妊娠期糖尿病对子代健康的影响:代谢综合征的传递

霍亭竹; 罗小丽; 毛萌

doi:10.11852/zgetbjzz2017-25-07-11

PDF(605 KB)

中国儿童保健杂志 ›› 2017, Vol. 25 ›› Issue (7) : 687-691. DOI: 10.11852/zgetbjzz2017-25-07-11

综述与讲座

妊娠期糖尿病对子代健康的影响:代谢综合征的传递

霍亭竹¹, 罗小丽², 毛萌³

作者信息 +

Effects of gestational diabetes mellitus on offspring`s health:transmission of metabolic syndrome

HUO Ting-zhu¹, LUO Xiao-li², MAO Meng³

Author information +

文章历史 +

摘要

妊娠期糖尿病对孕母和子代都会产生不良影响,母亲远期发生代谢综合征的风险已被证实,而其后代易发生巨大儿、大于胎龄儿,增加儿童肥胖的发病风险,罹患代谢综合征的风险也增加,代谢异常出现代代相传。虽然儿童代谢综合征的发生机制目前仍存在争议,但妊娠期糖尿病母亲高胰岛素、高血糖环境导致代谢及免疫紊乱,胎儿在宫内不良环境下也发生异常代谢变化,增加成人期代谢综合征的风险已有足够的证据。降低妊娠期糖尿病的发生率,加强孕母的健康教育,调整其生活方式及关注儿童期健康管理,可以降低妊娠期糖尿病母亲子代的远期疾病负担,减少代谢综合征的传递。

Abstract

Gestational diabetes mellitus has adverse impact on pregnant women and their offspring and increase the risk of metabolic syndrome for the posterity.Meanwhile,the incidence rate of macrosomia or large for gestational age infant will be increased and also the obesity rate of the children.However,the incidence of metabolic syndrome directly caused by gestational diabetes mellitus is still in controversy.Reports have point out that metabolic syndrome have some relations with hyperinsulinism,hyperglycemia and maternal metabolic and immunologic disturbance during pregnancy which can change the metabonomice of the fetus,which may increase the risk of metabolic syndrome.Hence,decreasing and controlling gestational diabetes mellitus,improving maternal realization for health herself and her offspring,adjusting her life styles and behaviors and managing their child after delivery may improve mother and child health and decrease the long term disease burden both for gestational diabetes mellitus and their children's,reduce the transmission of metabolic syndrome.

导出引用

霍亭竹, 罗小丽, 毛萌. 妊娠期糖尿病对子代健康的影响:代谢综合征的传递[J]. 中国儿童保健杂志. 2017, 25(7): 687-691 https://doi.org/10.11852/zgetbjzz2017-25-07-11

HUO Ting-zhu, LUO Xiao-li, MAO Meng. Effects of gestational diabetes mellitus on offspring`s health:transmission of metabolic syndrome[J]. Chinese Journal of Child Health Care. 2017, 25(7): 687-691 https://doi.org/10.11852/zgetbjzz2017-25-07-11

中图分类号： R179

参考文献

[1] 张淑兰.糖尿病[M]//乐杰.妇产科学.7版.北京:人民卫生出版社,2008:150-154.
[2] The HAPO Study Cooperative Research Group.Hyperglycemia and adverse pregnancy outcomes[J].N Engl J Med,2008,358(19):1991-2002.
[3] Weinert LS.International Association of Diabetes and Pregnancy Study Groups recommendation on the diagnosis and classification of hyperglycemia in pregnancy:comment to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel[J].Diabetes Care,2010,33(7):676-682.
[4] Yang H,Wei Y,Gao X,et al.Risk factors for gestational diabetes mellitus in Chinese women:a prospective study of 16 286 pregnant women in China[J].Diabet Med,2009,26(11):1099-1104.
[5] Durnwald C.Gestational diabetes:Linking epidemiology,excessive gestational weight gain,adverse pregnancy outcomes,and future metabolic syndrome[J].Seminars in Perinatology,2015,39(4):254-258.
[6] Reyes-Lopez R,Perez-Luque E,Malacara JM.Metabolic,hormonal characteristics and genetic variants of TCF7L2 associated with development of gestational diabetes mellitus in Mexican women[J].Diabetes Metab Res Rev,2014,30(8):701-706.
[7] Gillman MW.Interrupting intergenerational cycles of maternal obesity[J].Nestle Nutrition Institute Workshop,2016,85:59-69.
[8] Matuszek B,Lenart-Lipińska M,Burska A,et al.Increased serum insulin-like growth factor-1 levels in women with gestational diabetes[J].Adv Med Sci,2011,56(2):200-206.
[9] 毛邱娴,尹春艳.IGF-1/IFGBP-1与妊娠期糖尿病的相关性[J].中国妇幼保健,2012,27(3):442-443.
[10] Frasca F,Pandini G,Sciacca L,et al.The role of insulin receptors and IGF-1 receptors in cancer and other diseases[J].Arch Physiol Bilchem,2008,114(1):23-37.
[11] Reqnault N,Botton J,Heude B,et al.Higher cord C-peptide concentrations are associated with slower growth rate in the 1st year of life in girls but not in boys[J].Diabetes,2011,60(8):2152-2159.
[12] Herrera E,Desoye G.Maternal and fetal lipid metabolism under normal and gestational diabetic conditions[J].Hormone Molecular Biology & Clinical Investigation,2016,26(2):109.
[13] Khan NA,Yessoufou A,Kim M,et al.N-3 fatty acid modulate Th1 and Th2 dichomy in diabetic pregnancy and macrosomia[J].J Autoimmun,2006,26(4):268-277.
[14] Cocelli LP,Dikensoy E,Cicek H,et al.Pseudochlinesterase in gestational diabetes:positive correlation with LDL and negative correlation with triglyceride[J].Arch Gynecol Obstet,2012,286(1):43-49.
[15] Son GH,Kwon JY,Park YW.Maternal serum triglycerides as predictive factors for large-for-gestational age new born in women with gestational diabetes millitus[J].Acta Obstet Gynecol Scand,2010,89(5):700-704.
[16] Grissa O,Atègbo JM,Yessoufou A,et al.Antioxidant status and circulating lipids are altered in human gestational diabetes and macrosomia[J].Transl Res,2007,150(3):164-171.
[17] Schaefer-Graf UM,Meitzner K,Ortega-Senovilla H,et al.Differences in the implications of maternal lipids on fetal metabolism and growth between gestational diabetes mellitus and control pregnancies[J].Diabet Med,2011,28(9):1053-1059.
[18] Rabinovitch A.Immunoregulatory and cytokine imbalances in the pathogenesis of IDDM:therapeutic intervention by immunostimulation?[J].Diabetes,1994,43(5):613-615.
[19] Merzouk H,Khan NA.Implication of lipids in macrosomia of diabetic pregnancy:can n-3 polyunsaturated fatty acid exert beneficial effects?[J].Clin Sci(Lond),2003,105(5):519-529.
[20] Schwartz R,Teramo KA.Effects of diabetic pregnancy on the fetus and newborn[J].Semin Rerinatol,2000,24(2):120-135.
[21] He XJ,Qin FY,Hu CL,et al.Is gestational diabetes mellitus an independent risk factor for macrosomia:a meta-analysis?[J].Archives of Gynecology and Obstetrics,2015,291(4):729-735.
[22] 孙伟杰,杨慧霞.妊娠合并糖代谢异常孕妇的妊娠结局分析[J].中华妇产科杂志,2007,42(6):366-369.
[23] Júnior EA,Peixoto AB,Zamarian ACP,et al.Macrosomia[J].Best Practice & Research Clinical Obstetrics & Gynaecology,2017,38:83-96.
[24] Zimmet P,Alberti G,Kaufman F,et al.The metabolic syndrome in children and adolescents[J].Lancet,2007,369(9579):2059-2061.
[25] Charlotte M,Boney MD,Anila Verma,et al.Metabolic syndrome in childhood:association with birth weight,maternal obesity,and gestational diabetes mellitus[J].Pediatrics.2005,115(3):e290-296.
[26] Hillier TA,Pedula KL,Vesco KK,et al.Impact of maternal glucose and gestational weight gain on child obesity over the first decade of life in normal birth weight infants[J].Maternal and Child Health Journal,2016,20(8):1559-1568.
[27] Baptiste-Roberts K,Nicholson WK,Wang NY,et al.Gestational diabetes and subsequent growth patterns of offspring:the national collaborative perinatal project[J].Matern Child Health J,2012,16(1):125-132.
[28] Gillman MW,Rifas-Shimans,Berkey CS,et al.Maternal gestational diabetes,birth weight,and adolescent obesity[J].Pediatrics,2003,111(3):e221-226.
[29] Kim SY,England JL,Sharma JA,et al.Gestational diabetes mellitus and risk of childhood overweight and obesity in offspring:a systematic review[J].Exp Diabetes Res,2011,2011:541308.
[30] Rasmussen KM,Catalano PM,Yaktine AL.New guidelines for weight gain during pregnancy:what obstetrician/gynecologists should know[J].Curr Opin Obstet Gynecol,2009,21(6):521-526.
[31] Park JE,Park S,Daily JW,et al.Low gestational weight gain improves infant and maternal pregnancy outcomes in overweight and obese Korean women with gestational diabetes mellitus[J].Gynecol Endocrinol,2011,27(10):775-781.
[32] Viecceli C,Remonti LR,Hirakata VN,et al.Weight gain adequacy and pregnancy outcomes in gestational diabetes:a meta‐analysis[J].Obesity Reviews An Official Journal of the International Association for the Study of Obesity,2017,18(5):567-580.
[33] Phelan S,Hart C,Phipps M,et al.Maternal behaviors during pregnancy impact offspring obesity risk[J].Exp Diabetes Res,2011,2011:985139.
[34] Wei J,Heng W,Gao J.Effects of low glycemic index diets on gestational diabetes mellitus[J].Medicine,2016,95(22):e3792.
[35] Sanabria‐Martínez G,García‐Hermoso A,Poyatos‐León R,et al.Effectiveness of physical activity interventions on preventing gestational diabetes mellitus and excessive maternal weight gain:a meta‐analysis[J].Bjog An International Journal of Obstetrics & Gynaecology,2015,122(9):1167-1174.
[36] Gillman MW,Oakey H,Baqhurst PA,et al.Effect of treatment of gestational diabetes mellitus on obesity in the next generation[J].Diabetes Care,2010,33(5):964-968.
[37] Catalano P,Demouzon SH.Maternal obesity and metabolic risk to the offspring:why lifestyle interventions may have not achieved the desired outcomes[J].International Journal of Obesity,2015,39(4):642.