孕前超重及肥胖女性孕中期子宫-胎盘血流动力学的变化

Uterine-placental hemodynamic changes in the second trimester in women with overweight or obesity before pregnancy

目的探讨孕前超重及肥胖女性孕中期子宫-胎盘血流动力学及胎儿生长发育指标的变化。方法回顾性选取2019年6月至2020年9月在唐都医院进行产前检查并行胎儿超声心动图检查的孕妇127例。依据孕前体质量指数(BMI)将孕妇分为正常对照组55例、超重组45例和肥胖组27例。对3组孕妇的一般资料、子宫-胎盘血流、胎儿生物学测量指标和大脑中动脉、脐动脉血流进行比较分析。结果与正常组孕妇相比,超重组及肥胖组孕妇双侧子宫动脉收缩期峰值血流速度(Vs)、舒张期峰值血流速度(Vd)及搏动指数(PI)均升高,3组比较差异均有统计学意义(P均<0.05),其中肥胖组孕妇双侧子宫动脉PI较超重组升高(P均<0.05)。与正常组比较,肥胖组和超重组胎儿脐动脉游离段血流速度不同程度减低,3组比较差异均有统计学意义(Vs:F值=4.41,P=0.01;Vd:F值=4.03,P=0.02);进一步两两比较,超重组与正常组Vd比较,差异有统计学意义(P<0.05);肥胖组与正常组Vs比较,差异有统计学意义(P<0.05)。结论孕前超重及肥胖女性孕中期子宫-胎盘循环血流动力学已经出现明显改变,应用超声实时监测这些参数变化对指导临床合理控制孕期体重,避免或减少相关并发症有潜在价值。

Objective To investigate the changes of uterine-placental hemodynamics and fetal growth and development indexes in the second trimester in women with overweight or obesity before pregnancy.Methods One hundred and twenty-seven pregnant women who underwent prenatal examination and fetal echocardiography at Tangdu Hospital from June 2019 to September 2020 were included.According to the pre-pregnancy body mass index,the pregnant women were divided into normal(n=55),overweight(n=45),and obese pregnant women(n=27).The general data of the three groups of pregnant women,uterine-placental blood flow,fetal biological measurement indicators,and middle cerebral artery and umbilical artery blood flow were compared.Results Compared with pregnant women in the normal group,the uterine artery peak blood flow velocity(Vs),end-diastolic blood flow velocity(Vd),and pulsatility index(PI)of the pregnant women in the overweight and obese groups significantly increased(P<0.05),and PI of bilateral uterine arteries of pregnant women in the obesity group were higher than those of the overweight group(P<0.05).Compared with the normal group,the blood flow velocity of the free segment of the umbilical artery in the obesity and overweight groups was reduced to varying degrees,and the difference among the three groups was statistically significant(Vs:F=4.41,P=0.01;Vd:F=4.03,P=0.02);further pairwise comparisons showed that the Vd differed significantly between the overweight group and the normal group(P<0.05),and Vs differed significantly between the obese group and normal group(P<0.05).Conclusion There have been significant differences in uterine-placental circulation hemodynamics between pre-pregnancy overweight and obese pregnant women in the second trimester compared with the normal group.Timely monitoring of the changes in these indicators has potential value in guiding the clinical reasonable control of pregnant women's weight and reducing possible complications in later period.