饥荒对胎盘大小与后期高血压关联的性别特异性影响。

The sex-specific effects of famine on the association between placental size and later hypertension.

机构信息

Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.

Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

出版信息

Placenta. 2011 Sep;32(9):694-698. doi: 10.1016/j.placenta.2011.06.012. Epub 2011 Jul 13.

DOI:10.1016/j.placenta.2011.06.012

PMID:21742377

Abstract

BACKGROUND

People who had low birth weight are at increased risk of hypertension. This may reflect fetal programming by undernutrition. Placental size is also associated with hypertension. Maternal undernutrition during the Dutch famine reduced placental surface area. We examined whether maternal undernutrition altered the relationship between placental size and later hypertension.

METHODS

Retrospective cohort study among 860 subjects born in Amsterdam during 1943-47. 216 subjects were taking anti-hypertensive medication. Birth records included placental length and breadth from which we calculated its area.

RESULTS

Among men who were not in utero during the famine hypertension was associated with a small placental surface area due to a small placental breadth, and with an oval-shaped surface. The OR for hypertension was 0.83 (95% CI 0.70 to 1.00) for a 40 cm(2) increase in surface area. Among men who were in utero during the famine hypertension was associated with a large placental surface area due to a large placental breadth, and with a round-shaped surface. The OR for hypertension was 1.34 (95% CI 0.99 to 1.80) for a 40 cm(2) increase in surface area. The associations between placental size and hypertension in men who were and were not in utero during the famine were significantly different (p values for interaction = 0.008 for placental surface area, 0.001 for the breadth and 0.01 for the difference in the two diameters). Among women hypertension was not associated with placental size.

CONCLUSIONS

Our study provides the first direct evidence that changes in maternal diet during pregnancy alter the relationship between placental size and later hypertension among men but not women. We suggest that among men who were not in utero during the famine, hypertension was related to impaired implantation, whereas among men who were in utero during the famine it was related to compensatory expansion of the placental surface.

摘要

背景

出生体重较低的人患高血压的风险增加。这可能反映了营养不良对胎儿的编程作用。胎盘大小也与高血压有关。荷兰饥荒期间孕妇营养不良会减少胎盘面积。我们研究了孕妇营养不良是否改变了胎盘大小与后期高血压之间的关系。

方法

对 1943-1947 年在阿姆斯特丹出生的 860 名受试者进行回顾性队列研究。216 名受试者正在服用抗高血压药物。出生记录包括胎盘的长度和宽度，我们据此计算其面积。

结果

在男性中，非饥荒期间宫内的高血压与小胎盘面积有关，原因是胎盘宽度较小，且呈椭圆形。胎盘面积增加 40cm²，高血压的比值比为 0.83（95%可信区间为 0.70 至 1.00）。在饥荒期间宫内的高血压与大胎盘面积有关，原因是胎盘宽度较大，且呈圆形。胎盘面积增加 40cm²，高血压的比值比为 1.34（95%可信区间为 0.99 至 1.80）。在饥荒期间宫内和非宫内的男性中，胎盘大小与高血压之间的关联差异显著（p 值为胎盘面积 0.008，宽度 0.001，两者直径差异 0.01）。在女性中，高血压与胎盘大小无关。