Gallo L A, Barrett H L, Dekker Nitert M
Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia; School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia.
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia.
Placenta. 2017 Jun;54:59-67. doi: 10.1016/j.placenta.2016.12.006. Epub 2016 Dec 7.
Maternal obesity is growing in prevalence and is associated with increased morbidity and mortality for both mother and child. Women who are obese during pregnancy have a greater risk of metabolic complications such as gestational diabetes mellitus (GDM) as well as type 2 diabetes after pregnancy. Children of obese and/or GDM mothers have an increased susceptibility to congenital abnormalities and a range of cardio-metabolic disorders. The placenta is at the interface of the maternal and fetal environments and, its function per se, plays a major role in dictating the impact of maternal health on fetal development. Here, we review the literature on how placental function is affected in pregnancies complicated by obesity, and pre-gestational and gestational diabetes. The focus is on the availability of three key substrates in these conditions: glucose, lipids, and amino acids, and their impact on placental metabolic activity. Maternal obesity and diabetes are not always associated with fetal compromise and the adaptation of the placenta may partially determine the outcome. Understanding the differences in metabolic adaptation may open avenues for therapeutic development.
孕妇肥胖的患病率正在上升，并且与母亲和孩子发病率及死亡率的增加相关。孕期肥胖的女性发生代谢并发症的风险更高，如妊娠期糖尿病（GDM）以及产后2型糖尿病。肥胖和/或患有GDM的母亲所生的孩子患先天性异常及一系列心脏代谢疾病的易感性增加。胎盘处于母体和胎儿环境的界面，其本身的功能在决定母体健康对胎儿发育的影响方面起着主要作用。在此，我们综述了关于肥胖、孕前糖尿病和妊娠期糖尿病合并妊娠时胎盘功能如何受到影响的文献。重点关注这些情况下三种关键底物（葡萄糖、脂质和氨基酸）的可用性及其对胎盘代谢活性的影响。母体肥胖和糖尿病并不总是与胎儿生长受限相关，胎盘的适应性可能部分决定结局。了解代谢适应性的差异可能为治疗发展开辟道路。
