Migda M, Migda M S, Migda B, Wender-Ozegowska E
Civis Vita Medical Center, Torun, Poland.
Clinical Unit of Obstetrics, Women's Diseases and Gynecological Oncology, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Torun, Torun, Poland.
J Physiol Pharmacol. 2017 Dec;68(6):833-839.
Metabolic syndrome (MS) and obesity is an important risk factor for fetal complications like excessive fetal growth manifested by large for gestational age (LGA) and macrosomia, which is a consequence of metabolic disturbances present in the first trimester of pregnancy. The aim of this prospective observational study is to analyze the relationship between the first trimester biochemical and anthropometric parameters of fetuses with the incidence of their macrosomia and LGA so to early predict such complications in women with symptoms of MS. A total of 124 Caucasian women in singleton pregnancies who fulfilled MS criteria were enrolled into the study group and compared to 30 healthy pregnant controls. Patients' blood was drawn and sampled for analysis at 11 - 13 weeks of gestation. Specific factors were analyzed in terms of influence on fetal growth and perinatal morbidity in both pregnancy groups. The maternal parameters obtained at first trimester that with respect to controls proved influential towards macrosomia defined as > 4000 g were: BMI and weight (28.0 versus 22 m/kg; P < 0.001), (77.9 kg versus 60.8 kg; P < 0.001), fasting glucose (87.2 versus 82.1 mg/dl; P < 0.042), significantly higher s-E-selectin concentration (32.0 versus 24.5 ng/ml; P < 0.011) and lower adiponectin: (5.6 versus 9.1 μg/ml; P < 0.001). Similarly, the parameters for LGA fetuses were found to be: maternal weight (80.3 versus 60.8 kg; P < 0.001), BMI (28.7 versus 21.6 kg/m; P < 0.001), fasting glucose (87.2 versus 82.4mg/dl; P < 0.022), increased s-E-selectin (30.8 versus 24.5 ng/ml; P < 0.022) and decreased adiponectin (6.3 versus 8.2 μg/ml; P < 0.024). We concluded that: 1) first trimester BMI with cut-off of 25.5 was significant risk factor for excessive fetal growth; 2) maternal glycemia, as well as adiponectin and soluble E-selectin serum concentration in the first trimester of pregnancy could be predictive of LGA and fetal macrosomia; 3) maternal weight at 11 - 13 weeks of pregnancy cut-off 67 kg had high sensitivity and specificity in detecting LGA and fetal macrosomia.
代谢综合征（MS）和肥胖是胎儿并发症的重要危险因素，如巨大儿和大于胎龄儿（LGA）所表现出的胎儿过度生长，这是妊娠早期代谢紊乱的结果。这项前瞻性观察研究的目的是分析妊娠早期胎儿的生化和人体测量参数与其巨大儿和LGA发生率之间的关系，以便早期预测患有MS症状的女性的此类并发症。共有124名单胎妊娠且符合MS标准的白人女性被纳入研究组，并与30名健康孕妇对照组进行比较。在妊娠11 - 13周时采集患者血液进行分析。分析了两个妊娠组中特定因素对胎儿生长和围产期发病率的影响。与对照组相比，妊娠早期获得的对定义为> 4000 g的巨大儿有影响的母体参数为：体重指数（BMI）和体重（28.0对22 m/kg；P < 0.001），（77.9 kg对60.8 kg；P < 0.001），空腹血糖（87.2对82.1 mg/dl；P < 0.042），s - E - 选择素浓度显著更高（32.0对24.5 ng/ml；P < 0.011）和脂联素更低（5.6对9.1 μg/ml；P < 0.001）。同样，LGA胎儿的参数为：母体体重（80.3对60.8 kg；P < 0.001），BMI（28.7对21.6 kg/m；P < 0.001），空腹血糖（87.2对82.4mg/dl；P < 0.022），s - E - 选择素升高（30.8对
