Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Avenue, Campus Box B-119, Aurora, CO 80045, USA.
Diabetologia. 2011 Mar;54(3):504-7. doi: 10.1007/s00125-010-2008-1. Epub 2010 Dec 14.
AIMS/HYPOTHESIS: Recent studies have provided evidence that intrauterine exposure to maternal diabetes has lifelong effects on adult offspring, including increased risks of obesity, type 2 diabetes and cardiovascular disease. The aim of this study was to assess the relationship between exposure to maternal diabetes in utero and cardiovascular risk factors in healthy children and to investigate whether these associations are independent of maternal prepregnancy BMI and offspring attained BMI.
Data were from a retrospective cohort of children aged 6-13 years born during 1994-2002. Multiple linear regression was used to examine the associations between exposure and cardiovascular risk factors with adjustment for demographic factors and pubertal stage and additionally for maternal prepregnancy BMI and offspring attained BMI.
Ninety-nine offspring of diabetic pregnancies had significantly increased E-selectin, vascular adhesion molecule 1 (VCAM1), leptin, waist circumference, BMI and systolic blood pressure and decreased adiponectin levels compared with 422 offspring of non-diabetic pregnancies after adjustment for age, sex and race/ethnicity (p < 0.05 for each risk factor). Additional adjustment for maternal prepregnancy BMI substantially attenuated group differences in the risk factors except for E-selectin, VCAM1 and waist circumference, which remained significantly higher in exposed children.
CONCLUSIONS/INTERPRETATION: Compared with unexposed children, healthy offspring exposed to maternal diabetes in utero have a worse cardiovascular risk profile. In particular, offspring have substantially increased levels of circulating cellular adhesion molecules, which are biomarkers of adverse endothelium perturbation and may be related to the earliest preclinical stages of atherosclerosis and diabetes.
目的/假设：最近的研究提供了证据，表明母亲在子宫内患有糖尿病会对成年后代产生终身影响，包括肥胖、2 型糖尿病和心血管疾病的风险增加。本研究旨在评估子宫内暴露于母体糖尿病与健康儿童心血管危险因素之间的关系，并研究这些关联是否独立于母体孕前 BMI 和后代获得的 BMI。
数据来自于 1994 年至 2002 年期间出生的年龄在 6-13 岁的儿童的回顾性队列研究。采用多元线性回归分析，在调整了人口统计学因素和青春期阶段后，进一步调整了母体孕前 BMI 和后代获得的 BMI，来检验暴露与心血管危险因素之间的关联。
与非糖尿病妊娠的 422 名后代相比，99 名糖尿病妊娠的后代的 E-选择素、血管细胞黏附分子 1（VCAM1）、瘦素、腰围、BMI 和收缩压显著升高，脂联素水平降低（p 值均<0.05）。进一步调整母体孕前 BMI 后，除 E-选择素、VCAM1 和腰围外，各危险因素的组间差异明显减弱，暴露儿童的这些指标仍然显著较高。
结论/解释：与未暴露的儿童相比，子宫内暴露于母体糖尿病的健康后代具有更差的心血管风险特征。特别是，后代的循环细胞黏附分子水平显著升高，这些分子是内皮功能障碍的不良生物标志物，可能与动脉粥样硬化和糖尿病的最早临床前阶段有关。
