超重或肥胖个体的母体脂溶性维生素轨迹和婴儿出生体重

摘要(中文译文)

出生体重是长期代谢健康的重要决定因素，低出生体重和巨大儿都与心脏代谢风险增加有关。脂溶性维生素A、D和E调节与胎儿生长相关的途径，然而，在超重或肥胖的孕妇中，它们的轨迹和与出生体重的潜在关联仍然很少被描述。检测孕前超重或肥胖个体在妊娠中期和晚期母体维生素A（视黄醇）、D（25（OH）D）和E（α-生育酚）浓度及其与出生体重的关系。对妊娠期运动训练试验（ETIP）研究的二次分析包括57对在第二和第三孕期有可用维生素测量值的母婴。采用高效液相色谱法测定血浆视黄醇和α-生育酚，采用液相色谱-串联质谱法测定血清25-（OH）D。出生体重分为正常（2500-<4000g）或巨大（≥4000g）。使用Wilcoxon符号秩检验比较三个孕期之间的循环维生素浓度，并使用多元线性回归模型检查维生素与出生体重之间的关联。从妊娠中期到晚期，母体平均视黄醇和25（OH）D浓度显著下降（视黄醇：1.52（SD=0.37）至1.32（SD=0.33）µmol/L；25（OH）D:73.7（SD=30.0）至63.3（SD=25.0）nmol/L），而α-生育酚从34.6（SD=7.1）增加到46.3（SD=10.0）µmol/L。在妊娠晚期，19.3%的人维生素A不足，而维生素D缺乏和不足分别影响31.6%和33.3%。43.9%的婴儿出现巨大儿，56.1%的婴儿出生体重在正常范围内。母体维生素A、D和E与出生体重无关，也没有观察到维生素A和D的相互作用。在超重或肥胖的孕妇中，母体维生素A和D浓度在整个怀孕期间下降，而维生素E浓度上升。维生素A不足、维生素D缺乏/不足和巨大儿很常见。母体脂溶性维生素水平与出生体重没有独立关系，这表明在这个代谢高风险人群中，妊娠中期至晚期的维生素状态可能不是胎儿生长的主要决定因素。

Abstract

Birth weight is a strong determinant of long-term metabolic health, with both low birth weight and macrosomia linked to increased cardiometabolic risk. Fat-soluble vitamins A, D, and E modulate pathways relevant to fetal growth, however, their trajectories and potential associations with birth weight in pregnant individuals with overweight or obesity remain scarcely characterized. To examine maternal vitamins A (retinol), D (25(OH)D), and E (α-tocopherol) concentrations during the second and third trimesters of pregnancy and their associations with birth weight, in individuals with pre-pregnancy overweight or obesity. This secondary analysis of the Exercise Training in Pregnancy Trial (ETIP) study included 57 mother-infant pairs with available vitamin measurements in the second and third trimesters. Plasma retinol and α-tocopherol were measured by high performance liquid chromatography, and serum 25(OH)D by liquid chromatography-tandem mass spectrometry. Birth weight was classified as normal (2500 - < 4000 g) or macrosomic (≥ 4000 g). Circulating vitamin concentrations between trimesters were compared using the Wilcoxon signed-rank test and associations between vitamins and birth weight were examined using multivariate linear regression models. From the second to the third trimester, mean maternal retinol and 25(OH)D concentrations declined significantly (retinol: 1.52 (SD = 0.37) to 1.32 (SD = 0.33) µmol/L; 25(OH)D: 73.7 (SD = 30.0) to 63.3 (SD = 25.0) nmol/L), whereas α-tocopherol increased from 34.6 (SD = 7.1) to 46.3 (SD = 10.0) µmol/L. In the third trimester, 19.3% had vitamin A insufficiency, while vitamin D deficiency and insufficiency affected 31.6% and 33.3%, respectively. Macrosomia occurred in 43.9% of infants and 56.1% had birth weight within the normal range. Maternal vitamins A, D, and E were not associated with birth weight, and no vitamin A and D interaction was observed. In pregnant individuals with overweight or obesity, maternal vitamin A and D concentrations declined across pregnancy, while vitamin E increased. Vitamin A insufficiency, vitamin D deficiency/insufficiency, and macrosomia were common. Maternal fat-soluble vitamin levels were not independently associated with birth weight, suggesting that vitamin status during mid- to late pregnancy may not be a major determinant of fetal growth in this metabolically high-risk population.

如何引用

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