Dosch Natalie C, Guslits Elyssa F, Weber Morgan B, Murray Shannon E, Ha Barbara, Coe Christopher L, Auger Anthony P, Kling Pamela J
Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI; Department of Psychology, University of Wisconsin, Madison, WI.
J Pediatr. 2016 May;172:20-8. doi: 10.1016/j.jpeds.2016.02.023. Epub 2016 Mar 9.
To determine the impact of maternal obesity and gestational weight gain across pregnancy on fetal indices of inflammation and iron status.
Eighty-five healthy term newborns delivered via elective cesarean were categorized by 2 maternal body mass index (BMI) thresholds; above or below 30 kg/m(2) or above or below 35 kg/m(2). Umbilical cord plasma levels of C-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF)-α, ferritin, and hepcidin were assayed. Cytokines released by phytohemagglutinin-stimulated umbilical cord mononuclear cells (MNCs) were assayed.
Maternal class II obesity, defined as BMI of 35 kg/m(2) and above, predicted higher C-reactive protein and TNF-α in umbilical cord plasma (P < .05 for both), and also proinflammatory cytokines (IL-1β, IL-6, and TNF-α) from stimulated MNC (P < .05 for all). The rise in plasma TNF-α and MNC TNF-α was not linear but occurred when the threshold of BMI 35 kg/m(2) was reached (P < .005, P < .06). Poorer umbilical cord iron indices were associated with maternal obesity. When ferritin was low, IL-6 was higher (P < .04), but this relationship was present primarily when maternal BMI exceeded 35 kg/m(2) (P < .03). Ferritin was correlated with hepcidin (P < .0001), but hepcidin was unrelated to either maternal BMI or inflammatory indices.
Class II obesity and above during pregnancy is associated with fetal inflammation in a threshold fashion. Although maternal BMI negatively impacted fetal iron status, hepcidin, related to obesity in adults, was related to iron status and not obesity in fetuses. Pediatricians should be aware of these relationships.
确定孕期母亲肥胖及孕期体重增加对胎儿炎症指标和铁状态的影响。
通过择期剖宫产分娩的85名足月健康新生儿，根据两个母亲体重指数（BMI）阈值进行分类；高于或低于30kg/m²或高于或低于35kg/m²。检测脐血血浆中C反应蛋白、白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α、铁蛋白和铁调素的水平。检测植物血凝素刺激的脐血单个核细胞（MNCs）释放的细胞因子。
母亲II级肥胖定义为BMI为35kg/m²及以上，预测脐血血浆中C反应蛋白和TNF-α水平较高（两者P均<0.05），且刺激的MNC释放的促炎细胞因子（IL-1β、IL-6和TNF-α）水平也较高（所有P均<0.05）。血浆TNF-α和MNC TNF-α的升高不是线性的，而是在BMI达到35kg/m²阈值时出现（P<0.005，P<0.06）。较差的脐血铁指标与母亲肥胖有关。当铁蛋白水平较低时，IL-6水平较高（P<0.04），但这种关系主要在母亲BMI超过35kg/m²时出现（P<0.03）。铁蛋白与铁调素相关（P<0.0001），但铁调素与母亲BMI或炎症指标均无关。
孕期II级及以上肥胖与胎儿炎症呈阈值相关。虽然母亲BMI对胎儿铁状态有负面影响，但与成人肥胖相关的铁调素与胎儿的铁状态有关，而与肥胖无关。儿科医生应了解这些关系。
