孕妇体重和妊娠期糖尿病对胎盘和妊娠结局的影响

Effects of Pregnant Women′s Weight and Gestational Diabetes on Placenta and Pregnancy Outcome

目的孕妇肥胖和妊娠期糖尿病(gestational diabetes mellitus,GDM)均可能对妊娠结局产生不良影响,通过测定孕妇BMI与GDM,探讨其对胎盘和妊娠结局的影响。方法选取2016年5月-2017年4月于我院进行检查的孕妇共328例进行回顾性分析,依据的BMI及GDM情况分为5组,正常体重组(N),超重组(OW),肥胖组(O),妊娠糖尿病正常体重组(GDMN)和妊娠糖尿病肥胖组(GDMO),分娩时收集胎盘及脐带血并送检,同时对新生儿各项指标进行测量。结果 GDMO组于妊娠34周的胎儿预估体重较重,具有较高的早产风险和剖宫产风险。新生儿体重不受孕妇BMI或GDM的影响,但GDMO组妇胎盘重量、血清甘油三酯及胎盘瘦素表达量均升高。胎盘中能量传导和氧化应激标志物基因的表达与BMI存在关联,因mTOR表达量降低,而SIRT-1和UCP2表达量均上调。GDMO组胎盘中AMPK表达量降低,而mTOR的下游调节因子,p70S6KB1表达上调。结论胎盘中基因的表达对孕妇BMI及GDM的反应较为敏感,BMI及GDM都会影响胎盘甘油三酯含量及养分传导。因此,可对孕妇及胎儿的葡萄糖平衡进行调节,控制新生儿体重,以防止不良临床结局的出现。

Objective Pregnant women with obesity and gestational diabetes mellitus(GDM)may have adverse effects on pregnancy outcomes,BMI and GDM were measured to determine the effect on placenta and pregnancy outcome.Methods 328 pregnant women who were examined in our hospital from May 20 to April 2017 were retrospectively analyzed.BMI and GDM were divided into 5 groups,normal weight group(N),overweight group(OW),obese group(O),normal gestational diabetes mellitus group(GDMN)and gestational diabetes obesity group(GDMO).The placenta and umbilical cord blood collected at birth and censorship,while the indicators to measure the newborn.Results GDMO group in the 34 weeks of gestation fetal weight heavier,with a high risk of preterm birth and cesarean section risk.Neonatal weight was not affected by BMI or GDM in pregnant women,but the weight of placenta,serum triglyceride and placental leptin were increased in GDMO group.The expression of energy transfer and oxidative stress markers in the placenta was associated with BMI,and the expression of mTOR was decreased and the expression of SIRT-1 and UCP2 was up-regulated.The expression of AMPK in the placenta of GDMO group was decreased,while the downstream regulatory factor of mTOR and p70 S6 KB1 were up-regulated.Conclusion Placental gene expression in pregnant women BMI and GDM response is more sensitive,BMI and GDM will affect placental triglyceride content and nutrient conduction.Therefore,the balance of glucose in pregnant women and fetuses can be adjusted to control the weight of newborns to prevent the emergence of adverse clinical outcomes.