母亲接受减重手术后所生儿童的内皮功能及其决定因素。

Endothelial function and its determinants in children born after maternal bariatric surgery.

机构信息

Division of Pediatric Endocrinology, Department of Pediatrics, University Hospital Brussels, Jette, Belgium.

Research unit Organ Systems, Department of Development and Regeneration, Catholic University of Leuven, Leuven, Belgium.

出版信息

Pediatr Res. 2022 Feb;91(3):699-704. doi: 10.1038/s41390-021-01500-y. Epub 2021 Apr 9.

DOI:10.1038/s41390-021-01500-y

PMID:33837256

Abstract

BACKGROUND

Children born from mothers who underwent bariatric surgery were found to have an improved lipid profile and lower CRP levels compared to siblings born before surgery. We hypothesized that surgery before pregnancy might also influence endothelial function in the offspring.

METHODS

Blood sample analysis, blood pressure (BP) measurement, and peripheral arterial tonometry (PAT) were performed in 142 children (median age 10.5 years), either born from mothers who underwent bariatric surgery (BS) before pregnancy (n = 36) from mothers with overweight/obesity (OW/OB) (n = 71) or from normal weight (NW) mothers (n = 35), allowing the determination of the Reactive Hyperemia Index (RHI) in 111 children.

RESULTS

Children of the BS group had a higher diastolic blood pressure SDS and a lower RHI compared to the children of the OW/OB and NW group (1.32 versus 1.37 in OW/OB and 1.70 in NW; p = 0.004). After log transformation and correction for age, weight SDS, BMI SDS, body fat percentage, and diastolic BP SDS, RHI was comparable between the groups.

CONCLUSIONS

Children of mothers who underwent bariatric surgery before pregnancy do not have a disturbed endothelial function before puberty, when their increased diastolic BP and degree of adiposity is taken into account.

IMPACT

Children born after maternal bariatric surgery have a higher diastolic blood pressure without impaired endothelial function. To our knowledge, this is the first study that investigates the vascular function of children based on maternal characteristics during pregnancy. Adult offspring of mothers with obesity during pregnancy have an increased cardiovascular mortality. Since we cannot demonstrate a childhood-onset primary vascular dysfunction, this cardiovascular vulnerability might be more related to the hypertension and body adiposity. Thus, more emphasis should be made on the prevention of obesity and hypertension in the offspring at risk for development of obesity.

摘要

背景

与手术前出生的兄弟姐妹相比，接受过减重手术的母亲所生的孩子的血脂谱和 CRP 水平得到改善。我们假设，怀孕前的手术也可能影响后代的血管内皮功能。

方法

对 142 名儿童（中位年龄 10.5 岁）进行了血液样本分析、血压（BP）测量和外周动脉张力测定（PAT），这些儿童要么来自于怀孕前接受过减重手术（BS）的母亲（BS 组，n=36），要么来自于超重/肥胖（OW/OB）的母亲（OW/OB 组，n=71），要么来自于正常体重（NW）的母亲（NW 组，n=35），其中 111 名儿童的反应性充血指数（RHI）可以确定。

结果

与 OW/OB 和 NW 组相比，BS 组儿童的舒张压 SDS 较高，RHI 较低（OW/OB 组为 1.32，NW 组为 1.70）（p=0.004）。经过对数转换和年龄、体重 SDS、BMI SDS、体脂百分比和舒张压 SDS 校正后，各组间 RHI 无差异。

结论

考虑到青春期前儿童的舒张压升高和肥胖程度，接受过减重手术的母亲在怀孕前手术的儿童的内皮功能并未受损。据我们所知，这是第一项基于怀孕期间母亲特征调查儿童血管功能的研究。怀孕期间肥胖母亲的成年后代心血管死亡率增加。由于我们不能证明儿童期存在原发性血管功能障碍，这种心血管脆弱性可能与高血压和身体肥胖更相关。因此，应该更加重视预防肥胖和高血压，以降低肥胖高危儿童的发病风险。