Diabetes Care：母体血脂影响胎儿生长发育

为了研究母体血液循环中“燃料”与新生儿大小间的关系，并比较血糖和脂质的相对影响。来自印度浦那爱德华国王纪念医院研究中心Kamalnayan Bajaj 糖尿病学研究中心的Kulkarni等进行了一项研究，研究发现，除了已经明确的血糖对新生儿的影响，母体脂质对新生儿大小也有一定的影响。研究结果在线发表于2013年6月11日美国的《糖尿病治疗》(Diabetes Care)杂志上。

浦那母体营养研究(1993-1996)旨在调查母体营养对胎儿生长发育的影响。研究人员测定妊娠期母亲体形、血糖和脂质浓度，采用相关性和回归分析方法评价它们与足月新生儿大小的关系。

结果显示，参加研究的母亲(n=631)较年轻(平均年龄21岁)，身材矮小(平均身高151.9cm)，偏瘦(BMI 18.0kg/m²)，但是脂肪相对较多(身体脂肪21.1%)。她们的饮食主要以素食为主。妊娠18和28周，空腹血糖浓度仍较稳定，而总胆固醇和甘油三酯水平升高，HDL-胆固醇水平降低。胎儿平均出生体重为2666 g。妊娠18和28周时，总胆固醇和甘油三酯水平均与新生儿大小直接相关，而血糖水平仅在妊娠28周时与新生儿大小直接相关。妊娠28周时，母体空腹血糖、胆固醇和甘油三酯每升高1个SD值，胎儿出生体重分别增加37g，54g和36g(P值均<0.05)。HDL-胆固醇水平与新生儿测定结果没有相关性。在结果分析中(n=700)，即使加入早产的孕妇，得到的结果也相似。

研究表明，除了已经明确的血糖对新生儿的影响，母体脂质对新生儿大小也有一定的影响。作者建议，进一步的研究应该直接确定这些研究发现的临床相关性。

Maternal Lipids Are as Important as Glucose for Fetal Growth: Findings from the Pune Maternal Nutrition Study.
Abstract
OBJECTIVETo study the relationship between maternal circulating fuels and neonatal size and compare the relative effects of glucose and lipids.RESEARCH DESIGN AND METHODSThe Pune Maternal Nutrition Study (1993-1996) investigated the influence of maternal nutrition on fetal growth. We measured maternal body size and glucose and lipid concentrations during pregnancy and examined their relationship with birth size in full-term babies using correlation and regression techniques.RESULTSThe mothers (n = 631) were young (mean age 21 years), short (mean height 151.9 cm), and thin (BMI 18.0 kg/m2) but were relatively more adipose (body fat 21.1%). Their diet was mostly vegetarian. Between 18 and 28 weeks' gestation, fasting glucose concentrations remained stable, whereas total cholesterol and triglyceride concentrations increased and HDL-cholesterol concentrations decreased. The mean birth weight of the offspring was 2666 g. Total cholesterol and triglycerides at both 18 and 28 weeks and plasma glucose only at 28 weeks were associated directly with birth size. One SD higher maternal fasting glucose, cholesterol, and triglyceride concentrations at 28 weeks were associated with 37, 54, and 36 g higher birth weights, respectively (P < 0.05 for all). HDL-cholesterol concentrations were unrelated to newborn measurements. The results were similar if preterm deliveries also were included in the analysis (total n = 700).CONCLUSIONSOur results suggest an influence of maternal lipids on neonatal size in addition to the well-established effect of glucose. Further research should be directed at defining the clinical relevance of these findings.