孕前肥胖及超重女性的孕期管理模式探讨及肥胖相关胎盘因子分析

Study on pregnancy management mode of pre-pregnancy obese or overweight women and analysis of obesity related placental factors

目的探讨孕前肥胖/超重女性的孕期管理模式及胎盘因子改变。方法收集孕前体质量指数(body mass index,BMI)≥25 kg/m 2的149例单胎孕妇。分为饮食指导组及常规产检组,取同期孕前BMI正常的590例孕妇作为对照,比较分娩结局,随后检测不同孕前BMI孕妇胎盘中补体C1q/肿瘤坏死因子相关蛋白6(C1q/tumor necrosis factor-related protein 6,CTRP6)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的表达。结果饮食指导后的肥胖/超重孕妇的孕期增重、产后出血、难产率均显著降低,但新生儿体质量差异无统计学意义,且剖宫产率及妊娠期糖尿病(gestational diabetes mellitus,GDM)发生率仍高于对照组,差异有统计学意义。孕前肥胖/超重孕妇胎盘中CTRP6及TNF-α的表达高于孕前BMI正常/低体质量的孕妇,差异有统计学意义,GDM者CTRP6的表达升高。结论孕期有效饮食控制可减少肥胖/超重孕妇孕期增重,但未能降低新生儿体质量,考虑孕前体质量对母儿影响更大。CTRP6可能参与孕前肥胖女性的脂肪炎性反应及血糖代谢,进而对子代产生影响。

Objective To explore the pregnancy management mode and placental factor changes of pre-pregnancy obese or overweight women.Methods Totally 149 singleton pregnant women with pre-pregnancy body mass index(BMI)≥25 kg/m 2 were collected.They were divided into diet guidance group and routine examination group.Pregnant women with normal pre-pregnancy BMI in the same period were taken as control.Then,expression of CTRP6 and tumor necrosis factor-α(TNF-α)in placenta of pregnant women with different pre-pregnancy BMI were detected by immunohistochemistry.Results After dietary guidance,the weight gain during pregnancy,postpartum hemorrhage and dystocia rate of pre-pregnancy obese/overweight women were significantly reduced,but there was no significant difference in neonatal weight,and the cesarean section rate and the incidence of gestational diabetes mellitus(GDM)were still significantly higher than those in the control group.The expression of CTRP6 and TNF-αin placenta of pre-pregnancy obese/overweight women were significantly higher than those of women with pre-pregnancy normal/underweight BMI.The expression of CTRP6 in placenta of pregnant women with GDM was also significantly increased.Conclusion For pre-pregnancy obese and overweight pregnant women,effective dietary control during pregnancy can reduce the weight gain during pregnancy,but it does not reduce the neonatal weight.Therefore,pre-pregnancy weight has a greater impact on maternal and fetal complications.In pre-pregnancy obese women,CTRP6 may be involved in regulating the inflammatory response in adipose tissue,affecting blood glucose metabolism,then affecting their offspring,which should be further studied.