JCEM：SHG后代代谢性疾病发生风险增加

在妊娠期间妊娠剧吐改变母体（也可能包括胎儿）的营养状况，但目前缺乏妊娠剧吐对后代代谢长期影响的数据。为了评估严重妊娠剧吐（SHG）是否影响后代童年期间葡萄糖稳态和身体组成。来自新西兰奥克兰大学Liggins Institute教授及其团队进行了一项研究，该研究发现经历严重妊娠剧吐的母亲生出的胎儿有较低的胰岛素敏感性，可能增加他们向糖尿病发展的长期风险。该研究结果在线发表在2013年6月7日的《临床内分泌代谢杂志》（The journal of clinical endocrinology & metabolism）上。

该研究中，足月出生的、健康的、青春期前儿童（4–11岁）接受研究：严重妊娠剧吐住院治疗母亲的后代（SHG；36例）和正常妊娠母亲的后代（对照组；42例）。主要评价指标为用静脉葡萄糖耐量试验和Bergman最小模型测量的胰岛素敏感性。其他评价指标包括血脂谱和激素谱，以及用全身双能X线吸收法测量的身体组成。

该研究结果表明，SHG儿童的胰岛素敏感性比对照组低20%（8.49 vs 10.60×10^-4·min^-1·(mU/l)；p=0.014）。同时SHG儿童比对照组有更高的空腹胰岛素（6.88 vs 5.04mIU/l；p=0.024）和更低的IGFBP-1（11.8 vs 19.0ng/ml；p=0.004）。SHG后代基线皮质醇的浓度比对照组高22%（256 vs 210nmol/l；p=0.021）。两组儿童的人体测量相似。

该研究发现，经历严重妊娠剧吐的母亲生出的胎儿有较低的胰岛素敏感性，可能增加他们向糖尿病发展的长期风险。为了确定SHG后代迟发代谢性疾病的风险，对SHG后代进行随访是必要的。

Severe hyperemesis gravidarum is associated with reduced insulin sensitivity in the offspring in childhood.
Background
Hyperemesis gravidarum alters maternal (and possibly fetal) nutrition throughout pregnancy, but there are no data on long-term effects on offspring metabolism. Thus, we aimed to assess whether severe hyperemesis gravidarum affects glucose homeostasis and body composition in the offspring in childhood.
Methods
Healthy pre-pubertal children (aged 4-11 years) born at term were studied: offspring of mothers who were admitted to hospital with severe hyperemesis gravidarum (SHG; n=36) and offspring of mothers from control pregnancies (Control; n=42). Primary outcome was insulin sensitivity measured using intravenous glucose tolerance tests and Bergman's minimal model. Other assessments included lipid and hormonal profiles, and body composition using whole-body dual-energy X-ray absorptiometry.
Results
Insulin sensitivity in SHG children was 20% lower than in controls (8.49 vs 10.60 x10-4·min-1·(mU/l); p=0.014). SHG children also had higher fasting insulin (6.88 vs 5.04 mIU/l; p=0.024) and lower IGFBP-1 (11.8 vs 19.0 ng/ml; p=0.004) concentrations than controls. Baseline cortisol concentrations were 22% higher in SHG offspring (256 vs 210 nmol/l; p=0.021). Children in both groups were anthropometrically similar.
Conclusion
Children born to mothers who experienced severe hyperemesis gravidarum have lower insulin sensitivity, which may increase their long-term risk of developing diabetes mellitus. Follow up of SHG offspring is essential to determine later risk of metabolic disease.