Edison Robin J, Berg Kate, Remaley Alan, Kelley Richard, Rotimi Charles, Stevenson Roger E, Muenke Maximilian
Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Department of Health and Human Services, 35 Convent Dr, Bethesda, MD 20892-3717, USA.
Pediatrics. 2007 Oct;120(4):723-33. doi: 10.1542/peds.2006-1939.
The objective of this study was to assess whether low maternal serum cholesterol during pregnancy is associated with preterm delivery, impaired fetal growth, or congenital anomalies in women without identified major risk factors for adverse pregnancy outcome.
Mother-infant pairs were retrospectively ascertained from among a cohort of 9938 women who were referred to South Carolina prenatal clinics for routine second-trimester serum screening. Banked sera were assayed for total cholesterol; <10th percentile of assayed values (159 mg/dL at mean gestational age of 17.6 weeks) defined a "low total cholesterol" prenatal risk category. Eligible women were aged 21 to 34 years and nonsmoking and did not have diabetes; neonates were liveborn after singleton gestations. Total cholesterol values of eligible mothers were adjusted for gestational age at screening before risk group assignment. The study population included 118 women with low total cholesterol and 940 women with higher total cholesterol. Primary analyses used multivariate regression models to compare rates of preterm delivery, fetal growth parameters, and congenital anomalies between women with low total cholesterol and control subjects with mid-total cholesterol values >10th percentile but <90th percentile.
Prevalence of preterm delivery among mothers with low total cholesterol was 12.7%, compared with 5.0% among control subjects with mid-total cholesterol. The association of low maternal serum cholesterol with preterm birth was observed only among white mothers. Term infants of mothers with low total cholesterol weighed on average 150 g less than those who were born to control mothers. A trend of increased microcephaly risk among neonates of mothers with low total cholesterol was found. Low maternal serum cholesterol was unassociated with risk for congenital anomalies.
Total serum cholesterol <10th population percentile was strongly associated with preterm delivery among otherwise low-risk white mothers in this pilot study population. Term infants of mothers with low total cholesterol weighed less than control infants among both racial groups.
本研究的目的是评估在未发现不良妊娠结局主要危险因素的女性中，孕期母体血清胆固醇水平低是否与早产、胎儿生长受限或先天性异常有关。
母婴对是从9938名转诊至南卡罗来纳州产前诊所进行常规孕中期血清筛查的女性队列中回顾性确定的。检测储存血清中的总胆固醇；检测值的第10百分位数以下（平均孕周17.6周时为159mg/dL）定义为“总胆固醇低”的产前风险类别。符合条件的女性年龄在21至34岁之间，不吸烟且无糖尿病；新生儿为单胎妊娠后的活产儿。在进行风险组分配之前，对符合条件母亲的总胆固醇值进行孕周调整。研究人群包括118名总胆固醇低的女性和940名总胆固醇较高的女性。主要分析使用多变量回归模型比较总胆固醇低的女性与总胆固醇值处于第10百分位数以上但低于第90百分位数的对照受试者之间的早产率、胎儿生长参数和先天性异常情况。
总胆固醇低的母亲中早产的发生率为12.7%，而总胆固醇处于中等水平的对照受试者中早产发生率为5.0%。仅在白人母亲中观察到母体血清胆固醇低与早产之间的关联。总胆固醇低的母亲所生足月儿的平均体重比对照母亲所生的足月儿轻150g。发现总胆固醇低的母亲所生新生儿患小头畸形的风险有增加趋势。母体血清胆固醇低与先天性异常风险无关。
在本试点研究人群中，血清总胆固醇低于第10人群百分位数与其他方面低风险的白人母亲早产密切相关。两个种族中，总胆固醇低的母亲所生足月儿的体重均低于对照婴儿。
