孕期营养干预和代谢性危险因素对妊娠结局的影响

目的 探讨孕期营养干预和孕期代谢性危险因素对妊娠结局的影响。方法 研究对象为上海市国际和平妇幼保健院2010年5月至2012年4月接受常规产检并且分娩的孕妇。采用回顾性队列研究,在确诊为妊娠糖尿病(GDM)的孕妇中比较膳食干预组(接受膳食咨询) 和对照组(未接受膳食咨询)不良妊娠结局的差异,GDM诊断采用2010年国际糖尿病与妊娠研究组推荐标准。采用Logistics逐步回归分析母亲孕期危险因素对巨大儿发生的影响及作用大小。结果 ①10 421名孕妇的围生期信息进入数据分析。孕妇初诊时平均孕周20.8(19.4~22.4)周,初诊时空腹血糖(FBS)、三酰甘油(TG)和总胆固醇(CHOL)平均水平分别为(4.3±0.4)、(1.3±0.6)和(4.7±0.8) mmol·L-1,收缩压和舒张压的平均水平分别为(111.3±11.5)和(67.9±13.3)mmHg。高危孕妇的GDM的患病率为15.8%。新生儿平均出生体重(3 355.4±426.0) g,巨大儿发生率6.2%。②812名GDM孕妇中,干预组570例,对照组242例。两组孕妇年龄、文化程度、孕20周体重、初诊时血糖、血脂等基线水平均衡可比。干预组的新生儿出生体重、巨大儿发生率和妊娠期高血压发生率均低于对照组,分别为(3 347.4±19.6) vs (3 450.3±35.6) g(P=0.007)、6.7% vs 15.6%(P=0.001)和26.3% vs 47.9% (P<0.001)。随着营养干预次数的增加,孕中晚期体重增长量和新生儿出生体重均呈下降趋势(r=-0.126,P=0.003;r=-0.112,P=0.002),巨大儿的发生率也依次降低。③Logistic逐步回归分析显示,孕20周时体重(OR=1.08,95%CI:1.07～1.09)、孕中晚期体重增长量(OR=1.10,95%CI:1.07~1.12)和GDM(OR=1.63,95%CI:1.22~2.19)是巨大儿发生的危险因素。结论 对高危孕妇应考虑进行更早期的孕期危险因素管理以及膳食指导干预,控制孕期体重合理增长,有望减少不良妊娠结局的发生。     

孕前双亲体重指数、母孕期体重增值及其交互作用对新生儿出生体重的影响

目的 探讨孕前双亲体重指数（BMI）和母孕期体重增值及其交互作用对新生儿出生体重的影响。方法 选取2017年1月至2018年10月在西安交通大学第一附属医院做定期产检并足月单胎分娩的孕妇1 127例,收集其孕前BMI、孕期体重增值、孕前丈夫BMI、新生儿出生体重等信息,分析新生儿出生体重与孕前父母BMI和母亲孕期体重增值之间的相关性及两变量间的交互作用。结果 1 127例足月新生儿中,低出生体重检出25例（2.22%）,巨大儿检出43例（3.82%）。低出生体重儿、正常体重儿、巨大儿三组双亲孕前BMI值、母亲孕期体重增值的比较差异均有统计学意义（P < 0.05）。新生儿出生体重与孕前双亲BMI值、母亲孕期体重增值呈低度正相关（r=0.097~0.322,P < 0.05）;母亲孕前低体重可增加低出生体重儿的发生风险（RR=4.17,95% CI：1.86~9.38）;母亲孕前超重/肥胖、孕期体重增值超标可增加巨大儿的发生风险（分别RR=3.59,95% CI：1.93~6.67;RR=3.21,95% CI：1.39~7.37）。未发现母亲孕前BMI与孕期体重增值对新生儿出生体重的交互作用。结论 孕前双亲BMI和母亲孕期体重增值与新生儿出生体重有关,而母亲孕前BMI和孕期体重增值之间无交互作用。     

超重孕妇低生糖负荷膳食干预对新生儿DNA甲基化影响的探索性研究

目的通过对超重孕妇实施低血糖生成指数(GI)膳食的干预,探讨胎盘组织和脐血中与体重增长有关基因的甲基化的改变。 方法采用随机化单盲对照干预试验设计,研究对象为初次产检孕周≤12周且体重超重的孕妇。以研究对象纳入的顺序号为随机序列号,采用简单随机化的方法随机分为干预组和对照组。干预组在中国孕妇保健规范的基础上结合国家对孕妇的膳食和体力活动规范实施低GI膳食指导干预 ,对照组仅按照国家规范给予指导,不给予低GI膳食的指导。两组分别在孕早期、中期和晚期干预3次。 干预组和对照组各纳入25例。孕妇分娩时收集胎盘组织和脐血,提取DNA,采用Illumina甲基化芯片进行两步法全基因组甲基化测定。 结果孕妇孕期相关暴露因素在干预组与对照组差异无统计学意义;胎儿出生体重干预组高于对照组［（3.7±0.5） vs (3.5±0.4) kg］,但差异无统计学意义(P=0.248)。本研究结果结合生物信息数据库分析,筛选出19个基因位点,所属18个基因,其中5个基因位于1号染色体,2个基因位于7号染色体,其余基因分布分散。比较干预组与对照组甲基化的改变,发现脐血中2个差异的甲基化CpG位点,分别位于TEKT5和MIR378C基因上,胎盘组织中1个差异的甲基化CpG位点,所属PGBD5基因。 结论通过对超重孕妇采取低GI膳食干预,胎盘组织和脐血中基因的甲基化可以发生改变,为中国超重、肥胖孕妇疾病的预防提供新的方法,对子代的健康成长有重要的意义。     

孕前体重及孕期体重增长与巨大儿发生的关系

目的 研究孕前体重状况与孕期体重增长与巨大儿发生的关系。方法 以上海2家医院健康产妇为研究对象。采集产妇指标（年龄、身高、孕前BMI、文化程度、既往疾病史、分娩前体重、血三酰甘油）和新生儿指标（性别、出生体重、出生身长、出生孕周）。采用二项Logistic回归进行多因素分析。以孕前BMI分组,将新生儿是否为巨大儿作为因变量,孕期增重作为检验变量,对孕前营养不良、正常和超重（肥胖）组分别使用ROC曲线计算界值,得出孕期合理体重增长的上限值。结果 共纳入1 286例产妇,平均年龄（28.8±3.7）岁。孕前营养不良、正常和超重(肥胖)组分别为239例（18.6%）、872例（67.8%）和175例（13.6%）。孕期平均增重（15.4±4.7） kg,其中孕期体重增长过少206例（16.0%）、正常488例（37.9%）、过多592例（46.0%）。新生儿出生体重（3 380±384）g,巨大儿发生率6.0%（77/1 286）。孕前营养不良、正常和超重（肥胖）组巨大儿发生率分别为2.9%（7/239）、5.6%（49/872）和12.0%（21/175）。巨大儿产妇孕周、孕前BMI、孕期增重、高三酰甘油血症发生率均明显高于正常出生体重儿产妇。多因素Logistic分析显示孕前超重、孕周增加、孕期体重增长过多和高三酰甘油血症是巨大儿发生的危险因素。孕前营养不良、正常和超重（肥胖）组孕期体重增重界值分别为20.8、14.8和15.3 kg。结论 孕前超重、孕周增加、孕期体重增长过多和高三酰甘油血症与巨大儿发生相关。     

母亲孕早期代谢性危险因素与巨大儿发生风险的关联分析

目的 了解江苏省昆山市孕妇孕早期代谢综合征（MS）的患病情况并探讨其各组分对巨大儿发生的影响。方法 在江苏省昆山市妇幼保健所围产期保健监测平台上,收集2009至2010年常规围产期保健数据,筛选并分析在孕早期（孕20周以内）行初次产检且体格测量数据完整(包括孕妇体重、身高和血压）,同时采集孕早期血糖、血脂等实验室检测数据。根据国际糖尿病联盟（IDF）2005年有关MS的标准进行分组,其中超重/肥胖采用BMI≥24 kg·m-2作为标准。采用多因素Logistics逐步回归分析母亲孕早期MS及其各组分对巨大儿发生的影响。结果 共有1 405名孕妇围产期信息进入数据分析。孕妇初次产检时平均年龄为（26.5±3.2）岁,平均BMI（20.8±2.7）kg·m-2,平均收缩压和舒张压分别为（107.7±10.0）和（69.3±7.0）mmHg。孕早期平均甘油三酯（TG）、高密度脂蛋白（HDL-C）和空腹血糖（FPG）分别为（2.4±1.0）、（2.0±0.4）和（4.5±0.5）mmol·L-1。共有25名（1.8％）孕妇符合MS的诊断标准,其中超重/肥胖、高TG、低HDL-C、高血压和高FPG的患病率分别为12.0%、76.2%、2.8%、2.6%和2.3%。孕妇分娩时平均孕周为（39.0±1.4）周,新生儿出生体重为（3 365.0±418.6）g,其中巨大儿的发生率为7.0%。497名具完整的孕早期和出生结局数据,行多因素Logistic逐步回归分析显示,孕妇孕早期超重/肥胖是巨大儿发生的危险因素（OR=2.4, 95%CI: 1.0~5.5）。结论 昆山市2009至2010年孕妇孕早期MS患病率为1.8%,其最主要的两个组分是超重/肥胖和高TG,并且孕早期超重/肥胖是巨大儿发生的危险因素。提示对孕妇应考虑进行更早期的孕期代谢性危险因素的管理,有望减少不良妊娠结局的发生。     

孕期膳食脂肪酸与新生儿出生结局关系的研究

目的探讨孕期膳食脂肪酸与新生儿出生状况的关系。方法招募早孕妇女,采用即时性图像法调查孕中、晚期膳食状况,计算食物摄入量,以及能量、宏量营养素和脂肪酸摄入量;采集新生儿体质量、身长和BMI等体格生长指标,分析孕期膳食脂肪酸摄入与新生儿体格生长之间的关联。结果在有效纳入的516名孕妇中,孕中期和孕晚期膳食多不饱和脂肪酸(PUFA)平均摄入量以及占总脂肪酸比例分别为15.09g/d、23.93%和17.18g/d、24.7%,其中n-6和n-3 PUFA摄入量在孕中期为14.23 g/d和3.45 g/d,孕晚期为16.08 g/d和3.81 g/d,差异均有统计学意义(P0.05)。孕中期n-6/n-3 PUFA比值为4.11,孕晚期4.28,差异无统计学意义(P0.05)。二十二碳六烯酸(DHA)摄入量在孕中期为64.43 mg/d,孕晚期75.12 mg/d,差异有统计学意义(P0.05)。亚油酸(LA)和α-亚麻酸(ALA)两种必需脂肪酸占能量的百分比在孕中期分别为5.95%和1.42%,孕晚期为6.20%和1.45%,差异无统计学意义(P0.05)。孕中期n-3和n-6 PUFA摄入量、n-6/n-3比值均与新生儿BMI呈正相关(r=0.142~0.189,P0.05),孕晚期只有n-3 PUFA和DHA摄入量与新生儿出生体质量呈正相关(r=0.206,0.193,P0.05),n-6/n-3比值与新生儿BMI未表现出相关性(r=-0.018,P0.05)。结论孕中期膳食n-6和n-3摄入与新生儿BMI相关。     

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目的 通过比较小于胎龄儿(SGA)和足月正常新生儿脐血Ghrelin水平的变化,分析脐血Ghrelin与新生儿出生体重、身长、头围、BMI和胎盘重量、胎盘体积的关系,以及脐血Ghrelin水平与IGF-1、胰岛素、胰岛素敏感性和血糖的关系.探讨脐血Ghrelin水平与胎儿发育和代谢轴之间,尤其是Ghrelin与IGF-1的相互关系.方法 2006年12月至2007年3月选择中山大学附属一院新生儿78例,SGA组22例为观察组,足月适于胎龄儿(AGA)42例为正常对照组.采用酶联免疫反应法(ELISA)对新生儿脐血Ghrelin、胰岛素、IGF-1进行测定分析,测量新生儿净体重、身长、头围、胎盘体积、胎盘重量,计算体重指数(BMI)和胰岛素敏感指数(ISI).结果 (1)SGA组脐血Ghrelin水平(38.74±4.90 ng/mL)明显高于正常对照组(23.37±8.78 ng/mL),其差异有统计学意义(P＜0.05).(2)脐血Ghrelin水平与新生儿出生体重、身长、头围、BMI、胎盘重量、胎盘体积呈负相关,均有统计学意义(P＜0.05).(3)脐血Ghrelin水平与IGF-1、胰岛素、ISI呈负相关均有统计学意义(P＜0.05).与血糖无相关性(r=0.081,P=0.454).(4)通过偏相关分析,控制出生体重、身长、胎盘重量、BMI、胰岛素后,Ghrelin与IGF-1有明显负相关性,有统计学意义.(5)剖宫产新生儿脐血Ghrelin水平与顺产儿无明显差异(P=0.956);男性与女性新生儿脐血Ghrelin水平无明显差异(P=0.385).结论 新生儿脐血Ghrelin水平是反映胎儿的宫内发育及营养状态的指标之一.并以负反馈形式参与胎儿宫内发育和代谢轴的调控过程.小于胎龄儿出生时可能存在胰岛素抵抗.小于胎龄儿高Ghrelin并没有刺激胰岛素释放,提示小于胎龄儿可能存在Ghrelin受体或受体后信号传导通路的抵抗.     

系统性红斑狼疮产妇孕期体重增长对新生儿出生体重影响的巢式病例对照研究

目的 考察系统性红斑狼疮(SLE)产妇孕期体重增长(GWG)对新生儿出生体重的影响。方法 以上海交通大学医学院附属仁济医院(我院)产科分娩的SLE产妇及其新生儿为研究对象。采集产妇一般情况(年龄、身高、孕前体重、教育程度、GWG、既往疾病史、分娩孕周)、第一次产检指标(收缩压、舒张压、胆固醇、甘油三酯、空腹血糖)、新生儿性别、Apgar评分及出生体重。根据年龄和教育程度1:3匹配健康产妇及其新生儿作为对照。产妇GWG与新生儿出生体重关系采用一般线性回归分析。结果 共纳入SLE产妇45例和健康产妇135例。所有产妇平均年龄(29.0±3.0)岁,新生儿平均出生体重(3 198.8±501.8)g。SLE组GWG显著低于对照组,(12.4±5.5)kg vs (15.0±5.1)kg, P=0.004,GWG 低于适宜体重增长的比例显著高于对照组(37.8% vs 16.3%, P<0.01)。将所有产妇按GWG进行四分位分组,结果显示随着GWG增长,新生儿出生体重明显增加。与GWG处于最低四分位的SLE产妇相比,处于最高四分位的产妇的新生儿出生体重多(246.4±234.1)g,差异无统计学意义。结论 SLE产妇GWG明显低于正常产妇,随着GWG的增加,新生儿出生体重有增加趋势。     

糖尿病母亲的新生儿出生体重和疾病发生率的比较

目的　了解糖尿病母亲的发病孕期对其新生儿出生体重和疾病发生率的影响。方法　应用回顾性对照分析的方法 ,对 9例孕早期发病的糖尿病母亲的新生儿 (NODM) (1组 ) ,32例孕中期发病的NODM (2组 ) ,32例孕晚期发病的NODM(3组 )进行比较。结果　三组出生体重和胎盘重量上无显著差异 ,且出生体重与胎盘重量之间存在正相关 (r >r0 .0 5　　P <0 .0 1 )。新生儿疾病发生率 1组高于 2组和 3组 ,1组与 3组间差异有显著性意义 (χ2 =3 .88　P <0 .0 5)。结论　在现有的干预措施下 ,不同孕期发病的NODM在出生体重上无差别 ,但孕母患病越早、其新生儿的围生期疾病发生率越高     

孕期糖代谢状况对早产儿早期胰岛功能的影响

目的分析母亲孕期糖代谢状况对其早产儿早期胰岛功能的影响,并探讨监测早产儿早期胰岛功能的敏感指标。方法将2012年3月至12月入住新生儿重症监护病房的82例早产儿分为2组,母亲孕期糖代谢异常组(35例)和母亲孕期糖代谢正常组(47例),分别检测早产儿生后1 h和7 d的空腹血糖(FPG)、胰岛素(FINS)、C-肽和胰岛素原,并比较早产儿胰岛β细胞功能的相关指数。结果两组早产儿母亲的孕前和产前体质指数(BMI)、早产儿出生时体质量和头围的差异均有统计学意义(P<0.05),但母亲孕体质量期增加的差异无统计学意义(P>0.05)。两组早产儿出生时胰岛素原与生后7 d的C-肽、胰岛素原的差异有统计学意义(P<0.05)。两组早产儿胰岛素抵抗指数(IR)、空腹β细胞功能指数(FBCI)和胰岛素敏感指数(IAI)的差异无统计学意义(P>0.05)。结论母亲孕期糖代谢异常并不影响早产儿早期胰岛功能,但早产儿早期胰岛素原的分泌已受影响。     

A prospective survey of serial maternal serum zinc levels and pregnancy outcome

Serum zinc levels were monitored serially in pregnant women. Compared with those of age-matched nonpregnant women, their serum zinc levels were significantly decreased in the first trimester (p less than 0.005) and further decreased in the second trimester (p less than 0.005) but then remained unchanged until delivery. Cord blood zinc levels and the ratio of cord blood to maternal serum zinc at delivery were significantly higher in preterm than term (greater than or equal to 37 weeks) infants (p less than 0.05, p less than 0.05). The maternal serum zinc level in the second trimester was not related to the birth weights of the infants. Mothers with serum zinc levels of less than 65 micrograms/dl in the last trimester showed a higher incidence of birth weights of less than the 50th percentile (p less than 0.005) and also of less than the 25th percentile (p less than 0.005) on term delivery. The incidences of birth weights of less than the 10th percentile on term delivery were similar for mothers with serum zinc levels of greater than or equal to 65 micrograms/dl. This observation suggested that a relatively lower birth weight may be associated with lower maternal serum zinc levels in the third trimester, but an additional factor (factors) is also involved in the outcome of low birth weight infants.     

Observational study of maternal anthropometry and fetal insulin.

AIMS: To examine the relation between maternal body fat and fetal metabolism. METHODS: In this observational study, cord blood samples were collected from 60 infants of healthy women for the measurement of insulin and C peptide concentrations. Maternal weight, height, body mass index (BMI) and body composition (skinfold thickness measurements and bioelectrical impedance) were assessed at 13-15 weeks of gestation. Twenty five of the volunteers agreed to have a 75 g oral glucose tolerance test at 28-31 weeks of gestation. RESULTS: Positive correlations were observed with both cord insulin or C peptide concentrations and maternal early pregnancy BMI (r=0.44, p=0.002 and r=0.33, p=0.008, respectively). There was no significant correlation between cord insulin or C peptide concentrations and birthweight or birth weight centiles. CONCLUSION: Maternal BMI could be a predictor of fetal cord insulin concentration.     

母体高尿酸血症对妊娠结局和新生儿合并症影响的回顾性巢式病例对照研究

背景：高尿酸血症（HUA）患病率逐年增高,不仅与痛风、尿酸盐肾病和肾结石有关,还与内分泌代谢、心脑血管等系统疾病的发生和发展有关。 目的：探讨孕母妊娠晚期血尿酸水平与不良妊娠结局、新生儿尿酸水平及新生儿合并症的关系。 设计：回顾性巢式病例对照研究。 方法：以2020年1~12月在北京大学人民医院产检的孕母为队列人群,根据孕母妊娠晚期血尿酸水平分为HUA组和非HUA组,比较两组妊娠结局和新生儿临床结局。根据孕母妊娠晚期血尿酸水平（μmol·L-1）分为低浓度（<360）、中浓度（~420）和高浓度（>420）,采用线性回归和Logistic 回归模型分析孕母血尿酸水平与早产、低出生体重、小于胎龄儿的关系。孕母妊娠晚期尿酸值及新生儿生后24 h尿酸值相关性分析采用Spearman秩相关分析。 主要结局指标：孕母血尿酸水平与早产、低出生体重和小于胎龄儿的关系。 结果：共纳入孕母2 397例（新生儿2 581例）,HUA组216例（9.0%）,非HUA组2 181例。HUA组孕母所生新生儿出生体重低于非HUA组（2 925 g vs 3 260 g,P<0.001）,差异均有统计学意义;而早产（18.5% vs 8.9%）、低出生体重（23.1% vs 7.1%）、小于胎龄儿（29.2% vs 10.6%）和转儿科比例（19.9% vs 11.1%）均高于非HUA组,差异均有统计学意义（P<0.001）。尿酸水平高浓度组孕母分娩的新生儿出生体重较低浓度组低54.0 g（95%CI：-106.5~-1.6,P=0.043）,发生早产的风险增加74%（OR=1.74,95%CI：1.08~2.8,P=0.023）,发生小于胎龄儿的风险增加85%（OR=1.85,95%CI：1.26~2.73,P=0.002）。新生儿生后24 h内尿酸水平与孕母妊娠晚期尿酸水平呈中等相关（r=0.613,P=0.000）。两组早产儿合并症差异无统计学意义。 结论：母体妊娠晚期HUA与早产、低出生体重、小于胎龄儿的发生相关。     

Neonatal birth waist is positively predicted by second trimester maternal active ghrelin,a pro-appetite hormone,and negatively associated with third trimester maternal leptin,a pro-satiety hormone

IntroductionIn pregnancy physiological mechanisms activated by maternal appetite contribute to adequate energy intake for the mother and for the fetus. The role of maternal appetite-related peptides and their possible association with neonatal energy stores and glucose metabolism have not been investigated as yet. The aim was to investigate, during pregnancy, the association of fasting maternal appetite-related hormones levels [ghrelin (active), GLP1 (active), total PYY and leptin] with neonatal waist, percent total body fat and insulin levels at birth.MethodsForty-two normal and thirty eight overweight women (mean ± SD; age: 26.9 ± 2.5 years; pre-pregnancy BMI 26 ± 2.2 kg/m²) were seen during each of the three trimesters, had blood sampling and a 75 g oral glucose tolerance test. At birth, neonates underwent anthropometry and cord blood sampling for c-peptide, glucose, insulin.ResultsDuring all three trimesters maternal weight correlated positively with percent total neonatal body fat while during the second and third trimesters it correlated positively with birth weight. The second trimester maternal active ghrelin levels correlated positively with neonatal waist and were its best positive predictor. The third trimester maternal active ghrelin levels correlated positively with neonatal waist and negatively with percent total neonatal body fat, fetal cord blood insulin levels and were the best negative predictor of the latter. The third trimester maternal leptin levels correlated negatively with neonatal waist.ConclusionsDuring pregnancy circulating maternal active ghrelin, a pro-appetite hormone, is associated with neonatal visceral energy storage (as expressed by neonatal waist). By inhibiting glucose-driven maternal insulin secretion, ghrelin might ensure adequate fasting glucose and nutrient supplies to the fetus while limiting overall fetal adipose tissue deposition.     

The relationship of the levels of leptin, insulin-like growth factor-I and insulin in cord blood with birth size, ponderal index, and gender difference

In humans, serum levels of leptin correlate with total body fat in both adults and children. After collecting cord blood from 156 term neonates (82 males, 74 females; 132 AGA and 22 LGA), we measured the cord levels of leptin, insulin and IGF-I to determine the relationships between these three hormones and relationships of these hormones with birth size (birth weight and ponderal index for adiposity in newborn) and gender. The leptin and IGF-I levels were significantly higher in the LGA group (9.2+/-4.0 ng/ml and 96.1+/-34.1 ng/ml, respectively) than in the AGA group (4.8+/-3.8 ng/ml and 56.4+/-37.6 ng/ml, respectively). A significant positive correlation was observed between leptin levels and birth weight, and a weaker correlation between leptin levels and birth height. IGF-I level significantly correlated with birth weight and birth height, but there was no correlation between the levels of insulin and birth weight. There was no relationship between the levels of IGF-I, insulin and leptin. Ponderal index was higher in LGA than in AGA. A significant correlation was also observed between the levels of leptin and ponderal index, but not between the levels of insulin or IGF-I and ponderal index. The levels of leptin and ponderal index were higher in females than males despite no gender differences in gestational age and birth weight. In conclusion, our results suggest that the level of IGF-I is a useful index for fetal growth during late gestation, and the development of adipose tissue is the major determinant of fetal serum leptin levels, the production of which is not regulated by insulin or IGF-I. In addition, a gender difference with a higher level of leptin in female neonates suggests that sexual dimorphism in adipose tissue already exists in utero.     

Serum zinc and copper levels in the maternal blood and cord blood of neonates

Estimation of serum zinc and copper in the maternal blood and cord blood of neonates was carried out to correlate the trace metals in the neonates and their mothers in relation to gestational age and birth weight. Sixty-five healthy neonates, both term and preterm and their mothers were selected. This cross sectional study was done at Azimpur Maternity Centre, Dhaka Medical College Hospital and Chemistry Division, Atomic Energy Centre, Dhaka, Bangladesh from July 1997 to June 1998. The estimation of trace metals was carried out by Atomic Absorption Spectrophotometry (AAS). The mean serum zinc levels in the maternal blood and cord blood were 0.47 ± 0.24 μg/ml and 0.85 ± 0.33 μg/ml respectively and the mean copper levels in the maternal blood and cord blood were 1.37 ± 0.62 μg/ml and 0.31 ± 0.32 μg/ml respectively. Cord blood zinc level was significantly higher and cord blood copper level was significantly lower than the corresponding maternal blood levels. There was no significant correlation between gestational age and serum zinc levels in the cord or maternal blood. But significant inverse correlation was found between gestational age and serum levels of copper in the maternal and cord blood.     

Serial measurements of serum human placental lactogen (hPL) and serial ultrasound examinations in the evaluation of fetal growth

Serial serum hPL measurements and serial ultrasound fetometry were compared in the evaluation of fetal growth by relating these two parameters to size at birth and to clinical factors known to influence size at birth. The data were from a prospective study of 1000 consecutive pregnant women considered to be at risk for fetal growth retardation with retrospective analysis. Serum hPL was measured by radioimmunoassay and fetal weight estimated by ultrasound every 3 weeks during the last trimester. hPL values were expressed as multiples of the median (MoM) and linear regression analysis of the hPL MoM values was carried out for each pregnancy to find the slope of the line (hPL-slope); at least 3 serum hPL values were required. The estimated fetal weight and weight-for-age at birth was expressed in Z-scores. The individual intrauterine growth velocity was calculated by regression analysis and expressed as change in Z-score for 12 weeks. At least two ultrasound measurements over an interval of at least 42 days were used to estimate the fetal growth velocity. In 588 women the file was complete. The main outcome measures were the individual mean hPL, hPL-slope, fetal growth velocity, birth weight deviation, smoking in pregnancy and diagnosis of preeclampsia. A significant correlation was found between the hPL-slope and the intrauterine fetal growth velocity (r=0.34), and between hPL-slope and birth weight deviation (r=0.32). Mean hPL was correlated to birth weight deviation (r=0.27), but only very weakly to intrauterine growth velocity (r=0.08). hPL-slope and intrauterine growth velocity independently predicted birth weight deviation. Heavy smoking which was stopped before the third trimester was not associated with low intrauterine growth velocity, but with a low hPL-slope. Preeclampsia was associated with a trend towards low and decreasing hPL and with an increasing intrauterine growth velocity and birth weight deviation. In conclusion the rate of change of serial hPL measurements correlated well to intrauterine fetal growth velocity in the third trimester as estimated by ultrasound and to the deviation in birth weight, but hPL seems to have a separate physiological significance, since it did not pick up when smoking was stopped and growth velocity was normalised and it did not at all detect the increased growth associated with preeclampsia.     

宫内发育迟缓儿脐血内脂素及胎盘内脂素mRNA的表达

目的探讨内脂素与胎儿生长发育的关系。方法选择2008年12月—2010年6月足月出生的宫内发育迟缓(IUGR)儿、巨大儿及正常足月儿各35例,采用ELISA法测定脐血内脂素水平,Real-time PCR法检测胎盘内脂素mRNA相对含量,放射免疫法测定脐血胰岛素水平;分析脐血内脂素、胰岛素水平、胎盘内脂素mRNA相对含量与出生体质量的关系及脐血内脂素、胰岛素水平与胎盘内脂素mRNA相对含量间的关系。结果 IUGR儿脐血内脂素水平高于巨大儿及正常足月儿,差异有统计学意义(P<0.05);巨大儿与正常足月儿之间脐血内脂素水平差异无统计学意义(P>0.05)。三组间新生儿脐血胰岛素水平差异有统计学意义(P<0.05)。脐血内脂素水平与出生体质量呈负相关性(r=-0.341,P<0.05),与胰岛素水平无相关性(P>0.05)。三组间胎盘内脂素mRNA表达差异无统计学意义(P>0.05),胎盘内脂素mRNA水平与出生体质量、脐血内脂素、胰岛素水平均无相关性(P>0.05)。结论新生儿期内脂素与IUGR有关,可通过调节代谢而影响胎儿宫内的生长发育。     

脐血可溶性瘦素受体与胎儿生长发育关系探讨

目的：瘦素是肥胖基因的蛋白产物,除参与调节机体能量代谢外,与胎儿的生长发育密切相关,但其作用机制尚不清楚。本研究旨在探讨脐血可溶性瘦素受体与胎儿生长发育的关系及其可能机制。方法：67例足月新生儿根据出生体重分为小于胎龄儿(SGA)组23例,适于胎龄儿(AGA)组44例。采用ELISA法测定脐血和母血中瘦素及可溶性瘦素受体水平,并采用体脂含量估测新生儿营养状态。结果：①脐血可溶性瘦素受体水平与脐血瘦素水平及新生儿出生体重、体脂含量呈负相关(r分别为-0.405,-0.366,-0.356,P均0.05)。③SGA组脐血可溶性瘦素受体明显高于AGA组［(18.24±6.02) ng/ml vs (13.80±4.37) ng/ml］,P<0.01;而SGA组的瘦素含量低于AGA组［(6.79±4.59) ng/ml vs (16.30±11.62) ng/ml］,P<0.01。④脐血可溶性瘦素受体水平男性高于女性［(16.89±4.37) ng/ml vs (13.95±5.29) ng/ml］,P<0.05;而脐血瘦素水平则是男性低于女性［(10.28±8.28) ng/ml vs (15.70±12.11) ng/ml］,P<0.05。结论：可溶性瘦素受体可能通过对血清中游离瘦素水平的调节实现对胎儿生长发育的调控作用。同时测定瘦素和可溶性瘦素受体可能更有利于进一步了解瘦素的病理生理作用机制。