孕期母体血浆脂质水平与小于胎龄儿和低出生体重风险：来自冈比亚农村的队列研究。
Maternal plasma lipid levels across pregnancy and the risks of small-for-gestational age and low birth weight: a cohort study from rural Gambia.
机构信息
Department of Women and Children's Health, King's College London, London, SE1 7EH, UK.
MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.
出版信息
BMC Pregnancy Childbirth. 2020 Mar 12;20(1):153. doi: 10.1186/s12884-020-2834-1.
BACKGROUND
Sub-optimal maternal lipid levels during pregnancy may be implicated in the pathophysiological mechanisms leading to low birth weight (LBW) and small-for-gestational-age (SGA). We aimed to determine whether maternal lipid levels across pregnancy were associated with birth weight and the risks of LBW and SGA in rural Gambia.
METHODS
This secondary analysis of the ENID trial involved 573 pregnant women with term deliveries. Plasma levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were analyzed at enrolment (mean (SD) = 13.9 (3.3) weeks gestation), 20 and 30 weeks gestation as continuous variables and percentile groups. Regression models with adjustment for confounders were used to examine associations between gestational lipid levels and birth weight and the risks of LBW (birth weight < 2500 g) and SGA (<10th percentile INTERGROWTH-21ST for birth weight).
RESULTS
There were 7.9% LBW and 32.5% SGA infants. At enrolment, every unit increase in HDL-c was associated with a 2.7% (P = 0.011) reduction in relative risk of LBW. At 20 weeks gestation, every unit increase in TC levels was associated with a 1.3% reduction in relative risk of LBW (P = 0.002). Low (<10th percentile) HDL-c at enrolment or at 20 weeks gestation was associated with a 2.6 (P = 0.007) and 3.0 (P = 0.003) times greater risk of LBW, respectively, compared with referent (10th─90th) HDL-c. High (>90th percentile) LDL-c at 30 weeks gestation was associated with a 55% lower risk of SGA compared with referent LDL-c (P = 0.017). Increased levels of TC (β = 1.3, P = 0.027) at 20 weeks gestation and of TC (β = 1.2, P = 0.006) and LDL-c (β = 1.5, P = 0.002) at 30 weeks gestation were all associated with higher birth weight.
CONCLUSIONS
In rural Gambia, lipid levels during pregnancy were associated with infant birth weight and the risks of LBW and SGA. Associations varied by lipid class and changed across pregnancy, indicating an adaptive process by which maternal lipids may influence fetal growth and birth outcomes.
TRIAL REGISTRATION
This trial was registered as ISRCTN49285450 on: 12/11/2009.
背景
孕期母体脂质水平不理想可能与导致低出生体重（LBW）和小于胎龄儿（SGA）的病理生理机制有关。我们旨在确定妊娠期间母体脂质水平是否与出生体重以及在冈比亚农村地区 LBW 和 SGA 的风险相关。
方法
这是 ENID 试验的二次分析，涉及 573 名足月分娩的孕妇。在入组时（平均（SD）= 13.9（3.3）周妊娠）、20 周和 30 周妊娠时，将总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）和甘油三酯（TG）的血浆水平分析为连续变量和百分位组。使用调整混杂因素的回归模型来检查妊娠脂质水平与出生体重以及 LBW（出生体重<2500 克）和 SGA（<第 10 个 INTERGROWTH-21ST 百分位出生体重）风险之间的关联。
结果
有 7.9%的婴儿为 LBW，32.5%的婴儿为 SGA。在入组时，每增加 1 单位 HDL-c，LBW 的相对风险降低 2.7%（P=0.011）。在 20 周妊娠时，TC 水平每增加 1 单位，LBW 的相对风险降低 1.3%（P=0.002）。与参照（第 10-90 个百分位）HDL-c 相比，入组时或 20 周妊娠时低（<第 10 个百分位）HDL-c 与 LBW 的风险增加 2.6 倍（P=0.007）和 3.0 倍（P=0.003），分别。30 周妊娠时高（>第 90 个百分位）LDL-c 与参照 LDL-c 相比，SGA 的风险降低 55%（P=0.017）。20 周妊娠时 TC（β=1.3，P=0.027）和 30 周妊娠时 TC（β=1.2，P=0.006）和 LDL-c（β=1.5，P=0.002）水平升高均与出生体重增加有关。
结论
在冈比亚农村地区，妊娠期间的脂质水平与婴儿的出生体重以及 LBW 和 SGA 的风险相关。脂质类别和妊娠期间的关联有所不同，表明母体脂质可能通过适应性过程影响胎儿生长和出生结局。
试验注册
该试验于 2009 年 11 月 12 日在 ISRCTN49285450 注册。
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