健康足月妊娠孕妇孕中晚期血高密度脂蛋白胆固醇水平变化与出生小于胎龄儿的关系

目的：研究健康足月妊娠孕妇孕中晚期血高密度脂蛋白胆固醇（HDL-C）水平变化与小于胎龄儿（SGA）发生风险的关系。 方法：应用回顾性巢式病例对照研究，纳入2017年在浙江大学医学院附属妇产科医院产检分娩的健康足月妊娠孕妇为回顾性队列，将确认分娩SGA的孕妇纳入SGA组，按新生儿性别和受孕年龄个案匹配原则以1∶4比例将确认分娩适于胎龄儿的孕妇纳入对照组，采集两组孕妇的临床资料、孕中期（孕24~27周）和孕晚期（孕37周后）HDL-C水平，计算孕晚期平均每4周HDL-C的变化（ΔHDL-C）。采用配对 t检验比较两组孕妇间HDL-C和ΔHDL-C的差异，再采用条件logistic回归模型分析ΔHDL-C与SGA发病风险的关系。 结果：共纳入SGA组249名及对照组996名。两组足月后HDL-C水平均较孕24~27周时降低（即ΔHDL-C均小于0， P<0.05），SGA组ΔHDL-C显著高于对照组（P<0.05）。调整混杂因素后，与低水平ΔHDL-C孕妇比较，中水平、高水平ΔHDL-C孕妇分娩SGA的风险均升高（OR=1.74，95% CI：1.22~2.50; OR=2.48，95% CI：1.65~3.70，均 P<0.05）。结论：健康足月妊娠孕妇孕晚期HDL-C下降缓慢或不降反升与SGA的发生有关，在SGA筛查中可能具有一定的临床应用价值。

Relationship between changes of high-density lipoprotein cholesterol levels in advanced pregnancy and the risk of neonatal small for gestational age in healthy full-term puerpera

Objective: To explore the relationship between changes in blood high-density lipoprotein cholesterol (HDL-C) levels in advanced pregnancy and the risk of small for gestational age (SGA) in healthy full-term pregnant women. Methods: In this retrospective nested case-control study, pregnant women who got antenatal visits and experienced a healthy full-term delivery in Affiliated Women’s Hospital, Zhejiang University School of Medicine in 2017 were enrolled. From the cohort, 249 women delivered SGA infants with completed clinical data were set as SGA group, 996 women who delivered normal neonates were randomly selected as matched controls (1∶4). The data of baseline characteristics, the HDL-C levels in 24 ^th-27 ^th week and after 37 ^th week were collected, the average HDL-C changes every four weeks in the third trimester (ΔHDL-C) were calculated. Paired t test was used to compare the differences of HDL-C and ΔHDL-C between cases and controls, and a conditional logistic regression model was applied to analyze the association between ΔHDL-C and the risk of SGA. Results: HDL-C levels after the 37 ^th week in both groups were lower than those in mid-pregnancy (ΔHDL-C<0 andP<0.05 for both groups), while the ΔHDL-C levels in SGA group were significantly higher (P<0.05). Compared with women with low ΔHDL-C, the risk of SGA was higher for women with middle and high ΔHDL-C (OR=1.74, 95% CI：1.22–2.50; OR=2.48, 95% CI：1.65–3.70, both P<0.05).Conclusion: In healthy full-term pregnant women, the risk of SGA is associated with the HDL-C changing trend, HDL-C level decreasing slowly or even raising in the third trimester indicate that SGA may be likely to occur.