Schaefer-Graf Ute M, Graf Kristof, Kulbacka Irina, Kjos Siri L, Dudenhausen Joachim, Vetter Klaus, Herrera Emilio
Department of Obstetrics, Vivantes Medical Center Berlin-Neukoelln, Berlin, Germany.
Diabetes Care. 2008 Sep;31(9):1858-63. doi: 10.2337/dc08-0039. Epub 2008 Jul 7.
To determine the contribution of maternal glucose and lipids to intrauterine metabolic environment and fetal growth in pregnancies with gestational diabetes mellitus (GDM).
In 150 pregnancies, serum triglycerides (TGs), cholesterol, free fatty acids (FFAs), glycerol, insulin, and glucose were determined in maternal serum and cord blood during the 3rd trimester. Maternal glucose values came from oral glucose tolerance testing and glucose profiles. Measurements of fetal abdominal circumference (AC) were performed simultaneously with maternal blood sampling and birth weight, and BMI and neonatal fat mass were obtained following delivery.
Maternal TGs and FFAs correlated with fetal AC size (at 28 weeks: triglycerides, P = 0.001; FFAs, P = 0.02), and at delivery they correlated with all neonatal anthropometric measures (FFA: birth weight, P = 0.002; BMI, P = 0.001; fat mass, P = 0.01). After adjustment for confounding variables, maternal FFAs and TGs at delivery remained the only parameters independently related to newborns large for gestational age (LGA) (P = 0.008 and P = 0.04, respectively). Maternal FFA levels were higher in mothers with LGA newborns than in those with appropriate for gestational age (AGA) newborns (362.8 +/- 101.7 vs. 252.4 +/- 10.1, P = 0.002). Maternal levels of TGs, FFAs, and glycerol at delivery correlated with those in cord blood (P = 0.003, P = 0.004, and P = 0.005, respectively). Fetal triglyceride and cholesterol levels were negatively correlated with newborn birth weight (P = 0.001), BMI (P = 0.004), and fat mass (P = 0.001). TGs were significantly higher in small for gestational age (SGA) newborns compared with AGA or LGA newborns, while insulin-to-glucose ratio and FFAs were the highest in LGA newborns.
In well-controlled GDM pregnancies, maternal lipids are strong predictors for fetal lipids and fetal growth. Infants with abnormal growth seem to be exposed to a distinct intrauterine environment compared with those with appropriate growth.
确定妊娠糖尿病（GDM）孕妇的母体葡萄糖和脂质对子宫内代谢环境及胎儿生长的影响。
选取150例孕妇，在孕晚期测定母体血清和脐血中的甘油三酯（TGs）、胆固醇、游离脂肪酸（FFAs）、甘油、胰岛素和葡萄糖。母体葡萄糖值来自口服葡萄糖耐量试验和血糖谱。在采集母体血液样本时同时测量胎儿腹围（AC），并记录出生体重，分娩后获取BMI和新生儿脂肪量。
母体TGs和FFAs与胎儿AC大小相关（孕28周时：甘油三酯，P = 0.001；FFAs，P = 0.02），分娩时它们与所有新生儿人体测量指标相关（FFA：出生体重，P = 0.002；BMI，P = 0.001；脂肪量，P = 0.01）。在对混杂变量进行校正后，分娩时母体FFAs和TGs仍然是与大于胎龄儿（LGA）独立相关的唯一参数（分别为P = 0.008和P = 0.04）。LGA新生儿母亲的母体FFA水平高于适于胎龄儿（AGA）新生儿母亲（362.8±101.7 vs. 252.4±10.1，P = 0.002）。分娩时母体TGs、FFAs和甘油水平与脐血中的水平相关（分别为P = 0.003、P = 0.004和P = 0.005）。胎儿甘油三酯和胆固醇水平与新生儿出生体重（P = 0.001）、BMI（P = 0.004）和脂肪量（P = 0.001）呈负相关。与AGA或LGA新生儿相比，小于胎龄儿（SGA）新生儿的TGs显著更高，而LGA新生儿的胰岛素与葡萄糖比值和FFAs最高。
在血糖控制良好的GDM妊娠中，母体脂质是胎儿脂质和胎儿生长的有力预测指标。与生长正常的婴儿相比，生长异常的婴儿似乎暴露于不同的子宫内环境。
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