患有妊娠糖尿病的孕妇 宝宝2个月时比较胖


  【24drs.com】根据在线发表于2016年5月12日糖尿病照护期刊的一篇新研究,患有妊娠糖尿病之妇女(即便控制良好且婴儿是餵母乳)的婴儿在2-3个月大时,依旧比健康妇女所生婴儿胖16%,这些婴儿出生时的脂肪量并无差异。
  
  这是迄今首篇发现妊娠糖尿病妇女所生婴儿在几个月大时比健康妇女所生婴儿胖的研究。
  
  第一作者、英国伦敦帝国学院Karen Logan医师在电子邮件中写道,这篇研究显示,妊娠糖尿病妇女所生婴儿在几个月大时有较多脂肪组织,这可能是长期健康问题的先兆;重点在于,鼓励这类子代[长大时]要多运动与维持健康体重。
  
  之前的研究认为,妊娠糖尿病与子代的过重及肥胖有关。
  
  最近发表的一篇研究发现,妊娠糖尿病和/或怀孕期间体重增加过多会提高子代在10岁前的肥胖风险,即便出生时是正常体重。
  
  「Hyperglycemia and Adverse Pregnancy Outcome (HAPO)」这篇大型研究发现,母亲患有妊娠糖尿病时,婴儿出生体重较重(Diabetes. 2009;58:453–459)。
  
  不过,HAPO研究是使用间接方式测量脂肪量。
  
  Logan医师指出,这篇新研究使用全身MRI直接测量脂肪组织。
  
  该研究共包括86名婴儿(糖尿病组:n=42;对照组:n=44),这些婴儿在2011年10月至2014年10月间出生于英国伦敦的切尔西和威斯敏斯特医院,这些婴儿在出生后8-12周大时进行扫描,扫描量化全身和局部脂肪组织体积,以及肝脏内脂肪含量(强烈关系到内部腹部脂肪和代谢疾病)。
  
  血糖控制良好的妊娠糖尿病妇女,第3孕期的平均HbA1c值为5.3%,大多数婴儿是餵母乳到8-12个月(糖尿病组71%、对照组74%)。
  
  11天大时,妊娠糖尿病组和对照组的总脂肪体积差不多(P = .55),不过,到了10周时,妊娠糖尿病母亲所生婴儿的总脂肪体积显著高于对照组婴儿(P = .01)。
  
  校正婴儿体型大小之后,妊娠糖尿病组在10周时的总脂肪体积依旧显著大于对照组(16.0%, P = .002);不过,在任何时间点,两组之间的肝脏脂肪组织分布和脂肪量并无差异。
  
  虽然孩童时期发生肥胖可能是因为一些会促成体重增加的环境因素,这篇研究认为可能还有其它因素,因为在极幼小的婴儿时期就有差异出现。
  
  校正婴儿性别和母亲在怀孕前的身体质量指数(BMI)之后,研究结果依旧相同,作者们认为,这代表妊娠糖尿病对于婴儿脂肪量有独立的影响。
  Logan医师假设,可解释这些结果的可能机转包括在子宫内的「规划」、母乳所含成分的变化、婴儿食慾的差异。
  
  她结论表示,现在,重点是确认增加的脂肪对这些婴儿未来的健康的影响,是否可藉由治疗而减少妊娠糖尿病孕妇之子代的肥胖与改善长期的代谢健康。
  
  这篇研究的研究者并没有追踪这些子代的正式计画,不过,根据Logan医师指出,HAPO研究的研究者计画追踪孩童到10岁,以评估妊娠糖尿病的后续影响,以及婴儿期肥胖对肥胖和代谢健康的影响。
  
  资料来源:http://www.24drs.com/
  
  Native link:Mothers With Gestational Diabetes Have Fatter Babies at 2 Months

Mothers With Gestational Diabetes Have Fatter Babies at 2 Months

By Veronica Hackethal, MD
Medscape Medical News

Women who have gestational diabetes — even if it is well controlled and babies are breastfed — may still have babies that are 16% fatter at 2 to 3 months of age than those born to healthy mothers, according to a new study published online on May 12, 2016 in Diabetes Care.

No differences in fat volume existed at birth. The research is the first to find that babies born to mothers with gestational diabetes laid down more fat in the first few months of life, compared with babies born to healthy mothers.

"This study demonstrates babies born to mothers with gestational diabetes have greater adipose tissue in early infancy, which may be a harbinger for longer-term health problems," first author Karen Logan, MD, of Imperial College London, United Kingdom, wrote in an email to Medscape Medical News .

"It is important that these offspring are encouraged to exercise and maintain a healthy weight [as they grow up]," she added.

Study Assessed Fat Tissue With Whole-Body MRI

Past studies have suggested a link between gestational diabetes and overweight and obesity in offspring.

A recently published study found that gestational diabetes and/or excessive weight gain during pregnancy increases the risk of obesity in the offspring during the first 10 years of life, even when babies have a normal birth weight.

And the large Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study found that babies were fatter at birth when their mothers had gestational diabetes (Diabetes. 2009;58:453–459).

The HAPO study, though, used indirect techniques to measure fat mass.

This new study used whole-body MRI to directly measure fat tissue, Dr Logan pointed out.

It included 86 infants (diabetes group: n=42; control group: n=44) born at Chelsea and Westminster Hospital in London, United Kingdom, between October 2011 and October 2014. Babies were scanned shortly after birth and at 8 to 12 weeks of age. Scans quantified whole-body and regional fat-tissue volumes, as well as fat content within the liver (which correlates strongly to internal abdominal fat and metabolic disease).

Mothers with gestational diabetes had well-controlled blood glucose levels with a mean third-trimester HbA1c of 5.3%. Most infants were breastfed up to 8 to 12 months (diabetes group 71%, control 74%).

At about age 11 days, the gestational-diabetes group and control group had similar total fat volumes (P = .55). By 10 weeks, though, the babies born to mothers with gestational diabetes had significantly higher total fat volumes than babies in the control group (P = .01).

Even after adjustment for infant size, the gestational-diabetes group still had significantly more total fat volume at 10 weeks than the control group (16.0%, P = .002).

No significant between-group differences in the distribution of fat tissue and fat content in the liver existed at either time point, however.

While development of obesity in childhood may be due to environmental factors that promote weight gain, the study suggests something else might be going on, because differences in fatness occurred very early in infancy.

Does Gestational Diabetes Have Independent Effects on Fat Mass?

Results remained about the same after adjustment for infant sex and maternal prepregnancy body mass index (BMI). That suggests gestational diabetes could have an independent effect on infant fat mass, according to the authors.

Possible mechanisms that might explain these results include "programming" in the womb, changes in breast-milk content, and differences in infant appetite, Dr Logan hypothesized.

"It is now important to establish the possible effects of increased adiposity on the future health of these infants and whether treatment to reduce adiposity will improve long-term metabolic health in offspring of mothers with gestational diabetes," she concluded.

The researchers of this study do not have official plans to follow this group of infants over time. The HAPO researchers, however, plan to follow children up at age 10 to evaluate later effects of gestational diabetes and infant fatness on obesity and metabolic health, according to Dr Logan.

The study was funded by Action Medical Research Clinical Research Fellowship. The authors report no relevant financial relationships.

For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

Diabetes Care. Published online May 12, 2016.

    
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