婴儿出生体重和母亲孕期体重指数与胰岛素抵抗综合征的关系

Effects of infant birthweight and maternal body mass index in pregnancy on insulin resistance syndrome

目的 测定胰岛素抵抗综合征指标是否与胎儿发育降低和母亲孕期营养不良有联系。方法 对62 7名平均 45岁的男女性进行追访 ,测量其血压、血浆葡萄糖和胰岛素水平及血清胆固醇浓度。研究对象以母亲孕期体重指数、出生体重及成年期体重指数作为分析的主要解释变量。结果 控制性别和目前的体重指数后 ,低出生体重与血浆葡萄糖、胰岛素、甘油三酯水平和血压升高密切相关。出生体重每升高 1kg ,收缩压降低2 9mmHg (95 %CI:0 3～ 5 4mmHg) ,2h血浆葡萄糖水平降低 5 1 % (95 %CI:0 7%～ 9 3 % )。母亲孕早、晚期体重指数降低与子女成年期血浆葡萄糖、胰岛素和甘油三酯水平升高密切相关 ,与子女成年期血压水平没有联系。结论 胰岛素抵抗的危险可能部分产生于母亲孕前低体重指数和随后的胎儿营养不良 ,这一危险性产生的过程独立于成年期发生的肥胖。提高贫困地区女童和年轻妇女的营养状况 。

Objective To determine whether the insulin resistance syndrome is associated with reduced fetal growth and maternal undernutrition.Methods Six hundred and twenty seven men and women (mean age,45 years),whose mothers′ obstetric records were preserved,were followed up for a prospective study.The 627 adult offspring′s blood pressure,plasma glucose levels,insulin levels during an oral glucose tolerance test,and blood lipid levels were assayed.The main explanatory variables were mothers′ body mass index during pregnancy and offspring′s birthweight and adult body size.Results Given the sex and current body mass index disregarded,low birthweight was associated with elevated plasma glucose level,insulin level,triglyceride concentration,and blood pressure.For every 1 kg increase in birthweight,systolic blood pressure decreased by 2 9 mm Hg (95%CI,0 3～5 4 mm Hg) and the 2 hour plasma glucose level decreased by 5 1% ( 95%CI,0 7%～9 3%).Low maternal body mass index in early and late pregnancy was associated with elevated levels of plasma glucose,insulin,and triglycerides in adult offspring but was not associated with elevated blood pressure.Conclusion Risk of insulin resistance syndrome may be partially from progravid low maternal body mass index and consequent fetal undernutrition.This risk is independent of what associate with adult obesity.In developing countries such as China,especially in their poverty areas,to improve the nutriture of girls and young women may offer a long term benefit to offspring.