患有妊娠糖尿病的孕婦 寶寶2個月時比較胖


  【24drs.com】根據線上發表於2016年5月12日糖尿病照護期刊的一篇新研究,患有妊娠糖尿病之婦女(即便控制良好且嬰兒是餵母乳)的嬰兒在2-3個月大時,依舊比健康婦女所生嬰兒胖16%,這些嬰兒出生時的脂肪量並無差異。
  
  這是迄今首篇發現妊娠糖尿病婦女所生嬰兒在幾個月大時比健康婦女所生嬰兒胖的研究。
  
  第一作者、英國倫敦帝國學院Karen Logan醫師在電子郵件中寫道,這篇研究顯示,妊娠糖尿病婦女所生嬰兒在幾個月大時有較多脂肪組織,這可能是長期健康問題的先兆;重點在於,鼓勵這類子代[長大時]要多運動與維持健康體重。
  
  之前的研究認為,妊娠糖尿病與子代的過重及肥胖有關。
  
  最近發表的一篇研究發現,妊娠糖尿病和/或懷孕期間體重增加過多會提高子代在10歲前的肥胖風險,即便出生時是正常體重。
  
  「Hyperglycemia and Adverse Pregnancy Outcome (HAPO)」這篇大型研究發現,母親患有妊娠糖尿病時,嬰兒出生體重較重(Diabetes. 2009;58:453–459)。
  
  不過,HAPO研究是使用間接方式測量脂肪量。
  
  Logan醫師指出,這篇新研究使用全身MRI直接測量脂肪組織。
  
  該研究共包括86名嬰兒(糖尿病組:n=42;對照組:n=44),這些嬰兒在2011年10月至2014年10月間出生於英國倫敦的切爾西和威斯敏斯特醫院,這些嬰兒在出生後8-12週大時進行掃描,掃描量化全身和局部脂肪組織體積,以及肝臟內脂肪含量(強烈關係到內部腹部脂肪和代謝疾病)。
  
  血糖控制良好的妊娠糖尿病婦女,第3孕期的平均HbA1c值為5.3%,大多數嬰兒是餵母乳到8-12個月(糖尿病組71%、對照組74%)。
  
  11天大時,妊娠糖尿病組和對照組的總脂肪體積差不多(P = .55),不過,到了10週時,妊娠糖尿病母親所生嬰兒的總脂肪體積顯著高於對照組嬰兒(P = .01)。
  
  校正嬰兒體型大小之後,妊娠糖尿病組在10週時的總脂肪體積依舊顯著大於對照組(16.0%, P = .002);不過,在任何時間點,兩組之間的肝臟脂肪組織分佈和脂肪量並無差異。
  
  雖然孩童時期發生肥胖可能是因為一些會促成體重增加的環境因素,這篇研究認為可能還有其他因素,因為在極幼小的嬰兒時期就有差異出現。
  
  校正嬰兒性別和母親在懷孕前的身體質量指數(BMI)之後,研究結果依舊相同,作者們認為,這代表妊娠糖尿病對於嬰兒脂肪量有獨立的影響。
  Logan醫師假設,可解釋這些結果的可能機轉包括在子宮內的「規劃」、母乳所含成分的變化、嬰兒食慾的差異。
  
  她結論表示,現在,重點是確認增加的脂肪對這些嬰兒未來的健康的影響,是否可藉由治療而減少妊娠糖尿病孕婦之子代的肥胖與改善長期的代謝健康。
  
  這篇研究的研究者並沒有追蹤這些子代的正式計畫,不過,根據Logan醫師指出,HAPO研究的研究者計畫追蹤孩童到10歲,以評估妊娠糖尿病的後續影響,以及嬰兒期肥胖對肥胖和代謝健康的影響。
  
  資料來源:http://www.24drs.com/
  
  Native link:Mothers With Gestational Diabetes Have Fatter Babies at 2 Months

Mothers With Gestational Diabetes Have Fatter Babies at 2 Months

By Veronica Hackethal, MD
Medscape Medical News

Women who have gestational diabetes — even if it is well controlled and babies are breastfed — may still have babies that are 16% fatter at 2 to 3 months of age than those born to healthy mothers, according to a new study published online on May 12, 2016 in Diabetes Care.

No differences in fat volume existed at birth. The research is the first to find that babies born to mothers with gestational diabetes laid down more fat in the first few months of life, compared with babies born to healthy mothers.

"This study demonstrates babies born to mothers with gestational diabetes have greater adipose tissue in early infancy, which may be a harbinger for longer-term health problems," first author Karen Logan, MD, of Imperial College London, United Kingdom, wrote in an email to Medscape Medical News .

"It is important that these offspring are encouraged to exercise and maintain a healthy weight [as they grow up]," she added.

Study Assessed Fat Tissue With Whole-Body MRI

Past studies have suggested a link between gestational diabetes and overweight and obesity in offspring.

A recently published study found that gestational diabetes and/or excessive weight gain during pregnancy increases the risk of obesity in the offspring during the first 10 years of life, even when babies have a normal birth weight.

And the large Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study found that babies were fatter at birth when their mothers had gestational diabetes (Diabetes. 2009;58:453–459).

The HAPO study, though, used indirect techniques to measure fat mass.

This new study used whole-body MRI to directly measure fat tissue, Dr Logan pointed out.

It included 86 infants (diabetes group: n=42; control group: n=44) born at Chelsea and Westminster Hospital in London, United Kingdom, between October 2011 and October 2014. Babies were scanned shortly after birth and at 8 to 12 weeks of age. Scans quantified whole-body and regional fat-tissue volumes, as well as fat content within the liver (which correlates strongly to internal abdominal fat and metabolic disease).

Mothers with gestational diabetes had well-controlled blood glucose levels with a mean third-trimester HbA1c of 5.3%. Most infants were breastfed up to 8 to 12 months (diabetes group 71%, control 74%).

At about age 11 days, the gestational-diabetes group and control group had similar total fat volumes (P = .55). By 10 weeks, though, the babies born to mothers with gestational diabetes had significantly higher total fat volumes than babies in the control group (P = .01).

Even after adjustment for infant size, the gestational-diabetes group still had significantly more total fat volume at 10 weeks than the control group (16.0%, P = .002).

No significant between-group differences in the distribution of fat tissue and fat content in the liver existed at either time point, however.

While development of obesity in childhood may be due to environmental factors that promote weight gain, the study suggests something else might be going on, because differences in fatness occurred very early in infancy.

Does Gestational Diabetes Have Independent Effects on Fat Mass?

Results remained about the same after adjustment for infant sex and maternal prepregnancy body mass index (BMI). That suggests gestational diabetes could have an independent effect on infant fat mass, according to the authors.

Possible mechanisms that might explain these results include "programming" in the womb, changes in breast-milk content, and differences in infant appetite, Dr Logan hypothesized.

"It is now important to establish the possible effects of increased adiposity on the future health of these infants and whether treatment to reduce adiposity will improve long-term metabolic health in offspring of mothers with gestational diabetes," she concluded.

The researchers of this study do not have official plans to follow this group of infants over time. The HAPO researchers, however, plan to follow children up at age 10 to evaluate later effects of gestational diabetes and infant fatness on obesity and metabolic health, according to Dr Logan.

The study was funded by Action Medical Research Clinical Research Fellowship. The authors report no relevant financial relationships.

For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

Diabetes Care. Published online May 12, 2016.

    
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