孕期胆碱摄入及母婴体内胆碱代谢水平的相关性

Association between choline intake during pregnancy and choline metabolism in parturients and infants

目的观察孕期胆碱摄入及母婴体内胆碱代谢水平的相关性，以及出生时早产儿与足月儿体内胆碱代谢水平的差异。方法研究对象为2014年9月至2016年5月期间于上海交通大学医学院附属新华医院产科分娩的单胎妊娠产妇及其新生儿。收集这些研究对象的临床资料，于产后第2天通过膳食频率法调查母亲妊娠期间膳食胆碱摄入情况。采集母体分娩前的静脉血及新生儿脐动脉血，检测其中胆碱水平。采用独立样本t检验、趋势χ2检验、χ2检验以及线性回归等方法对数据进行统计学分析。结果（1）共134例产妇及其新生儿纳入本研究，足月和早产组分别为80和54例。与足月组相比，早产组产妇孕前体重指数较高（22.7±3.2与20.8±2.3，t=－3.720），文化程度偏低（χ2趋势=4.020）（P值均〈0.05）。（2）食物频率调查显示，足月组和早产组达到孕期胆碱适宜摄入量的母亲分别为30.0%（24/80）和11.1%（6/54）。（3）母体外周血血浆胆碱水平与孕期膳食胆碱摄入水平呈正相关（r=0.882，r2=0.778，P〈0.001），新生儿脐动脉血浆胆碱水平与母体外周静脉血浆胆碱水平也呈正相关（r=0.965，r2=0.931，P〈0.001）。（4）早产组产妇孕期膳食中胆碱摄入量、产妇外周静脉血浆胆碱水平及其新生儿脐动脉血浆中胆碱水平，均低于足月组[（305.24±102.17）与（386.16±21.36） mg/d，t=4.026；（5.23±0.79）与（7.18±1.51） μmol/L，t=9.783；（20.68±3.52）与（27.96±3.94） μmol/L，t=10.930；P值均〈0.01]。结论孕妇在孕期的每日胆碱摄入量多低于推荐量。早产儿母亲的孕期胆碱摄入量低于足月儿母亲。孕妇膳食胆碱摄入水平与胎儿胆碱水平相关。需要加强孕妇饮食指导，鼓励孕妇及哺乳期妇女进食富含胆碱的食物。而对发育不成熟的早产儿应及时补充胆碱，以满足其重要器官继续发育和迅速生长的需要。

ObjectiveTo investigate the association between choline intake during pregnancy and choline metabolism in parturients and infants, and to analyze the difference in plasma choline level between premature and healthy full-term infants at birth.MethodsNeonates who were born in the Department of Obstetrics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2014 to May 2016 were enrolled. Demographic and clinical information of these neonates and their mothers were recorded. Dietary choline intake during pregnancy was determined on the second day after delivery using food frequency questionnaires. Free choline levels in plasma of all parturients and neonates were measured. Then, data were collected and analyzed by independent samples t-test, trend Chi-square test, Chi-square test and linear regression methods.Results（1） A total of 134 parturients and their neonates were enrolled in this study including 80 full-term infants and 54 premature infants. Compared with the full-term group, the parturients in the premature group had higher pregestational BMI （22.7±3.2 vs 20.8±2.3, t=-3.720） and less education background （trend χ2=4.020） （both P〈0.05）. （2） The food frequency questionnaires showed that 30.0% （24/80） of pregnant women in the full-term group reached adequate intake （AI） of choline during pregnancy, while only 11.1% （6/54） in the premature group did. （3） Plasma choline level in maternal peripheral blood was positively associated with maternal dietary choline intake during pregnancy （r=0.882, r2=0.778, P〈0.001）. Moreover, plasma choline level in the umbilical artery was closely related to maternal plasma choline level （r=0.965, r2=0.931, P〈0.001）. （4） The dietary choline intake during pregnancy, maternal plasma choline level and plasma choline level in umbilical artery in premature infant group were all lower than those of full-term group [（305.24±102.17） vs （386.16±121.36） mg/d, t=4.026; （5.23±0.79） vs （7.18±1.51） μmol/L, t=9.783; （20.68±3.52） vs （27.96±3.94） μmol/L, t=10.930; all P〈0.01].ConclusionsInsufficient dietary intake of choline during pregnancy is common. The dietary choline intake during pregnancy in parturients of preterm delivery group is lower than that in full-term group. Dietary choline intake during pregnancy is related to plasma choline level in umbilical artery. Therefore, dietary guidance should be emphasized for pregnant and lactating women to increase the intake of foods rich in choline. It is also important to provide premature infants with choline in time to meets the needs of their development.