Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, University of Milan, Via L. Castelvetro 32, Milan, Italy.
Department of Obstetrics and Gynecology, Luigi Sacco Hospital, University of Milan, Via GB Grassi 74, Milan, Italy.
Placenta. 2021 Jan 1;103:59-63. doi: 10.1016/j.placenta.2020.10.013. Epub 2020 Oct 13.
Maternal pregestational obesity is a significant risk factor for adverse pregnancy outcomes, such as gestational diabetes. Both these conditions can have an impact on placental development and affect maternal-fetal exchanges, compromising fetal metabolic status. The aim of the study is to investigate the influence of pre-pregnancy BMI on placental size and to evaluate the role of obesity and gestational diabetes mellitus (GDM) on fetal oxygenation in overweight and obese pregnant women.
208 normal weight (NW), 57 overweight (OW) and 69 obese (OB) women were studied at elective cesarean section (CS) at term. 10 OW and 24 OB women were affected by GDM. Maternal, fetal and placental data were collected. Respiratory gases and acid-base balance were measured in umbilical venous and arterial blood.
Placental weight and thickness were higher in OB pregnancies. Lower fetal-placental ratios (F/P) were found in GDM pregnancies, both OW and OB. Fetuses from OB mothers were more hypoxic and acidemic compared to NW, particularly when complicated by GDM.
In agreement with previous studies, our data show that placentas from OB and GDM pregnancies are heavier and thicker, suggesting that an unbalanced pregestational nutritional status can decrease the placental efficiency in maternal-fetal exchanges. Fetuses from obese women are also hypoxic and acidemic, while fetuses from gestational diabetic mothers are hypoxic, reflecting that an altered pre-pregnancy BMI can affect fetal oxygenation, and GDM can play an additional detrimental role, thus worsening placental function and fetal oxygenation.
孕妇孕前肥胖是不良妊娠结局的一个重要危险因素，例如妊娠糖尿病。这两种情况都可能影响胎盘发育，并影响母婴交换，损害胎儿代谢状态。本研究旨在探讨孕前 BMI 对胎盘大小的影响，并评估肥胖和妊娠糖尿病（GDM）对超重和肥胖孕妇胎儿氧合的作用。
在择期剖宫产（CS）时，研究了 208 名正常体重（NW）、57 名超重（OW）和 69 名肥胖（OB）的孕妇。10 名 OW 和 24 名 OB 患有 GDM。收集了产妇、胎儿和胎盘数据。测量了脐静脉和动脉血中的呼吸气体和酸碱平衡。
OB 妊娠的胎盘重量和厚度更高。在 GDM 妊娠中，OW 和 OB 妊娠的胎儿-胎盘比（F/P）均较低。与 NW 相比，OB 母亲的胎儿更缺氧和酸中毒，尤其是合并 GDM 时。
与先前的研究一致，我们的数据表明，来自 OB 和 GDM 妊娠的胎盘更重更厚，这表明孕前营养失衡会降低母婴交换的胎盘效率。肥胖妇女的胎儿也缺氧和酸中毒，而妊娠糖尿病母亲的胎儿则缺氧，这表明孕前 BMI 的改变会影响胎儿的氧合，而 GDM 可以发挥额外的不利作用，从而恶化胎盘功能和胎儿氧合。
