妊娠期糖尿病对母婴脂代谢及胎盘脂质转运酶的影响

doi:10.12372/jcp.2025.24e0524

Abstract

Abstract:

Objective To explore the impact of gestational diabetes mellitus (GDM) on lipid metabolism in pregnant women and neonates at different gestational weeks, as well as the expression of placental lipid transport enzymes. Methods A retrospective analysis was conducted on clinical data from pregnant women and their neonates who delivered between January 2022 and December 2022. Placentas were collected from women who delivered between August 2023 and October 2023. Participants were divided into a GDM group and a control group based on the presence or absence of GDM. The serum lipids were compared between the two groups for both pregnant women and neonates. Additionally, differences in the expression of endothelial lipase (EL) and lipoprotein lipase (LPL) in placental tissue were compared between the two groups. Results A total of 541 full-term pregnant women were included, with 123 in the GDM group and 418 in the control group. There were 203 pregnant women with premature delivery, with 110 in the GDM group and 93 in the control group. Among full-term pregnant women, compared with the control group, the GDM pregnancies had greater weight gain and a higher rate of cesarean section, and the differences were statistically significant (P<0.05). However, the premature pregnant women with GDM had a smaller gestational age at delivery and less weight gain during pregnancy than those in the control group (P<0.05). Both in full-term and premature pregnancies, compared with the control group, triacylglycerol (TG) was higher and high-density lipoprotein cholesterol (HDL) was lower in the GDM group before delivery, and the difference was statistically significant (P<0.05). In GDM group, 77 full-term newborns were admitted to NICU, and 77 newborns were matched according to gestation week and birth date at a 1:1 ratio as control group; Total cholesterol (TC) and TG in the GDM group were higher than those in the control group, while HDL was lower than that in the control group, and the difference was statistically significant (P<0.05). In the placentas of full-term pregnant women, the expression of EL in the GDM group was significantly increased (P<0.05), but there was no difference in LPL expression between the two groups (P>0.05). In pregnant women with premature delivery, both EL and LPL had no differences in expression between the two groups (P>0.05). Conclusions GDM was associated with lipid metabolism disorders during pregnancy, but only in full-term newborns. Placental EL may be involved in the occurrence of lipid metabolism disorders in full-term newborns delivered by GDM mothers.

Key words: gestational diabetes mellitus, lipid metabolism, placental transport, newborn

XU Die, LU Chunxia, LI Wei, DONG Wenbin, KANG Lan, LEI Xiaoping. Effect of gestational diabetes mellitus on maternal and fetal lipid metabolism and placental lipid transport enzymes[J].Journal of Clinical Pediatrics, 2025, 43(4): 251-256.

Figures/Tables 5

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References 34

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项目	足月妊娠		统计量	P	早产妊娠		统计量	P
项目	GDM组(n=123)	对照组(n=418)	统计量	P	GDM组(n=110)	对照组(n=93)	统计量	P
孕期增重[M(P₂₅~P₇₅)]/kg	14.8(10.0~17.0)	12.0(10.0~15.0)	Z=3.54	<0.001	10.0(6.0~12.1)	10.0(8.0~15.0)	Z=2.29	0.022
孕次[n(%)]			χ²=0.40	0.528			χ²=0.01	0.976
1次	47(38.2)	173(41.4)			27(24.5)	23(24.7)
≥2次	76(61.8)	245(58.6)			83(75.5)	70(75.3)
产次[n(%)]			χ²=0.34	0.558			χ²=0.49	0.485
1次	78(63.4)	277(66.3)			42(38.2)	40(43.0)
≥2次	45(36.6)	141(33.7)			68(61.8)	53(57.0)
胎龄( x±s)/周	39.4±1.1	39.5±1.1	t=1.07	0.283	33.8±2.8	34.7±1.8	t=2.76	0.006
剖宫产[n(%)]	77(63.0)	209(50.0)	χ²=6.06	0.010	71(64.5)	58(62.3)	χ²=0.10	0.748
新生儿为男性[n(%)]	68(55.3)	221(52.9)	χ²=0.22	0.640	55(50.0)	50(53.8)	χ²=0.29	0.593

项目	足月妊娠孕妇		统计量	P	早产妊娠孕妇		统计量	P
项目	GDM组(n=123)	对照组(n=418)	统计量	P	GDM组(n=110)	对照组(n=93)	统计量	P
TC( x±s)/mmol·L^-1	6.3±1.5	6.2±1.3	t=0.64	0.525	6.3±2.2	6.3±1.3	t=0.11	0.914
TG[M(P₂₅~P₇₅)]/mmol·L^-1	4.1(3.3~5.0)	3.5(2.7~4.5)	Z=4.08	<0.001	3.9(2.8~4.9)	3.1(2.3~3.9)	Z=3.09	0.002
HDL( x±s)/mmol·L^-1	1.8±0.4	1.9±0.4	t=2.92	0.004	1.8±0.4	1.9±0.5	t=2.17	0.032
LDL[M(P₂₅~P₇₅)]/mmol·L^-1	3.2(2.5~4.1)	3.2(2.7~3.8)	Z=0.13	0.897	3.1(2.5~3.7)	3.4(2.8~4.1)	Z=2.39	0.017

项目	足月儿		统计量	P	早产儿		统计量	P
项目	GDM组(n=77)	对照组(n=77)	统计量	P	GDM组(n=110)	对照组(n=93)	统计量	P
TC( x±s)/mmol·L^-1	1.8±0.4	1.6±0.4	t=2.58	0.011	2.3±0.8	2.4±0.6	t=0.92	0.360
TG[M(P₂₅~P₇₅)]/mmol·L^-1	0.6(0.5~0.8)	0.5(0.4~0.7)	Z=2.06	0.040	0.2(0.2~0.3)	0.2(0.2~0.3)	Z=0.64	0.519
HDL( x±s)/mmol·L^-1	0.95±0.25	1.04±0.28	t=2.11	0.037	1.1±0.3	1.2±0.3	t=1.34	0.182
LDL[M(P₂₅~P₇₅)]/mmol·L^-1	0.6(0.5~0.7)	0.6(0.5~0.8)	Z=0.04	0.932	1.0(0.7~1.3)	1.0(0.8~1.3)	Z=0.41	0.680
APOA1( x±s)/g·L^-1	1.0±0.2	0.9±0.2	t=0.85	0.398	1.0±0.2	1.7±7.6	t=1.07	0.489
APOB( x±s)/g·L^-1	0.2±0.1	0.2±0.1	t=1.01	0.314	0.3±0.2	0.3±0.1	t=1.05	0.296

胎龄	组别	例数	TC( x±s)/ mmol·L^-1	TG[M(P₂₅~P₇₅)]/ mmol·L^-1	HDL( x±s)/ mmol·L^-1	LDL[M(P₂₅~P₇₅)]/ mmol·L^-1	APOA1( x±s)/ g·L^-1	APOB[M(P₂₅~P₇₅)]/ g·L^-1
35~37周	GDM组	63	2.3±0.7	0.2(0.2~0.3)	1.3±0.4	0.9(0.7~1.3)	1.0±0.2	0.3(0.2~0.4)
	对照组	73	2.4±0.6	0.2(0.2~0.3)	1.3±0.2	0.9(0.8~1.2)	1.0±0.2	0.3(0.2~0.4)
	统计量		t=0.83	Z=0.33	t=0.95	Z=1.09	t=0.99	Z=0.60
	P		0.410	0.743	0.345	0.276	0.326	0.550
32~34周	GDM组	22	2.5±0.8	0.2(0.1~0.3)	1.3±0.4	1.0(0.7~1.3)	1.0±0.1	0.3(0.2~0.4)
	对照组	13	2.7±0.8	0.2(0.1~0.3)	1.3±0.2	1.1(0.9~1.4)	1.0±0.2	0.3(0.3~0.4)
	统计量		t=1.04	Z=0.22	t=0.00	Z=1.19	t=0.40	Z=0.82
	P		0.309	0.824	1.000	0.232	0.694	0.412
<32周	GDM组	25	2.5±0.8	0.2(0.1~0.6)	1.0±0.3	1.3(0.9~1.7)	0.9±0.1	0.4(0.3~0.5)
<32周	对照组	7	2.4±0.4	0.2(0.1~0.4)	1.1±0.2	1.2(1.0~1.3)	0.7±0.3	0.4(0.3~0.4)
	统计量		t=0.64	Z=1.21	t=0.77	Z=0.84	t=1.77	Z=0.23
	P		0.528	0.227	0.459	0.399	0.121	0.819

妊娠类别	组别	例数	EL[M(P₂₅~P₇₅)]/ng·mL^-1	LPL[M(P₂₅~P₇₅)]/ng·mL^-1
足月妊娠	GDM组	10	2 850.1(2 328.7~4 358.8)	804.2(319.2~1 378.7)
	对照组	10	1 853.5(1 593.9~2 375.1)	517.3(333.3~830.4)
	Z值		2.50	0.61
	P		0.013	0.545
早产妊娠	GDM组	5	737.8(733.2~761.8)	243.7(215.6~771.4)
	对照组	5	753.0(559.7~782.1)	287.8(240.5~739.6)
	Z值		0.31	0.52
	P		0.754	0.602

Effect of gestational diabetes mellitus on maternal and fetal lipid metabolism and placental lipid transport enzymes

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