Am J Obstet Gynecol:在妊娠满37周不足39周间出生的儿童更容易患糖尿病和肥胖相关疾病。

2017-07-20 MedSci MedSci原创

众所周知,内分泌和代谢性疾病在早产儿中的发病率较高。也已证实足月早期(满37周不足39周)出生的新生儿在谋几类疾病中的长期发病率与晚期早产儿(接近足月产的早产儿)相似。

(提示:妊娠满27周不足37周分娩为早产,妊娠满37周不足42周为足月产;妊娠达到或超过42周为过期产。故本文中涉及的早期分娩和晚期分娩均是足月产。)

众所周知,内分泌和代谢性疾病在早产儿中的发病率较高。也已证实足月早期(满37周不足39周)出生的新生儿在某几类疾病中的长期发病率与晚期早产儿(接近足月产的早产儿)相似。

足月早期分娩是否会影响新生儿内分泌和代谢相关的长期健康状况。

研究人员做了一个基于人口的队列分析,收集1991年-2013年期间在单一地区医疗中心的全部单胎分娩数据。排除先天畸形和多胎妊娠。按照分娩时间分组,足月早期出生和晚期出生(满39周)。根据医院病历档案评估0岁-18岁人群中内分泌和代谢性疾病的发病率(包括糖尿病、肥胖、低血糖、高脂血症和甲状腺功能低下等)的发病率。运用不同的统计学方法处理数据。

在研究期间,纳入225 260例符合要求的足月产数据。其中,24%(54 073例)是早期出生。在早期出生的儿童中内分泌和代谢性疾病的发病率明显更高(0.51% 比 0.41%,p=0.003),特别是超重和肥胖更为常见(p=0.002)。5岁以后差异更为明显,早期出生组中,不仅是肥胖,I型糖尿病也表现出更高的发病率(p<0.05)。生存曲线(比较累积发病率)显示足月早期出生组中所有内分泌和代谢性疾病的累积发病率更高。早期出生是新生儿在儿童期内分泌和代谢性疾病长期发病率的独立相关因素,而且在5岁以后相关性更强。

与晚期出生相比,早期出生的新生儿中内分泌和代谢性疾病的长期发病率会更高。可能是因为早期出生的新生儿的激素轴未完全建立,也或许是提示胎儿本身有内分泌功能紊乱,并会导致其自发性早期出生。

原始出处:

Dorit Paz Levy,Eyal Sheiner,et al.Evidence that Children Born at Early Term (37-38-6/7 weeks) Are at Increased Risk for Diabetes and Obesity-related Disorders.Am J Obstet Gynecol.July 17,2017.http://dx.doi.org/10.1016/j.ajog.2017.07.015

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