PDF(Pubmed)
Abstract：
Gestational Diabetes Mellitus (GDM) carries an increased risk for adverse perinatal and longer-term cardiometabolic consequences in offspring. This study evaluated the utility of maternal anthropometric, metabolic and fetal (cord blood) parameters to predict offspring anthropometry up to 1 year in pregnancies with GDM.
In this prospective analysis of the MySweetheart study, we included 193/211 women with GDM that were followed up to 1 year postpartum. Maternal predictors included anthropometric (pre-pregnancy BMI, gestational weight gain (GWG), weight and fat mass at the 1st GDM visit), and metabolic parameters (fasting insulin and glucose, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative insulin-sensitivity check index (QUICKI), HbA1c, triglycerides, and high-density lipoprotein (HDL) at the 1st visit and HbA1c at the end of pregnancy). Fetal predictors (N=46) comprised cord blood glucose and insulin, C-Peptide, HOMA-IR, triglycerides and HDL. Offspring outcomes were anthropometry at birth (weight/weight z-score, BMI, small and large for gestational age (SGA,LGA)), 6-8 weeks and 1 year (weight z-score, BMI/BMI z-score, and the sum of 4 skinfolds).
In multivariate analyses, birth anthropometry (weight, weight z-score, BMI and/or LGA), was positively associated with cord blood HDL and HbA1c at the 1st GDM visit, and negatively with maternal QUICKI and HDL at the 1st GDM visit (all p ≤ 0.045). At 6-8 weeks, offspring BMI was positively associated with GWG and cord blood insulin, whereas the sum of skinfolds was negatively associated with HDL at the 1st GDM visit (all p ≤0.023). At 1 year, weight z-score, BMI, BMI z-score, and/or the sum of skinfolds were positively associated with pre-pregnancy BMI, maternal weight, and fat mass at the 1st GDM visit and 3rd trimester HbA1c (all p ≤ 0.043). BMI z-score and/or the sum of skinfolds were negatively associated with cord blood C-peptide, insulin and HOMA-IR (all p ≤0.041).
Maternal anthropometric, metabolic, and fetal metabolic parameters independently affected offspring anthropometry during the 1st year of life in an age-dependent manner. These results show the complexity of pathophysiological mechanism for the developing offspring and could represent a base for future personalized follow-up of women with GDM and their offspring.
In this prospective analysis of the MySweetheart study, we included 193/211 women with GDM that were followed up to 1 year postpartum. Maternal predictors included anthropometric (pre-pregnancy BMI, gestational weight gain (GWG), weight and fat mass at the 1st GDM visit), and metabolic parameters (fasting insulin and glucose, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative insulin-sensitivity check index (QUICKI), HbA1c, triglycerides, and high-density lipoprotein (HDL) at the 1st visit and HbA1c at the end of pregnancy). Fetal predictors (N=46) comprised cord blood glucose and insulin, C-Peptide, HOMA-IR, triglycerides and HDL. Offspring outcomes were anthropometry at birth (weight/weight z-score, BMI, small and large for gestational age (SGA,LGA)), 6-8 weeks and 1 year (weight z-score, BMI/BMI z-score, and the sum of 4 skinfolds).
In multivariate analyses, birth anthropometry (weight, weight z-score, BMI and/or LGA), was positively associated with cord blood HDL and HbA1c at the 1st GDM visit, and negatively with maternal QUICKI and HDL at the 1st GDM visit (all p ≤ 0.045). At 6-8 weeks, offspring BMI was positively associated with GWG and cord blood insulin, whereas the sum of skinfolds was negatively associated with HDL at the 1st GDM visit (all p ≤0.023). At 1 year, weight z-score, BMI, BMI z-score, and/or the sum of skinfolds were positively associated with pre-pregnancy BMI, maternal weight, and fat mass at the 1st GDM visit and 3rd trimester HbA1c (all p ≤ 0.043). BMI z-score and/or the sum of skinfolds were negatively associated with cord blood C-peptide, insulin and HOMA-IR (all p ≤0.041).
Maternal anthropometric, metabolic, and fetal metabolic parameters independently affected offspring anthropometry during the 1st year of life in an age-dependent manner. These results show the complexity of pathophysiological mechanism for the developing offspring and could represent a base for future personalized follow-up of women with GDM and their offspring.
摘要：
妊娠糖尿病（GDM）对后代的不良围产期和长期心脏代谢后果的风险增加。这项研究评估了产妇人体测量学的实用性，代谢和胎儿（脐带血）参数，以预测GDM孕妇的后代长达1年的人体测量学。
■在对MySweetheart研究的前瞻性分析中，我们纳入了193/211例GDM患者,随访至产后1年.母亲的预测因素包括人体测量学(孕前BMI，妊娠期体重增加（GWG），第一次GDM就诊时的体重和脂肪量)，和代谢参数（空腹胰岛素和葡萄糖，胰岛素抵抗的稳态模型评估（HOMA-IR），定量胰岛素敏感性检查指数（QUICKI），HbA1c,甘油三酯，和高密度脂蛋白（HDL）在第一次访问和妊娠结束时的HbA1c）。胎儿预测因子（N=46）包括脐带血葡萄糖和胰岛素，C-肽,HOMA-IR,甘油三酯和HDL。后代结局是出生时的人体测量学(体重/体重z评分，BMI,胎龄小和大(SGA，LGA)),6-8周和1年（体重z评分，BMI/BMIz评分，和4个褶皱的总和）。
■在多变量分析中，出生人体测量学(体重，体重z分数，BMI和/或LGA），在第1次GDM访视时与脐血HDL和HbA1c呈正相关，在第1次GDM访视时，母体QUICKI和HDL呈阴性（所有p≤0.045）。在6-8周，子代BMI与GWG和脐带血胰岛素呈正相关,而在第1次GDM访视时,皮褶总和与HDL呈负相关(所有p≤0.023).在1年,体重z分数，BMI,BMIz评分,和/或皮肤褶皱的总和与孕前BMI呈正相关，产妇体重,第1次GDM访视时的脂肪量和第3个月的HbA1c（所有p≤0.043）。BMIz评分和/或皮褶总和与脐带血C肽呈负相关，胰岛素和HOMA-IR（所有p≤0.041）。
■母体人体测量学，新陈代谢，和胎儿代谢参数以年龄依赖性方式独立地影响后代在生命的第一年中的人体测量学。这些结果表明了发育后代的病理生理机制的复杂性，可以为将来对GDM妇女及其后代进行个性化随访奠定基础。
■在对MySweetheart研究的前瞻性分析中，我们纳入了193/211例GDM患者,随访至产后1年.母亲的预测因素包括人体测量学(孕前BMI，妊娠期体重增加（GWG），第一次GDM就诊时的体重和脂肪量)，和代谢参数（空腹胰岛素和葡萄糖，胰岛素抵抗的稳态模型评估（HOMA-IR），定量胰岛素敏感性检查指数（QUICKI），HbA1c,甘油三酯，和高密度脂蛋白（HDL）在第一次访问和妊娠结束时的HbA1c）。胎儿预测因子（N=46）包括脐带血葡萄糖和胰岛素，C-肽,HOMA-IR,甘油三酯和HDL。后代结局是出生时的人体测量学(体重/体重z评分，BMI,胎龄小和大(SGA，LGA)),6-8周和1年（体重z评分，BMI/BMIz评分，和4个褶皱的总和）。
■在多变量分析中，出生人体测量学(体重，体重z分数，BMI和/或LGA），在第1次GDM访视时与脐血HDL和HbA1c呈正相关，在第1次GDM访视时，母体QUICKI和HDL呈阴性（所有p≤0.045）。在6-8周，子代BMI与GWG和脐带血胰岛素呈正相关,而在第1次GDM访视时,皮褶总和与HDL呈负相关(所有p≤0.023).在1年,体重z分数，BMI,BMIz评分,和/或皮肤褶皱的总和与孕前BMI呈正相关，产妇体重,第1次GDM访视时的脂肪量和第3个月的HbA1c（所有p≤0.043）。BMIz评分和/或皮褶总和与脐带血C肽呈负相关，胰岛素和HOMA-IR（所有p≤0.041）。
■母体人体测量学，新陈代谢，和胎儿代谢参数以年龄依赖性方式独立地影响后代在生命的第一年中的人体测量学。这些结果表明了发育后代的病理生理机制的复杂性，可以为将来对GDM妇女及其后代进行个性化随访奠定基础。
