妊娠糖尿病母亲初乳中内分泌激素的水平及其与婴儿早期生长的关系

Level of endocrine hormones in colostrum of mothers with gestational diabetes mellitus and its association with early-life growth of infants

目的:探讨妊娠期糖尿病(gestational diabetes mellitus, GDM)产妇初乳中内分泌相关激素与婴儿早期体质量增长的关系。方法:收集常州市妇幼保健院2019年7月至2020年6月单胎足月分娩GDM产妇和母乳喂养健康婴儿(GDM组)以及单胎足月分娩孕期无并发症产妇和母乳喂养健康婴儿(对照组)出生、1、3、6月龄时的临床资料。采用随机方法收集两组初乳,检测脂联素、胰岛素、瘦素、抵抗素、肝细胞生长因子(HGF)、表皮生长因子(EGF)和血管内皮生长因子(VEGF)水平。结果:两组各纳入250例,对照组剖宫产比例、婴儿出生体质量及体质量Z评分分别是94/250(18.80%)、(3.35±0.36)kg、(0.14±0.79)分,GDM组为116/250(23.20%)、(3.43±0.39)kg、(0.29±0.79)分,差异均有统计学意义(P<0.05)。两组1、3、6月龄体质量及Z评分无差异(P>0.05)。GDM组初乳中HGF含量为3.88(1.79~4.39)ng·ml,显著高于对照组的1.64(0.52~3.66)ng·ml(P<0.05),其它均无差异(P>0.05)。结论:虽然GDM组婴儿出生体质量及Z评分明显高于对照组,但在母乳喂养条件下GDM组婴儿早期特别是新生儿期的体质量与非GDM组婴儿没有差异。母乳喂养对GDM产妇婴儿早期体质量增长有益,可避免婴儿早期肥胖的发生,且可能与初乳HGF水平明显升高有关,这有待更进一步的研究。

Objective: To investigate the hormones levels in colostrum of mothers with gestational diabetes mellitus(GDM) and its relationship with early-life weight gain of infants. Methods: The singleton full-term delivery of GDM maternal and breastfeeding infants(GDM group) in Changzhou Maternal and Child Health Hospital from July 2019 to June 2020 was enrolled. At the same time, the maternal and singleton full-term delivery with the same gestational age and without pregnancy complications were selected as the control group. Maternal perinatal information and weight of the infants were regularly measured at birth, 1, 3 and 6 months old and the Z score of the weight were calculated to evaluate the development level of all the infants. And the colostrum of the two groups was collected randomly. The levels of adiponectin, insulin, leptin, resistin, hepatocyte growth factor(HGF), epidermal growth factor(EGF) and vascular endothelial cell growth factor(VEGF) in colostrum were detected by enzyme linked immunosorbent assay(ELISA) or chemiluminescence analysis. Results: A total of 500 breast-fed infants were included, including 250 in control group and 250 in GDM group. In the control group, cesarean section rate, birth weight, birth weight Z score of infants were 94/250(18.80%),(3.35±0.36)kg,(0.14±0.79), respectively, while those in the GDM group were 116/250(23.20%),(3.43±0.39)kg,(0.29±0.79), respectively. There were statistically significant differences in cesarean delivery ratio, birth weight, birth weight Z score(P<0.05) except for maternal age. And there were no significant differences in infants’ weight and Z score of weight at age of 1, 3, 6 months old between the two groups(P>0.05). The content of HGF in colostrum of the control group[n=38,1.64(0.52-3.66)ng·ml] was significantly lower than that of the GDM group[n=27,3.88(1.79-4.39) ng·ml](P<0.05), while there was no significant difference in adiponectin, insulin, leptin, resistin, EGF and VEGF(P>0.05). Conclusion: The birth weight and Z score of infants in the GDM group are significantly higher than those in the control group. However, there is no difference in the weight and Z score of infants with breastfeeding in the early infancy, especially neonatal period of the two groups. Breastfeeding is beneficial to the early infant weight gain with GDM mothers, which may avoid early infant obesity. And it may be related to the significantly increase of HGF in colostrum, which needs further study.