孕晚期妇女的社会经济学因素、营养素摄入、肠道菌群和孕期增重的关系

Associations of Socioeconomic Factors,Nutrients Intake,and Gut Microbiota of Healthy Pregnant Women in the Third Trimester with Gestational Weight Gain

目的研究孕晚期妇女的社会经济学因素、营养素摄入、肠道菌群和孕期增重的关系。方法招募2015年10月至2016年5月于北京协和医院妇产科行产检的健康孕晚期妇女98人,采用结构式问卷调查年龄、民族、身高、孕前体质量和文化程度等,采用24 h膳食回顾法评估孕妇营养素摄入状况,收集粪便样本,记录临分娩前体质量。依据世界卫生组织成人体质量指数(BMI)分类标准和美国医学研究所孕期增重推荐值(2009)评价孕前BMI和孕期增重,采用宏基因组测序技术检测肠道菌群。结果孕期增重不足和过量者分别占15. 3%和50. 0%。孕期增重是否合理与年龄(F=2. 495,P=0. 088)、民族(χ2=0. 065,P=0. 968)、文化程度(χ2=0. 827,P=0. 661)、孕前BMI (F=0. 121,P=0. 887)无关,但与脂肪(F=3. 113,P=0. 049)、碳水化合物(F=3. 750,P=0. 027)、膳食纤维(F=4. 499,P=0. 014)摄入有关。孕期增重过量组Akkermansia muciniphila、Atopobium parvulum和Alistipes indistinctus丰度显著高于孕期增重适宜组,而Lactobacillus rhamnosus、Weissella unclassified、Eubacterium ventriosum、Ruminococcus torques和Bacteroides uniformis丰度则较低;孕期增重不足组Dialister invisus、Alistipes unclassified、Peptoniphilus harei、Escherichia unclassified、Parvimonas unclassified、Campylobacter ureolyticus、Lactobacillus crispatus和Fusobacterium nucleatum丰度显著高于孕期增重适宜组,而Eubacterium ventriosum丰度则较低。结论孕妇孕期增重不合理现象比较普遍,除脂肪、碳水化合物、膳食纤维摄入外,肠道菌群和孕期增重也存在显著关联。

Objective To investigate the associations of socioeconomic factors,nutrients intake,and gut microbiota of healthy pregnant women in the third trimester with gestational weight gain(GWG).Methods We recruited 98 pregnant women in the third trimester who had received antenatal care in the Department of Obstetrics&Gynecology,Peking Union Medical College Hospital from October,2015 to May,2016.We collected socioeconomic information through a structured questionnaire covering age,ethnicity,height,pre-pregnancy weight,and education.Nutritional status of these pregnant women was assessed by a 24-hour dietary intake recall.The participants were provided with collective tubes for faecal sample collection at home;their weight before the delivery was recorded.The pre-pregnancy weight and GWG were classified according to World Health Organization body mass index(BMI)standard for adults and the Institute of Medicine GWG guidelines(2009),respectively.The gut microbiota of the participants were analyzed using a whole-metagenome shotgun sequencing method.Results Insufficient and excessive GWG accounted for 15.3%and 50.0%of the cohort,respectively.Appropriate GWG level was associated with intakes of fat(F=3.113,P=0.049),carbohydrates(F=3.750,P=0.027),and dietary fiber(F=4.499,P=0.014)but not with age(F=2.495,P=0.088),ethnicity(χ2=0.065,P=0.968),education(χ2=0.827,P=0.661),or pre-pregnancy BMI(F=0.121,P=0.887).Compared with the participants with appropriate GWG,those with excessive GWG had significantly higher abundance of Akkermansia muciniphila,Atopobium parvulum,and Alistipes indistinctus as well as lower abundance of Lactobacillus rhamnosus,Weissella unclassified,Eubacterium ventriosum,Ruminococcus torques,and Bacteroides uniformis.Compared with the participants with appropriate GWG,those with insufficient GWG had significantly higher abundance of Dialister invisus,Alistipes unclassified,Peptoniphilus harei,Escherichia unclassified,Parvimonas unclassified,Campylobacter ureolyticus,Lactobacillus crispatus,and Fusobacterium nucleatum and lower abundance of Eubacterium ventriosum.Conclusions Abnormal GWG is common in pregnant women.GWG is significantly associated with gut microbiota as well as with nutritional factors including fat,carbohydrate,and dietary fiber intake.