孕前糖尿病：母体体重指数和孕期体重增加与增加的脐静脉血流、胎儿肝脏灌注以及出生体重相关。
Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight.
机构信息
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, Research Group for Pregnancy, Fetal Development and Birth, University of Bergen, Bergen, Norway.
出版信息
PLoS One. 2021 Aug 16;16(8):e0256171. doi: 10.1371/journal.pone.0256171. eCollection 2021.
OBJECTIVES
To assess how maternal body mass index and gestational weight gain are related to on fetal venous liver flow and birthweight in pregnancies with pre-gestational diabetes mellitus.
METHODS
In a longitudinal observational study, 49 women with pre-gestational diabetes mellitus were included for monthly assessments (gestational weeks 24-36). According to the Institute Of Medicine criteria, body mass index was categorized to underweight, normal, overweight, and obese, while gestational weight gain was classified as insufficient, appropriate or excessive. Fetal size, portal flow, umbilical venous flow and distribution to the fetal liver or ductus venosus were determined using ultrasound techniques. The impact of fetal venous liver perfusion on birthweight and how body mass index and gestational weight gain modified this effect, was compared with a reference population (n = 160).
RESULTS
The positive association between umbilical flow to liver and birthweight was more pronounced in pregnancies with pre-gestational diabetes mellitus than in the reference population. Overweight and excessive gestational weight gain were associated with higher birthweights in women with pre-gestational diabetes mellitus, but not in the reference population. Fetuses of overweight women with pre-gestational diabetes mellitus had higher umbilical (p = 0.02) and total venous liver flows (p = 0.02), and a lower portal flow fraction (p = 0.04) than in the reference population. In pre-gestational diabetes mellitus pregnancies with excessive gestational weight gain, the umbilical flow to liver was higher than in those with appropriate weight gain (p = 0.02).
CONCLUSIONS
The results support the hypothesis that umbilical flow to the fetal liver is a key determinant for fetal growth and birthweight modifiable by maternal factors. Maternal pre-gestational diabetes mellitus seems to augment this influence as shown with body mass index and gestational weight gain.
目的
评估孕前糖尿病孕妇的母体体重指数和孕期体重增加与胎儿静脉肝血流和出生体重的关系。
方法
在一项纵向观察性研究中，纳入了 49 例孕前糖尿病孕妇进行每月评估（孕 24-36 周）。根据医学研究所的标准，将体重指数分为消瘦、正常、超重和肥胖，而孕期体重增加分为不足、适当和过多。使用超声技术确定胎儿大小、门静脉血流、脐静脉血流以及向胎儿肝脏或静脉导管的分布。比较了胎儿静脉肝灌注对出生体重的影响，以及体重指数和孕期体重增加如何改变这种影响，并与参考人群（n=160）进行了比较。
结果
与参考人群相比，孕前糖尿病孕妇脐血流与肝血流与出生体重之间的正相关更为明显。超重和孕期体重增加过多与孕前糖尿病妇女的出生体重较高相关，但在参考人群中则不然。孕前糖尿病超重妇女的脐静脉（p=0.02）和总静脉肝血流（p=0.02）较高，门静脉血流比例较低（p=0.04），而参考人群则不然。在孕期体重增加过多的孕前糖尿病孕妇中，脐血流至肝脏的流量高于体重增加适当的孕妇（p=0.02）。
结论
研究结果支持这样的假设，即脐血流向胎儿肝脏是胎儿生长和出生体重的关键决定因素，可受母体因素的影响。母体孕前糖尿病似乎增强了这种影响，如体重指数和孕期体重增加所示。
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