Callegari Sandra Beatriz Mangucci, de Resende Elisabete Aparecida Mantovani Rodrigues, Barbosa Neto Octávio, Rodrigues Virmondes, de Oliveira Eduardo Mangucci, Borges Maria de Fátima
Disciplina de Ginecologia e Obstetrícia, Universidade Federal do Triângulo Mineiro - UFTM, Uberaba, MG, Brasil.
Disciplina de Endocrinologia, Universidade Federal do Triângulo Mineiro - UFTM, Uberaba, MG, Brasil.
Rev Bras Ginecol Obstet. 2014 Oct;36(10):449-55. doi: 10.1590/so100-720320140004946. Epub 2014 Oct 3.
To assess cardiometabolic risk factors during normal pregnancy and the influence of maternal obesity on them.
This study included 25 healthy pregnant women with a single pregnancy and a gestational age of less than twenty weeks. Longitudinal analysis of blood pressure, body weight, body mass index (BMI), serum concentrations of leptin, adiponectin, cortisol, total cholesterol and fractions, triglycerides, uric acid, fasting glucose, oral glucose tolerance test, HOMA-IR and insulin/glucose ratio was performed each trimester during pregnancy. In order to evaluate the impact of obesity, pregnant women were divided into two groups based on BMI for the first quarter of pregnancy: Gpn for pregnant women with BMI<25 kg/m2 and Gso for BMI≥25 kg/m2. One-Way ANOVA for repeated measurements or Friedman test and Student-t or Mann-Whitney tests for statistical comparisons and Pearson correlations test were used for statistical analysis.
The mean values for the first quarter of pregnancy for the following parameters were: age: 22 years; weight: 66.3 kg and BMI 26.4 kg/m2, with 20.2 and 30.7 kg/m2 for the Gpn and Gso groups, respectively. Mean weight gain during pregnancy was ±12.7 kg with 10.3 kg for the Gso group and 15.2 kg for the Gpn group. Regarding plasma determinations, cortisol, uric acid and lipid profile increased during all trimesters of pregnancy, except for HDL-cholesterol, which did not change. Blood pressure, insulin and HOMA-IR only increased in the third quarter of pregnancy. The Gso group tended to gain more weight and to show higher concentrations of leptin, total cholesterol, LDL-cholesterol, VLDL-cholesterol, TG, glucose, insulin, HOMA-IR, besides lower HDL-cholesterol and greater diastolic blood pressure in the 3rd quarter of pregnancy. Three pregnant women developed gestational hypertension, presented prepregnancy obesity, excessive weight gain, hyperleptinemia and an insulin/glucose ratio greater than two. Weight and BMI were positively correlated with total cholesterol and its LDL fraction, TG, uric acid, fasting blood glucose, insulin and HOMA-IR; and were negatively correlated with adiponectin and HDL-cholesterol. Leptin level was positively correlated with blood pressure.
The metabolic changes in pregnancy are more significant in obese women, suggesting, as expected, an increased risk of cardiometabolic complications. During their first visit for prenatal care, obese women should be informed about these risks, have their BMI and insulin/glucose ratio calculated along with their lipid profile to identify pregnant women at higher risk for cardiovascular diseases.
评估正常孕期的心脏代谢危险因素以及孕妇肥胖对其的影响。
本研究纳入了25名单胎妊娠且孕周小于20周的健康孕妇。在孕期的每个 trimester 对血压、体重、体重指数（BMI）、瘦素、脂联素、皮质醇、总胆固醇及其组分、甘油三酯、尿酸、空腹血糖、口服葡萄糖耐量试验、HOMA-IR和胰岛素/葡萄糖比值进行纵向分析。为了评估肥胖的影响，根据孕早期第一个季度的BMI将孕妇分为两组：BMI<25 kg/m²的孕妇为Gpn组，BMI≥25 kg/m²的孕妇为Gso组。采用重复测量的单因素方差分析或Friedman检验以及Student-t检验或Mann-Whitney检验进行统计比较，并使用Pearson相关检验进行统计分析。
孕早期第一个季度以下参数的平均值为：年龄22岁；体重66.3 kg，BMI 26.4 kg/m²，Gpn组和Gso组分别为20.2和30.7 kg/m²。孕期平均体重增加±12.7 kg，Gso组为10.3 kg，Gpn组为15.2 kg。关于血浆测定，除高密度脂蛋白胆固醇（HDL-胆固醇）无变化外，皮质醇、尿酸和血脂谱在孕期的所有trimester均升高。血压、胰岛素和HOMA-IR仅在孕晚期第三个季度升高。Gso组在孕晚期第三个季度往往体重增加更多，瘦素、总胆固醇、低密度脂蛋白胆固醇、极低密度脂蛋白胆固醇、甘油三酯、葡萄糖、胰岛素、HOMA-IR浓度更高，同时高密度脂蛋白胆固醇更低，舒张压更高。三名孕妇发生妊娠期高血压，孕前肥胖，体重过度增加，高瘦素血症，胰岛素/葡萄糖比值大于2。体重和BMI与总胆固醇及其低密度脂蛋白组分、甘油三酯、尿酸、空腹血糖、胰岛素和HOMA-IR呈正相关；与脂联素和高密度脂蛋白胆固醇呈负相关。瘦素水平与血压呈正相关。
肥胖女性孕期的代谢变化更为显著，正如预期的那样，提示心脏代谢并发症风险增加。在首次产前检查时，应告知肥胖女性这些风险，计算其BMI、胰岛素/葡萄糖比值以及血脂谱，以识别心血管疾病风险较高的孕妇。
