RESUMO
OBJECTIVE: To examine whether the association of prepregnancy body mass index (BMI) with fetal macrosomia is mediated through maternal circulating lipid concentrations during pregnancy. STUDY DESIGN: In this prospective cohort, 3011 eligible pregnant women were enrolled. Information on demographic characteristics were collected using questionnaires, and anthropometrics and laboratory tests were performed at 24 weeks of gestation and before delivery. Macrosomia was defined as birth weight ≥4000 g. Logistic regression and multivariable linear regression, adjusted for age, fetal sex, education, gestational weight gain, fasting blood glucose, gestational diabetes, gestational hypertension, gestational age at delivery, delivery mode, and parity, were used to assess the mediation path between prepregnancy BMI, maternal serum lipids, and fetal macrosomia. RESULTS: A total of 2454 participants with completed records were included in the final analyses. Among the maternal circulating lipid biomarkers, only triglyceride was significantly associated with both prepregnancy BMI and fetal macrosomia risk, adjusting for potential confounders. Mediation analyses demonstrated that the direct effect of prepregnancy BMI on fetal macrosomia was 0.0085 (95% CI, 0.0003-0.018; P < .05), the indirect effect mediated through maternal serum triglycerides was 0.0016 (95% CI, 0.0007-0.0029; P < .001), and the estimated proportion of mediated effect was 15.7% (P < .05). CONCLUSIONS: Maternal circulating triglycerides mediate the association of prepregnancy BMI with the risk of fetal macrosomia.
Assuntos
Índice de Massa Corporal , Macrossomia Fetal/sangue , Triglicerídeos/sangue , Adulto , China , Estudos de Coortes , Feminino , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido , Lipoproteínas/sangue , Modelos Logísticos , Gravidez , Fatores de RiscoRESUMO
BACKGROUND: Recent studies have demonstrated that low and high birth-weight at birth are risk factors of developing diabetes. The aim of this study was to determine if the abnormal birth-weight is related with hyperinsulinemia and elevated index of the Homeostasis Model assessment for Insulin Resistance (HOMA-IR) at birth, in at term newborns. METHODS: Newborns with gestational age between 38 and 41 weeks, products of normal pregnancies of healthy mothers aged 18 to 39 years, were eligible to participate. Small-for-gestational age (SGA) and large-for-gestational age (LGA) newborns were compared with appropriate-for-gestational (AGA) age newborns. Incomplete or unclear data about mother's health status, diabetes, gestational diabetes, history of gestational diabetes, hypertension, pre-eclampsia, eclampsia, and other conditions that affect glucose metabolism were exclusion criteria. Hyperinsulinemia was defined by serum insulin levels ≥13.0 µU/mL and IR by HOMA-IR ≥2.60. Multiple logistic regression analysis was used to determine the odds ratio (OR) that computes the association between birth-weight (independent variable) with hyperinsulinemia and HOMA-IR index (dependent variables). RESULTS: A total of 107 newborns were enrolled; 13, 22, and 72 with SGA, LGA, and AGA, respectively. Hyperinsulinemia was identified in 2 (15.4%), 6 (27.3%), and 5 (6.9%) with SGA, LGA, and AGA (p=0.03), whereas IR in 3 (23.1%), 8 (36.4%), and 10 (13.9%) newborns with SGA, LGA and AGA (p=0.06). The LGA showed a strong association with hyperinsulinemia (OR 5.02; CI 95%, 1.15-22.3; p=0.01) and HOMA-IR (OR 3.54; CI 95%, 1.03-12.16; p=0.02); although without statistical significance, the SGA showed a tendency of association with hyperinsulinemia (OR 2.43; CI 95%, 0.43-17.3 p=0.29) and HOMA-IR (OR 1.86; CI 95%, 0.33-9.37; p=0.41). CONCLUSIONS: Our results suggest that LGA is associated with hyperinsulinemia and elevated HOMA-IR at birth whereas the SGA show a tendency of association.
Assuntos
Macrossomia Fetal/complicações , Hiperinsulinismo/etiologia , Recém-Nascido Pequeno para a Idade Gestacional , Adulto , Biomarcadores/sangue , Peso ao Nascer , Glicemia/metabolismo , Estudos Transversais , Feminino , Macrossomia Fetal/sangue , Indicadores Básicos de Saúde , Homeostase , Humanos , Hiperinsulinismo/sangue , Hiperinsulinismo/diagnóstico , Recém-Nascido , Insulina/sangue , Resistência à Insulina , Modelos Logísticos , Modelos Biológicos , Razão de Chances , GravidezRESUMO
Six of 22 mothers with gestational diabetes mellitus had infants with macrosomia, cord blood hyperinsulinemia, and increased amounts of a key mitogenic intermediate, farnesylated p21-Ras. The ability of fetal hyperinsulinemia to increase the availability of farnesylated p21-Ras may represent one mechanism of the growth-promoting action of insulin during fetal development.
Assuntos
Diabetes Gestacional/metabolismo , Sangue Fetal/química , Macrossomia Fetal/sangue , Insulina/sangue , Leucócitos/química , Prenilação de Proteína , Proteínas Proto-Oncogênicas p21(ras)/metabolismo , Feminino , Macrossomia Fetal/metabolismo , Humanos , Recém-Nascido , GravidezAssuntos
Sangue Fetal/química , Macrossomia Fetal/sangue , Insulina/sangue , Peptídeo C/sangue , Feminino , Humanos , Recém-Nascido , MasculinoAssuntos
Peptídeo C/sangue , Sangue Fetal/química , Macrossomia Fetal/sangue , Feminino , Humanos , Hipoglicemia/sangue , Recém-Nascido , GravidezRESUMO
C-peptide concentrations in the cord blood of 29 macrosomic neonates born of nondiabetic mothers were higher than in 23 control infants whose birth weight was appropriate for gestational age, and there was a significant direct correlation between birth weight and C-peptide concentration. Six of the macrosomic infants studied (20%) had hypoglycemia in the first 24 hours of life, compared with none of the infants born with appropriate weight. We conclude that chronic fetal hyperinsulinemia may be one of the causes of macrosomia and neonatal hypoglycemia in infants of nondiabetic mothers.