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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2021, Vol. 17 ›› Issue (05): 536 -544. doi: 10.3877/cma.j.issn.1673-5250.2021.05.006

Original Article

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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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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