对新生儿体重的预测价值。

研究设计与方法

我们纳入了180例糖尿病筛查阳性的白人孕妇。所有孕妇在妊娠27±4周时接受了3小时100克口服葡萄糖耐量试验（OGTT）。在进行OGTT时，我们测量了：空腹血糖、空腹血脂谱，并确定了载脂蛋白E（ApoE）基因多态性，以评估其对血脂水平的影响。在83例糖耐量正常且足月分娩的孕妇中，我们评估了母亲血清TG、已知影响胎儿生长的特定母亲参数与新生儿体重之间的关联。

结果

根据OGTT，36例（20%）孕妇被诊断为妊娠期糖尿病（GDM），23例（13%）为糖耐量受损（IGT），121例（67%）为糖耐量正常（NGT）。与NGT（1.99±0.64 mmol/L）或IGT（1.98±0.81 mmol/L）相比，GDM孕妇的血清TG浓度显著更高（2.47±0.77 mmol/L）（P<0.01）。ApoE3等位基因频率为86%，ApoE2和ApoE4分别为5%和9%。我们未发现ApoE基因型与血清TG浓度之间有明确的关联。IGT孕妇中巨大儿和大于胎龄儿（LGA）新生儿比GDM或NGT孕妇更常见（P<0.01）。在83例糖尿病筛查阳性但糖耐量正常且足月分娩的孕妇中（LGA），TG水平高于第75百分位数（>2.30 mmol/L）的孕妇中LGA婴儿的发生率（21%）显著高于TG水平正常的母亲（4.5%）（P<0.05）。孕前体重指数（r² = 0.067）、孕期体重增加（r² = 0.062）、空腹血清TG（r² = 0.09）和OGTT后2小时血糖水平（r² = 0.044）均与新生儿体重相关（均P<0.05或更低）。然而，在多元回归分析中，只有孕前体重指数（F检验 = 7.26，P<0.01）和空腹血清TG（F检验 = 4.07，P<0.01）与出生体重独立相关。