Department of Nutritional Sciences, University of Toronto, Toronto, Canada.
Am J Clin Nutr. 2012 Apr;95(4):867-74. doi: 10.3945/ajcn.111.028431. Epub 2012 Feb 29.
Emerging evidence indicates that metabolic hormones are present in human milk, but, to our knowledge, no studies have investigated the impact of maternal metabolic status assessed during pregnancy on insulin and adiponectin concentrations in milk.
We aimed to investigate the associations of prenatal metabolic abnormalities with insulin and adiponectin in human milk and to compare the concentrations of these hormones in early and mature milk.
Pregnant women aged ≥20 y with intention to breastfeed and without preexisting type 1 or 2 diabetes were recruited. Participants (n = 170) underwent a 3-h oral-glucose-tolerance test at 30 wk (95% CI: 25, 33 wk) gestation and donated early (the first week postpartum) and mature (3 mo postpartum) milk.
Adiponectin and insulin concentrations in early milk were higher than those in mature milk (both P < 0.0001). Prenatal metabolic abnormalities, including higher pregravid BMI (β ± SEE: 0.053 ± 0.014; P = 0.0003) and gravid hyperglycemia (0.218 ± 0.087; P = 0.01), insulin resistance (0.255 ± 0.047; P < 0.0001), lower insulin sensitivity (-0.521 ± 0.108; P < 0.0001), and higher serum adiponectin (0.116 ± 0.029; P < 0.0001), were associated with higher insulin in mature milk after covariate adjustment. Prenatal metabolic measures were not associated with milk adiponectin, but obstetrical measures that included nulliparity (0.171 ± 0.058; P = 0.004), longer duration of gestation (0.546 ± 0.146; P = 0.0002), and unscheduled cesarean delivery (0.387 ± 0.162; P = 0.02) were associated with higher adiponectin in early milk after covariate adjustment, including the time elapsed from delivery to milk collection.
Maternal prenatal metabolic abnormalities are associated with high insulin concentrations in mature milk, whereas only obstetrical variables are associated with adiponectin concentrations in early milk.
越来越多的证据表明代谢激素存在于人乳中，但据我们所知，尚无研究调查孕期母体代谢状态对乳汁中胰岛素和脂联素浓度的影响。
我们旨在研究产前代谢异常与乳汁中胰岛素和脂联素的关系，并比较初乳和成熟乳中这些激素的浓度。
招募了年龄≥20 岁、有母乳喂养意向且无 1 型或 2 型糖尿病既往史的孕妇。参与者（n=170）在妊娠 30 周（95%CI：25，33 周）时接受 3 小时口服葡萄糖耐量试验，并在产后第 1 周（初乳）和第 3 个月（成熟乳）捐献乳汁。
初乳中的脂联素和胰岛素浓度高于成熟乳（均 P＜0.0001）。产前代谢异常，包括较高的孕前 BMI（β±SEE：0.053±0.014；P=0.0003）和妊娠高血糖（0.218±0.087；P=0.01）、胰岛素抵抗（0.255±0.047；P＜0.0001）、较低的胰岛素敏感性（-0.521±0.108；P＜0.0001）和较高的血清脂联素（0.116±0.029；P＜0.0001），经协变量调整后与成熟乳中胰岛素水平升高相关。产前代谢指标与乳汁脂联素无关，但包括初产妇（0.171±0.058；P=0.004）、较长的孕期（0.546±0.146；P=0.0002）和无计划剖宫产分娩（0.387±0.162；P=0.02）等产科指标，与经协变量调整后的初乳中脂联素升高相关，包括从分娩到采集乳汁的时间间隔。
母亲孕期代谢异常与成熟乳中胰岛素浓度升高有关，而只有产科变量与初乳中脂联素浓度有关。
