Prioreschi Alessandra, Aronoff David M, Koethe John, Norris Shane A, Goldstein Jeffrey A
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232.
Glob Pediatr. 2023 Mar;3. doi: 10.1016/j.gpeds.2022.100030. Epub 2022 Dec 5.
We aimed to examine maternal metabolic correlates of neonate body composition, and the potential mediating effect of the placenta.
Data were collected throughout pregnancy and at delivery. An oral glucose tolerance test (OGTT) was conducted in order to diagnose or rule out gestational diabetes mellitus (GDM). Maternal weight and blood pressure were taken and hypertension and gestational weight gain (GWG) were defined. Gestational age, birth weight (BW) and weight to length ration (WLR) were recorded. Photographs were taken of the placenta, and the widths and lengths were measured digitally. Body composition was analysed via air displacement plethysmography or dual-energy x-ray absorptiometry. Mediation models were conducted to determine the mediation effect of the placental variables on the relationships between maternal health variables and neonate outcomes. Next, interaction terms were added to models to determine how maternal and placental variables interacted in their effect on neonate outcomes.
A total of = 280 women were included in the analysis. Majority were overweight or obese. Fourteen percent of women developed GDM during pregnancy, 5% had hypertension during pregnancy, 32% were HIV positive, and 32% had anemia. For the birth weight outcome, coefficients of BMI were attenuated by the addition of placental variables (Model 1 =18.66 vs Model 2 =16.40). Similar patterns were evident for GWG and hypertension, and for the WLR outcome. In all cases the addition of the placental variables attenuated associations between maternal exposures and neonatal outcomes, yet the level of significance did not change. Inclusion of interaction terms reversed the direction of the relationships between hypertension and BW and WLR, and between GWG and WLR.
The placenta buffers some harmful effects of obesity, GWG, and hypertension on neonate size, and placental efficiency interacted with most maternal risk factors to either counteract, or attenuate relationships with neonate size at birth. However the placenta was unable to completely counteract the negative effect of excess nutrient supply on growth.
我们旨在研究新生儿身体组成的母体代谢相关性，以及胎盘的潜在中介作用。
在整个孕期及分娩时收集数据。进行口服葡萄糖耐量试验（OGTT）以诊断或排除妊娠期糖尿病（GDM）。测量母体体重和血压，并定义高血压和孕期体重增加（GWG）情况。记录孕周、出生体重（BW）和体重身长比（WLR）。拍摄胎盘照片，并通过数字方式测量其宽度和长度。通过空气置换体积描记法或双能X线吸收法分析身体组成。采用中介模型来确定胎盘变量对母体健康变量与新生儿结局之间关系的中介作用。接下来，在模型中加入交互项，以确定母体和胎盘变量如何相互作用影响新生儿结局。
共有280名女性纳入分析。大多数为超重或肥胖。14%的女性孕期患GDM，5%孕期患高血压，32%为HIV阳性，32%患有贫血。对于出生体重结局，添加胎盘变量后BMI系数减弱（模型1 = 18.66 vs模型2 = 16.40）。GWG和高血压以及WLR结局也有类似模式。在所有情况下，添加胎盘变量均减弱了母体暴露与新生儿结局之间的关联，但显著性水平未改变。纳入交互项后，高血压与BW和WLR之间以及GWG与WLR之间关系的方向发生了逆转。
胎盘缓冲了肥胖、GWG和高血压对新生儿大小的一些有害影响，并且胎盘效率与大多数母体危险因素相互作用，以抵消或减弱与出生时新生儿大小的关系。然而，胎盘无法完全抵消营养供应过多对生长的负面影响。
