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中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (05) : 536 -544. doi: 10.3877/cma.j.issn.1673-5250.2021.05.006

论著

肥胖孕妇分娩新生儿的体脂率及其影响因素
叶樱琳, 郭晓蒙, 郑燕伟, 蒋荣珍†()   
  • 收稿日期:2021-04-10 修回日期:2021-08-13 出版日期:2021-10-01
  • 通信作者: 蒋荣珍

Analysis of body fat percentage and its influencing factors of neonates delivered by obese pregnant women

Yinglin Ye, Xiaomeng Guo, Yanwei Zheng, Rongzhen Jiang†()   

  • Received:2021-04-10 Revised:2021-08-13 Published:2021-10-01
  • Corresponding author: Rongzhen Jiang
  • Supported by:
    National Natural Science Foundation of China(81570444); Key Discipline Construction Project in the Fourth Round of Public Health Action Plan of Shanghai Health and Family Planning Commission(15GWZK0701); Project of Science and Technology Innovation Action Plan of Shanghai(17411950602)
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引用本文：

叶樱琳, 郭晓蒙, 郑燕伟, 蒋荣珍. 肥胖孕妇分娩新生儿的体脂率及其影响因素[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(05): 536-544.

Yinglin Ye, Xiaomeng Guo, Yanwei Zheng, Rongzhen Jiang. Analysis of body fat percentage and its influencing factors of neonates delivered by obese pregnant women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(05): 536-544.

目的

探讨不同人体质量指数(BMI)孕妇分娩新生儿的体脂率及其相关影响因素。

方法

选择2019年1月至2020年1月，于上海市第六人民医院采取择期剖宫产术分娩的77例单胎、足月妊娠孕妇为研究对象。根据孕妇分娩前的BMI值，将其分为肥胖组(n＝28，BMI≥30.0 kg/m2)，超重组(n＝33，25.0 kg/m2≤BMI<30.0 kg/m2)及正常组(n＝16，18.5 kg/m2≤BMI<25.0 kg/m2)。采集孕妇分娩前空腹外周静脉血及分娩时新生儿脐静脉血各5 mL，分别对孕妇及新生儿空腹血糖(FPG)、空腹胰岛素(FINS)及血脂水平进行检测。采用Kruskal-Wallis H检验、单因素方差分析及最小显著性差异法(LSD)-t，对3组孕妇一般临床资料，新生儿出生体重及体脂率，孕妇孕期血糖、血脂水平，孕妇分娩前及新生儿FPG、FINS及血脂水平，进行总体及两两比较。对于与新生儿出生体重、体脂率的相关因素分析，采用Pearson直线相关分析及Spearman秩相关分析法(分娩孕龄)。进一步采用多重线性回归分析，推导新生儿体脂率相关因素的多重线性回归方程。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》，与所有受试者签署临床研究知情同意书。3组孕妇年龄、身高、孕期增重等一般临床资料比较，差异均无统计学意义(P>0.05)。

结果

①3组孕妇孕前体重及BMI、分娩前体重及BMI，以及新生儿体脂率比较，差异均有统计学意义(P<0.001)，其中肥胖组这5项指标最高，正常组最低。3组新生儿出生体重比较，差异无统计学意义(P>0.05)。②肥胖组及超重组孕妇晚孕期FPG水平分别为(4.8±0.7) mmol/L、(4.7±0.4) mmol/L，均分别高于正常组的(4.3±0.4) mmol/L，并且差异均有统计学意义(P＝0.001、0.008)。3组孕妇早、中、晚孕期其余血糖指标，总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)及低密度脂蛋白(LDL)水平比较，差异均无统计学意义(P>0.05)。③肥胖组孕妇分娩前血清FINS及游离脂肪酸(FFA)水平显著高于超重组，血清FINS水平显著高于正常组；肥胖组及超重组孕妇分娩新生儿的FPG水平均分别高于正常组，并且上述差异均有统计学意义(P<0.05)。④相关性分析结果：新生儿体脂率与孕妇分娩前体重、孕妇晚孕期血清TG水平、孕妇分娩前血清FFA及FINS水平，以及新生儿出生体重均呈正相关关系(r＝0.461、0.535、0.414、0.541、0.703，P＝0.009、0.002、0.028、0.003、<0.001)，而与孕妇早孕期血清HDL水平呈负相关关系(r＝-0.378、P＝0.047)。多重线性回归方程为，新生儿体脂率＝-5.431+0.004×新生儿体重+0.231×孕妇分娩前血清FINS水平。

结论

肥胖孕妇分娩新生儿存在较高体脂储备，孕妇胰岛素抵抗(IR)是导致新生儿体脂率升高的重要原因。对肥胖孕妇进行孕期体重控制，并且监测其孕期血糖、FINS及血脂水平，可以有效预防新生儿肥胖。

关键词: 人体质量指数, 肥胖症, 血脂, 血糖, 体脂肪率, 孕妇, 婴儿，新生
Objective

To investigate body fat percentage and influencing factors of neonates delivered by pregnant women with different body mass index (BMI).

Methods

From January 2019 to January 2020, a total of 77 cases of singleton, full-term pregnant women who gave birth by elective cesarean section in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University were selected as research subjects. They were divided into obese group (n=28, BMI≥30.0 kg/m2), overweight group (n=33, 25.0 kg/m2≤BMI<30.0 kg/m2) and normal group (n=16, 18.5 kg/m2≤BMI<25.0 kg/m2) according to BMI of pregnant women before delivery. Collection of 5 mL fasting peripheral venous blood of pregnant women before delivery and 5 mL umbilical venous blood of neonates during delivery, and levels of fasting plasma glucose (FPG), fasting insulin (FINS) and blood lipids of pregnant women and their neonates were detected. The general clinical data, neonatal birth weight and body fat percentage, blood glucose and blood lipids levels of pregnant women during pregnancy; FPG, FINS and blood lipids levels of pregnant women before delivery and neonatal among three groups were compared statistically overall by Kruskal-Wallis H test or one-way ANOVA and pairwise by least significant difference (LSD)-t test. The correlation with neonatal birth weight and body fat percentage were investigated by Pearson linear correlation analysis and Spearman rank correlation analysis (gestational age). A multiple linear regression equation of neonatal body fat percentage with influencing factors was derived by multiple linear regression analysis. This study was in line with the World Medical Association Declaration of Helsinki revised in 2013, and all subjects signed the informed consents of clinical research. There were no significant differences in age, height, gestational weight gain of pregnant women among three groups (P>0.05).

Results

① There were significant differences in weight and BMI pre-pregnant and pre-delivery of pregnant women, and neonatal body fat percentage among three groups (P<0.001), these 5 indexes mentioned above were the highest in obesity group while the lowest in normal group. There was no significant difference in neonatal birth weight among three groups (P>0.05). ② The FPG levels of obesity group and overweight group pregnant women during the third trimester were (4.8±0.7) mmol/L and (4.7±0.4) mmol/L, which were significantly higher than that of (4.3±0.4) mmol/L in normal group, and the differences were statistically significant (P=0.001, 0.008). There were no significant differences among three groups of pregnant women in other indexes of blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels in the first, the second and the third trimesters (P>0.05). ③ Levels of serum FINS and free fatty acids (FFA) of pregnant women before delivery in obese group were significantly higher than those of overweight group, and serum FINS level was higher than that of normal group; and neonatal FPG level in obese or overweight group was higher than that of normal group, respectively, and all the differences mentioned above were statistically significant (P<0.05). ④ Results of correlation analysis: maternal prenatal weight, serum TG level in the third trimester, prenatal serum FFA and FINS levels, and neonatal birth weight were all positively correlated with neonatal body fat percentage (r=0.461, 0.535, 0.414, 0.541, 0.703; P=0.009, 0.002, 0.028, 0.003, <0.001), while maternal serum HDL level in the first trimester was negatively correlated with neonatal body fat percentage (r=-0.378, P=0.047). The multiple linear regression equation was: neonatal body fat percentage(%)=-5.431+ 0.004×neonatal birth weight+ 0.231× maternal prenatal serum FINS level.

Conclusions

Neonates delivered by obese pregnant women have higher body fat reserves, and maternal insulin resistance (IR) is the important reason to raise neonatal body fat percentage. Through weight control, and blood glucose, FINS and blood lipids levels monitoring during pregnancy, neonatal obesity can be effectively prevented.

Key words: Body mass index, Obesity, Blood lipids, Blood glucose, Adiposity, Pregnant women, Infant, newborn
表1 3组孕妇一般临床资料及新生儿出生体重、体脂率比较
组别 例数 孕妇年龄(岁，±s) 孕妇身高(cm，±s) 孕前体重(kg，±s) 孕前BMI(kg/m2，±s) 分娩前体重(kg，±s) 分娩前BMI(kg/m2，±s) 孕期增重(kg，±s)
肥胖组 28 32.3±3.9 160.4±5.3 73.7±13.5 28.6±4.8 87.3±14.2 33.9±5.2 13.6±6.2
超重组 33 31.6±4.4 160.5±4.1 55.7±6.6 21.6±2.0 70.0±5.3 27.2±1.3 14.3±3.6
正常组 16 31.8±4.6 159.5±5.0 47.9±5.6 18.8±1.7 59.7±4.3 23.4±1.0 11.8±3.7
检验值   F＝0.209 F＝0.237 F＝45.000 F＝55.212 F＝48.792 F＝59.583 F＝1.588
P值   0.812 0.789 <0.001 <0.001 <0.001 <0.001 0.211
组别 例数 孕次[次，M(P25~P75)] 产次[次，M(P25~P75)] 分娩孕龄[周，M(P25~P75)] 胎盘重量(g，±s) 新生儿出生体重(g，±s) 新生儿体脂率(%，±s)
肥胖组 28 2(1~3) 1.0(0~1.0) 39.1(38.5~39.5) 598.0±92.6 3 350±495 11.6±2.0
超重组 33 3(2~4) 1.0(0.5~1.0) 39.1(38.9~39.6) 607.0±113.0 3 404±406 9.6±2.6
正常组 16 2(1~3) 1.0(0~1.0) 39.3(38.8~39.6) 551.2±52.9 3 329±353 8.8±1.8
检验值   Z＝3.896 Z＝2.273 Z＝1.350 F＝1.487 F＝0.205 F＝14.735
P值   0.143 0.321 0.509 0.233 0.815 <0.001
表2 3组孕妇孕期血糖、血脂水平比较(mmol/L，±s)
组别 例数 早孕期 中孕期血糖
FPG TC TG HDL LDL FPG OGTT 1 h
肥胖组 28 4.9±0.5 4.9±0.6 1.5±0.5 1.7±0.3 2.5±0.4 4.8±0.5 8.5±2.0
超重组 33 4.8±0.4 4.8±0.9 1.4±0.5 1.7±0.3 2.4±0.7 4.7±0.4 7.6±1.6
正常组 16 4.7±0.8 4.8±1.0 1.4±0.5 1.8±0.5 2.3±0.8 4.8±1.1 8.7±2.5
F值   1.381 0.091 0.703 0.411 0.215 0.192 2.619
P值   0.258 0.913 0.499 0.665 0.807 0.826 0.080
组别 例数 中孕期OGTT 2 h血糖 晚孕期
FPG TC TG HDL LDL
肥胖组 28 7.0±1.5 4.8±0.7 6.3±1.1 3.5±1.1 1.9±0.5 3.4±0.9
超重组 33 6.6±1.5 4.7±0.4 6.6±1.3 3.5±1.5 1.8±0.4 3.7±1.1
正常组 16 7.4±2.0 4.3±0.4 6.9±1.2 3.3±0.8 1.9±0.6 4.0±1.0
F值   1.149 5.889 0.980 0.195 0.140 1.756
P值   0.323 0.004 0.380 0.824 0.870 0.180
表3 3组孕妇分娩前及其分娩新生儿的血清FPG、FINS及血脂水平比较(±s)
组别 例数 孕妇分娩前
FPG(mmol/L) FINS(μU/mL) TC(mmol/L) TG(mmol/L) HDL(mmol/L) LDL(mmol/L) apoA-1(g/L) apoB(g/L)
肥胖组 28 4.3±0.5 16.1±7.0 6.1±1.2 3.1±0.9 1.9±0.5 3.3±0.8 1.74±0.34 1.11±0.26
超重组 33 4.3±0.4 11.9±6.4 6.2±1.2 3.4±1.8 1.7±0.3 3.5±1.0 1.63±0.29 1.16±0.27
正常组 16 4.2±0.4 8.9±2.9 6.3±1.0 3.0±0.9 1.8±0.4 3.6±0.9 1.75±0.32 1.20±0.24
F值   0.797 7.006 0.075 0.685 1.207 0.641 1.194 0.536
P值   0.455 0.002 0.928 0.508 0.305 0.530 0.309 0.587
组别 例数 孕妇分娩前 新生儿
apoE(mg/dL) 脂蛋白(a)(mg/dL) apoA/apoB FFA(mEq/L) FPG(mmol/L) FINS(μU/mL) TC(mmol/L) TG(mmol/L)
肥胖组 28 5.4±1.4 14.1±10.0 1.6±0.5 0.63±0.23 3.2±0.8 6.2±4.5 2.1±1.3 0.44±0.85
超重组 33 5.8±3.3 11.2±7.7 1.5±0.5 0.47±0.18 3.3±0.4 6.4±4.4 1.7±0.5 0.23±0.14
正常组 16 4.8±1.3 11.2±12.0 1.5±0.4 0.51±0.15 2.7±0.8 6.3±3.1 1.7±0.4 0.18±0.07
F值   0.829 0.793 0.578 4.698 4.235 0.011 1.319 1.500
P值   0.441 0.457 0.564 0.012 0.019 0.989 0.274 0.230
组别 例数 新生儿
HDL(mmol/L) LDL(mmol/L) apoA-1(g/L) apoB(g/L) apoE(mg/dL) 脂蛋白(a)(mg/dL) apoA/apoB FFA(mEq/L)
肥胖组 28 0.82±0.54 0.72±0.60 0.84±0.38 0.24±0.23 4.5±1.4 2.6±5.0 5.3±5.0 0.17±0.08
超重组 33 0.69±0.18 0.58±0.39 0.71±0.08 0.18±0.09 4.5±1.4 1.7±1.1 4.9±2.4 0.18±0.05
正常组 16 0.60±0.26 0.58±0.19 0.75±0.11 0.16±0.05 4.3±1.1 1.3±1.4 5.2±1.8 0.15±0.08
F值   1.756 0.862 1.988 1.507 0.073 0.815 0.101 0.752
P值   0.180 0.427 0.145 0.229 0.930 0.447 0.904 0.476
图1 本组77例孕妇分娩新生儿的体重及体脂率与相关因素的相关性分析散点图(图1A~1D：分别为胎盘重量、孕妇身高、孕妇晚孕期血清TG水平、新生儿体脂率与新生儿体重的相关性分析散点图；图1E~1I：分别为孕妇分娩前体重、孕妇晚孕期血清TG水平、孕妇分娩前血清FFA水平、孕妇分娩前血清胰岛素水平、孕妇早孕期血清HDL水平与新生儿体脂率的相关性分析散点图)注：TG为总胆固醇，FFA为游离脂肪酸，HDL为高密度脂蛋白
表4 本组77例孕妇分娩新生儿体脂率影响因素的多重线性回归分析结果
变量 偏回归系数 偏回归系数标准误 标准化偏回归系数 t值 P值
常数项 -5.431 2.632 -a -2.064 0.051
新生儿体重 0.004 0.001 0.608 4.786 <0.001
孕妇分娩前血清FINS水平 0.231 0.072 0.408 3.207 0.004
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