Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany.
Division of 'Experimental Obstetrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany.
BMC Pregnancy Childbirth. 2018 Jun 20;18(1):250. doi: 10.1186/s12884-018-1889-8.
Both gestational diabetes mellitus (GDM) as well as overweight/obesity during pregnancy are risk factors for detrimental anthropometric and hormonal neonatal outcomes, identified to 'program' adverse health predispositions later on. While overweight/obesity are major determinants of GDM, independent effects on critical birth outcomes remain unclear. Thus, the aim of the present study was to evaluate, in women with GDM, the relative/independent impact of overweight/obesity vs. altered glucose metabolism on newborn parameters.
The prospective observational 'Early CHARITÉ (EaCH)' cohort study primarily focuses on early developmental origins of unfavorable health outcomes through pre- and/or early postnatal exposure to a 'diabetogenic/adipogenic' environment. It includes 205 mother-child dyads, recruited between 2007 and 2010, from women with treated GDM and delivery at the Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Germany. Recruitment, therapy, metabolite/hormone analyses, and data evaluation were performed according to standardized guidelines and protocols. This report specifically aimed to identify maternal anthropometric and metabolic determinants of anthropometric and critical hormonal birth outcomes in 'EaCH'.
Group comparisons, Spearman's correlations and unadjusted linear regression analyses initially confirmed that increased maternal prepregnancy body-mass-index (BMI) is a significant factor for elevated birth weight, cord-blood insulin and leptin (all P < 0.05). However, consideration of and adjustment for maternal glucose during late pregnancy showed that no maternal anthropometric parameter (weight, BMI, gestational weight gain) remained significant (all n.s.). In contrast, even after adjustment for maternal anthropometrics, third trimester glucose values (fasting and postprandial glucose at 32nd and 36th weeks' gestation, HbA1c in 3rd trimester and at delivery), were clearly positively associated with critical birth outcomes (all P < 0.05).
Neither overweight/obesity nor gestational weight gain appear to be independent determinants of increased birth weight, insulin and leptin. Rather, 3rd trimester glycemia seems to be crucial for respective neonatal outcomes. Thus, gestational care and future research studies should greatly consider late pregnancy glucose in overweight/obese women with or without GDM, for evaluation of critical causes and interventional strategies against 'perinatal programming of diabesity' in the offspring.
妊娠糖尿病（GDM）和孕期超重/肥胖都是不利于新生儿人体测量和激素指标的危险因素，这些因素被认为会“编程”后代不良的健康倾向。虽然超重/肥胖是 GDM 的主要决定因素，但它们对关键分娩结局的独立影响尚不清楚。因此，本研究旨在评估 GDM 女性中，超重/肥胖与葡萄糖代谢改变对新生儿参数的相对/独立影响。
前瞻性观察性“早期 CHARITÉ（EaCH）”队列研究主要通过在德国柏林夏洛蒂医科大学妇产科接受治疗的 GDM 女性及其分娩期间，在产前和/或产后早期暴露于“致糖尿病/脂肪形成”环境，来研究不良健康结局的早期发育起源。该研究纳入了 205 对母婴对子，招募于 2007 年至 2010 年，招募时纳入标准为患有 GDM 的女性及其分娩。招募、治疗、代谢物/激素分析以及数据评估均按照标准化指南和方案进行。本报告特别旨在确定“EaCH”中影响新生儿人体测量和关键激素分娩结局的母体人体测量和代谢决定因素。
组间比较、Spearman 相关分析和未校正线性回归分析初步证实，母体孕前体重指数（BMI）增加是出生体重、脐血胰岛素和瘦素升高的重要因素（均 P<0.05）。然而，考虑到晚期妊娠时的母体血糖，并对其进行校正后，母体的人体测量参数（体重、BMI、妊娠体重增加）均不再显著（均 n.s.）。相比之下，即使在校正了母体人体测量参数后，第 3 孕期的血糖值（第 32 周和第 36 周的空腹和餐后血糖、第 3 孕期和分娩时的糖化血红蛋白）仍与关键分娩结局明显正相关（均 P<0.05）。
超重/肥胖或妊娠体重增加似乎都不是增加出生体重、胰岛素和瘦素的独立决定因素。相反，第 3 孕期的血糖水平对新生儿结局至关重要。因此，在超重/肥胖合并或不合并 GDM 的孕妇中，妊娠晚期的血糖应作为妊娠护理和未来研究的重要考虑因素，以评估“围产期编程致糖尿病肥胖”的关键原因和干预策略。
