Kramer Caroline K, Hamilton Jill K, Ye Chang, Hanley Anthony J, Connelly Philip W, Sermer Mathew, Zinman Bernard, Retnakaran Ravi
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada; Division of Endocrinology, University of Toronto, Toronto, ON, Canada.
Clin Endocrinol (Oxf). 2014 Sep;81(3):387-94. doi: 10.1111/cen.12437. Epub 2014 Mar 13.
Rapid weight gain in the first 3 months of life has been associated with an unfavourable cardio-metabolic phenotype in adulthood. However, little is known about the antepartum determinants of this rapid weight gain, which may reflect key developmental exposures that program metabolic pathways. Thus, we sought to characterize the antepartum determinants of rapid weight gain in the first 3 months of life in infants exposed to gestational diabetes mellitus (GDM), a patient population at risk for early cardio-metabolic disease.
Prospective observational cohort study.
Pregnant women with (n = 90) and without GDM (n = 250) underwent detailed antepartum metabolic characterization, followed by assessment of their term offspring at age 3 months.
Rapid infant weight gain in the first 3 months was defined as weight gain ≥ 0·5 SD.
No features of maternal metabolic function in pregnancy (including insulin sensitivity, lipid profile, adiponectin, leptin and C-reactive protein) were associated with infant weight gain in either the GDM or non-GDM group. Interestingly, although all infants were born at term (≥37 weeks), length of gestation was inversely associated with weight gain at 3 months in the infants of women with GDM (β = -148·5, P = 0·01). In these infants, length of gestation <39 weeks was an independent predictor of rapid weight gain (OR = 7·9, 95%CI 1·7-38, P = 0·009) in the fully adjusted model. These associations were not observed in infants of women without GDM.
Delivery before 39 weeks is independently associated with rapid weight gain in the first 3 months of life in term infants of women with GDM and hence may be an antepartum marker of future cardio-metabolic risk.
出生后前3个月体重快速增加与成年期不良的心脏代谢表型有关。然而，对于这种体重快速增加的产前决定因素知之甚少，这些因素可能反映了对代谢途径进行编程的关键发育暴露因素。因此，我们试图确定患有妊娠期糖尿病（GDM）的婴儿（这是一个有早期心脏代谢疾病风险的患者群体）出生后前3个月体重快速增加的产前决定因素。
前瞻性观察队列研究。
患有（n = 90）和未患有GDM（n = 250）的孕妇进行了详细的产前代谢特征分析，随后对其足月后代在3个月大时进行评估。
婴儿出生后前3个月体重快速增加定义为体重增加≥0·5标准差。
妊娠期间母体代谢功能的特征（包括胰岛素敏感性、血脂谱、脂联素、瘦素和C反应蛋白）在GDM组或非GDM组中均与婴儿体重增加无关。有趣的是，尽管所有婴儿均足月出生（≥37周），但患有GDM的女性所生婴儿的妊娠时长与3个月时的体重增加呈负相关（β = -148·5，P = 0·01）。在这些婴儿中，妊娠时长<39周是完全调整模型中体重快速增加的独立预测因素（OR = 7·9，95%CI 1·7 - 38，P = 0·009）。在未患有GDM的女性所生婴儿中未观察到这些关联。
39周前分娩与患有GDM的女性足月婴儿出生后前3个月体重快速增加独立相关，因此可能是未来心脏代谢风险的产前标志物。
