超重和肥胖孕妇的妊娠期糖尿病对胎儿生长和肥胖的中介作用：LIMIT 随机试验的二次分析。
The mediating effects of gestational diabetes on fetal growth and adiposity in women who are overweight and obese: secondary analysis of the LIMIT randomised trial.
机构信息
Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth, SA, Australia.
出版信息
BJOG. 2018 Nov;125(12):1558-1566. doi: 10.1111/1471-0528.15288. Epub 2018 Jun 14.
OBJECTIVE
To describe the mediating effect of maternal gestational diabetes on fetal biometry and adiposity measures among overweight or obese pregnant women.
DESIGN
Secondary analysis of the LIMIT randomised trial.
SETTING
Public hospitals, metropolitan Adelaide, South Australia.
POPULATION
Pregnant women with body mass index (BMI) ≥25 kg/m and singleton gestation.
METHODS
Fetal ultrasound measures at 36 weeks of gestation and baseline BMI from women randomised to the LIMIT trial Standard Care group (n = 912 women) were used to conduct causal mediation analyses using regression-based methods.
MAIN OUTCOMES MEASURES
Ultrasound measures of fetal biometry and adiposity at 36 weeks of gestation.
RESULTS
Increased maternal BMI was associated with increased measures of fetal head circumference [direct (unmediated) effect 0.18 (95% CI: 0.05-0.31), P = 0.005; total effect 0.17 (95% CI: 0.02-0.31), P = 0.018], abdominal circumference [direct effect 0.26 (95% CI: 0.11-0.41), P = 0.001; total effect 0.26 (95% CI: 0.11-0.42), P = 0.001] and estimated fetal weight [direct effect 0.22 (95% CI: 0.08-0.35), P = 0.002; total effect 0.22 (95% CI: 0.08-0.35), P = 0.002], with no evidence of mediation by treated gestational diabetes. There was no apparent association between maternal BMI and fetal adiposity measures, or mediation by treated gestational diabetes.
CONCLUSIONS
We show an important association between increased maternal BMI and fetal growth, not mediated by treated gestational diabetes. There was no association between increased maternal BMI and fetal adiposity measures, or mediation by treated gestational diabetes. Whether these findings represent 'saturation' in the effect of maternal BMI on fetal growth or the effect of treatment of GDM is unclear.
FUNDING
This project was funded by a 4-year project grant from the National Health and Medical Research Council (NHMRC), Australia (ID 519240); The Channel 7 Children's Research Foundation, South Australia; and the US National Institutes of Health (R01 HL094235-01).
TWEETABLE ABSTRACT
Increased fetal growth associated with maternal obesity is not mediated by gestational diabetes.
目的
描述母体妊娠期糖尿病对超重或肥胖孕妇胎儿生物测量和脂肪量指标的中介作用。
设计
LIMIT 随机试验的二次分析。
地点
南澳大利亚阿德莱德大都市的公立医院。
人群
BMI≥25kg/m2且单胎妊娠的孕妇。
方法
对随机分配到 LIMIT 试验标准护理组的女性（n=912 名女性）的 36 孕周胎儿超声测量值和基线 BMI 进行因果中介分析，采用基于回归的方法。
主要结局测量
36 孕周胎儿生物测量和脂肪量的超声测量值。
结果
母体 BMI 增加与胎儿头围的增加有关[直接（无中介）效应 0.18（95%CI：0.05-0.31），P=0.005；总效应 0.17（95%CI：0.02-0.31），P=0.018]、腹围[直接效应 0.26（95%CI：0.11-0.41），P=0.001；总效应 0.26（95%CI：0.11-0.42），P=0.001]和估计胎儿体重[直接效应 0.22（95%CI：0.08-0.35），P=0.002；总效应 0.22（95%CI：0.08-0.35），P=0.002]，但妊娠期糖尿病治疗的中介作用不明显。母体 BMI 与胎儿脂肪量指标之间没有明显的关联，也没有中介作用。
结论
我们发现，母体 BMI 增加与胎儿生长之间存在重要关联，而妊娠期糖尿病治疗的中介作用不明显。母体 BMI 增加与胎儿脂肪量指标之间没有关联，也没有中介作用。这些发现是母体 BMI 对胎儿生长的影响达到“饱和”，还是妊娠期糖尿病治疗的影响尚不清楚。
资金
本项目由澳大利亚国家健康与医学研究委员会（NHMRC）为期 4 年的项目资助（ID 519240）；第七频道儿童研究基金会，南澳大利亚州；和美国国立卫生研究院（R01 HL094235-01）。
推文摘要
与母体肥胖相关的胎儿生长增加不受妊娠期糖尿病的影响。
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