摘要
目的 探讨足月妊娠孕母妊娠期血脂水平与子代小于胎龄儿(small for gestational age,SGA)风险的关系.方法 选择2020年1～12月在北京大学人民医院产检并足月分娩的孕母及其新生儿进行回顾性病例对照研究,根据新生儿是否为SGA分为SGA组和非SGA组,收集孕母孕早、中、晚期的血脂情况,比较两组孕母及新生儿情况.并将孕母妊娠各期血脂按百分位数分为＜P10组,P10～P90组及＞P90组,比较各组SGA发生情况.采用logistic回归模型分析孕母妊娠各期血脂水平与SGA发生风险的关系.结果 共纳入2 225例孕母及其单胎足月新生儿,SGA组206例,非SGA组2 019例,SGA发生率为9.26％.SGA组孕母年龄和剖宫产比例小于非SGA组,初产、合并高尿酸血症及男婴比例高于非SGA组(P＜0.05).孕母血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及非高密度脂蛋白胆固醇(Non-HDL-C)均随孕周增加而升高.调整后的回归模型显示,随着孕母妊娠各期TC、LDL-C、Non-HDL-C及孕晚期TG水平增加,子代发生SGA的风险降低.按血脂百分位数分组后,孕晚期高TC及高LDL-C是发生SGA的保护性因素;而孕早期及孕中期低TG是发生SGA的危险因素.结论 孕母血脂水平随孕周增加呈升高趋势.TC及LDL-C水平升高可能降低SGA发生风险,低水平TG可能增加SGA的发生风险,建议加强孕妇孕期血脂监测,尽早制定我国孕妇孕期血脂评价标准.
Abstract
Objective Exploring the relationship between maternal plasma lipid levels in full-term pregnant women and the risk of small for gestational age(SGA).Methods In this retrospective case-control study,pregnant women who underwent prenatal examination at Peking University People's Hospital from January to December 2020 were enrolled.They were divided into SGA group and non SGA group based on whether the newborns were SGA.The logistic regression model was used to analyze the relationship between maternal plasma lipid levels and the risk of SGA during each stage of pregnancy.Results During the study period,2 225 pregnant women and single term newborns were included,and the incidence of SGA was 9.26％.The concentrations of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and non high-density lipoprotein cholesterol(Non HDL-C)in maternal serum increased with the progression of pregnancy.In the SGA group,maternal TG,Non-HDL-C,and LDL-C levels during all stages of pregnancy,and TC level in late pregnancy were lower than those in the non-SGA group,but no difference was found regarding HDL-C.The increased levels of Non-HDL-C,LDL-C,TC,and late pregnancy TG in the adjusted regression model resulted in a reduced risk of SGA.The plasma lipids of each pregnancy period were grouped according to percentiles,with＜10％being the low-level group,10％-90％being the control group,and＞90％being the high-level group.It was found that high TC and high LDL-C in late pregnancy were protective factors for the occurrence of SGA,while low TG in early and midpregnancy is a risk factor for SGA.Conclusions The plasma lipid levels of pregnant women tend to increase with the progression of pregnancy.Elevated levels of TC and LDL-C may reduce the risk of SGA,while low levels of TG may increase the risk of SGA.Our studies provides evidence that we should strengthen maternal blood lipid monitoring during pregnancy,and establish Chinese evaluation standards.It would be recommended to regularly monitor and control gestational plasma lipids to reduce the risk of SGA,and improve the health of both mother and baby.
基金项目
北京市临床重点专科项目(2018)(2199000726)
NETL
NSTL
万方数据