宫内营养对胎儿心血管健康的远期影响

Long-term Consequences of Intrauterine Nutrition for Fetal Vascular Health

宫内生长发育是复杂的动态过程,这一过程受到胎儿本身遗传因素的控制和影响,只有当母亲营养充足,胎盘功能良好足以维持胎儿的高效增殖、生长和分化时,胎儿才能依其生长轨迹生长发育。能量和(或)蛋白质的摄入情况对胎儿发育起着重要的决定作用。宫内营养不均衡包括营养不足和营养过剩。越来越多的证据表明宫内营养不均衡对胎儿远期的心血管健康造成了负面影响。宫内营养不均衡直接影响子代的血管结构及功能并增加子代心血管代谢异常的危险,从而影响子代的血管健康。母体营养不良可能导致胎儿生长受限;同样,母体的代谢性疾病,如胰岛素抵抗、糖尿病、高血压、血脂异常也会增加子代发生动脉粥样硬化和心血管疾病的风险。

There are many instances in life when the environment plays a critical role in the health outcomes of an individual, especially those experienced in fetal and neonatal life. The most detrimental environmental problems encountered during this critical growth period are changes in nutrition to the growing fetus and newborn. Disturbances in the supply of nutrients and oxygen to the fetus can not only lead to adverse fetal growth patterns, but also be associated with the development of features of metabolic syndrome in adult life. Energy and/or protein restriction is the most critical determinant for fetal programming. There is a growing body of evidence that improper intrauterine nutrition may negatively influence vascular health in later life. It concerns both undernutrition and overnutrition. Imbalanced intrauterine nutrition seems to influence vascular health in the offspring by both an increase in their cardiometabolic risk factors and direct influence on vascular structure and function.Maternal malnutrition may result in intrauterine growth retardation and, in turn, metabolic disorders such as insulin resistance,diabetes, hypertension, and dyslipidemia, can also enhanced risk of atherosclerosis and cardiovascular death in the offspring.