高血压和血压正常妊娠中母血与脐带血脂参数与子宫及胎儿-胎盘血流的关联
Association of Maternal and Umbilical Cord Blood Lipid Parameters with Uterine and Fetal-Placental Blood Flow in Hypertensive and Normotensive Pregnancies.
作者信息
Hessami Kamran, Kasraeian Maryam, Asadi Nasrin, Vafaei Homeira, Foroughinia Leila
机构信息
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
出版信息
Int J Womens Health. 2020 Feb 28;12:115-125. doi: 10.2147/IJWH.S233029. eCollection 2020.
PURPOSE
There is a growing evidence suggesting that hypertensive disorders of pregnancy (HDP), especially preeclampsia, are associated with an increased risk of cardiometabolic disease for both mother and child later in life. The objective of this study was to determine the association of maternal and umbilical cord blood (UCB) lipid profiles with uterine and fetal-placental blood flow at the third trimester of pregnancy.
PATIENTS AND METHODS
A total of 1,135 women were prospectively followed through pregnancy and data for 812 mother-newborn pairs, including 170 HDP developed subjects and 642 normotensive subjects were analyzed at the end of the study. Maternal serum and UCB triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-HDL-C levels were compared between HDP and normotensive groups; moreover, the association between lipid parameters and abnormal pulsatility indices (PIs) of uterine (UtA), umbilical (UA), and middle cerebral (MCA) arteries was evaluated with multivariate regression analysis models. The same analyses were carried out on subgroups of HDP (preeclampsia vs gestational hypertension).
RESULTS
The mean TG, TC, LDL-C, and non-HDL-C levels were significantly higher in mother-newborn pairs of the HDP group compared to the normotensive group. In the HDP group, maternal TG and non-HDL-C levels were shown to have a significant association with abnormal UtA-PI (p<0.001 and p=0.039, respectively). We also found a positive significant association of fetal hypertriglyceridemia with abnormal UA-PI and MCA-PI in the HDP group (p=0.042 and p=0.021, respectively). However, no such associations were observed in normotensive mother-newborn pairs. Similar trends were observed in preeclamptic subjects after subgroup analysis.
CONCLUSION
Maternal TG and non-HDL-C levels as well as fetal TG level are significantly associated with disturbed uterine and fetal-placental blood flow in HDP.
目的
越来越多的证据表明，妊娠期高血压疾病（HDP），尤其是先兆子痫，与母亲和孩子日后患心脏代谢疾病的风险增加有关。本研究的目的是确定妊娠晚期孕妇和脐带血（UCB）脂质谱与子宫及胎儿 - 胎盘血流之间的关联。
患者与方法
共有1135名妇女在孕期接受前瞻性随访，研究结束时分析了812对母婴的数据，其中包括170名患HDP的受试者和642名血压正常的受试者。比较了HDP组和血压正常组孕妇血清及UCB甘油三酯（TG）、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）和非HDL-C水平；此外，使用多变量回归分析模型评估脂质参数与子宫动脉（UtA）、脐动脉（UA）和大脑中动脉（MCA）异常搏动指数（PI）之间的关联。对HDP亚组（先兆子痫与妊娠高血压）进行了相同的分析。
结果
与血压正常组相比，HDP组母婴对的平均TG、TC、LDL-C和非HDL-C水平显著更高。在HDP组中，孕妇TG和非HDL-C水平与UtA-PI异常显著相关（分别为p<0.001和p = 0.039）。我们还发现HDP组胎儿高甘油三酯血症与UA-PI和MCA-PI异常呈显著正相关（分别为p = 0.042和p = 0.021）。然而，在血压正常的母婴对中未观察到此类关联。亚组分析后，先兆子痫患者中也观察到类似趋势。
结论
在HDP中，孕妇TG和非HDL-C水平以及胎儿TG水平与子宫及胎儿 - 胎盘血流紊乱显著相关。
Zotero 插件