妊娠中期母亲血脂水平与新生儿出生结局关系研究
Study on the Relationship between Maternal Blood Lipid Levels in the Second Trimester and Neonatal Birth Outcomes
DOI: 10.12677/acm.2026.161176, PDF,   
作者: 张引红, 刘红艳, 高阳洋, 邓 妍, 郑元瑞, 李奇聪：西安医学院第一附属医院全科医学院，陕西 西安；李亚军*：西安医学院第一附属医院全科医学院，陕西 西安；西北妇女儿童医院生殖中心，陕西 西安
关键词: 妊娠中期；孕期血脂；不良出生结局；新生儿结局；Second Trimester； Blood Lipids during Pregnancy； Adverse Birth Outcomes； Neonatal Outcomes
摘要: 妊娠期女性存在生理性血脂升高，以甘油三酯(TG)、总胆固醇(TC)变化显著，TG可升至非妊娠的2.25倍，但其调节机制尚未明确。孕期进餐 ≥ 4次、喜食清淡食品及妊娠期糖尿病(GDM)血糖波动大是血脂异常的危险因素，而目前尚无统一诊断标准，不同孕周参考值不同，需多中心研究明确。妊娠期血脂异常与多种不良分娩结局相关：与巨大儿、大于胎龄儿(LGA)风险呈正相关，是早产的独立危险因素，且影响小于胎龄儿(SGA)发生；还可能增加远期心血管疾病风险，妊娠早期脂质水平可作为相关风险预测指标。综上，需开展多中心研究制定统一诊断标准，深入探索其机制及与不良结局的关联，为临床管理提供依据。
Abstract: Pregnant women have increased physiological blood lipids, with significant changes in triglyceride (TG) and total cholesterol (TC). TG can rise to 2.25 times that of non-pregnant women, but its regulatory mechanism is not yet clear. Eating more than 4 times during pregnancy, preference for light food and large blood glucose fluctuation in gestational diabetes mellitus (GDM) are risk factors for dyslipidemia. At present, there is no uniform diagnostic criterion, and the reference values of different gestational weeks are different, which need to be clarified by multi-center studies. Dyslipidemia during pregnancy is associated with a variety of adverse birth outcomes: it is positively correlated with the risk of macrosomia and large for gestational age (LGA), is an independent risk factor for preterm birth, and affects the occurrence of small for gestational age (SGA); it may also increase the risk of long-term cardiovascular disease, and lipid levels in early pregnancy can be used as a related risk predictor. In summary, it is necessary to carry out multi-center studies to develop unified diagnostic criteria, explore its mechanism and its association with adverse outcomes, and provide a basis for clinical management.
文章引用：张引红, 刘红艳, 高阳洋, 邓妍, 郑元瑞, 李奇聪, 李亚军. 妊娠中期母亲血脂水平与新生儿出生结局关系研究[J]. 临床医学进展, 2026, 16(1): 1365-1374. https://doi.org/10.12677/acm.2026.161176

参考文献

[1] 中国血脂管理指南修订联合专家委员会. 中国血脂管理指南(2023年) [J]. 中国循环杂志, 2023, 38(3): 237-271.
[2] 杨怡珂, 丁新. 妊娠期女性血脂变化特点[J]. 中国医刊, 2018, 53(4): 420-424.
[3] 袁作为, 付晓, 马华兰, 等. 重庆黔江地区健康孕妇血脂水平变化特点及参考区间建立[J]. 重庆医学, 2019, 48(11): 1952-1955.
[4] Wu, L., Wu, Q., Li, Q., Cao, S., Zhang, Y., Liu, Y., et al. (2022) Consecutive Reference Intervals for Biochemical Indices Related to Serum Lipid Levels and Renal Function during Normal Pregnancy. BMC Pregnancy and Childbirth, 22, Article No. 642. [Google Scholar] [CrossRef] [PubMed]
[5] Li, C., Li, X., Wu, D., Chen, Q., Xiao, Z., Wen, D., et al. (2021) Influence of Dietary Behaviors on Dyslipidemia in Pregnant Women and Its Effects on Physical Development of Fetuses and Infants: A Bidirectional Cohort Study. Nutrients, 13, Article 3398. [Google Scholar] [CrossRef] [PubMed]
[6] Bai, M., Chen, M., Zeng, Q., Lu, S., Li, P., Ma, Z., et al. (2022) Up-Regulation of Hepatic CD36 by Increased Corticosterone/Cortisol Levels via GR Leads to Lipid Accumulation in Liver and Hypertriglyceridaemia during Pregnancy. British Journal of Pharmacology, 179, 4440-4456. [Google Scholar] [CrossRef] [PubMed]
[7] 岳书帆, 裴玲, 陈文湛, 曾蕊, 曹筱佩. 不同孕期血脂值与妊娠并发症的关系[J]. 中山大学学报(医学科学版), 2021, 42(5): 762-770.
[8] 陈莲, 阮政文, 顾军清, 等. 妊娠中期高脂血症不同诊断标准与妊娠结局分析[J]. 现代实用医学, 2020, 32(5): 500-502.
[9] 袁仙仙, 李静, 王佳, 等. 妊娠期血脂异常患病率及妊娠早期血脂水平预测价值研究[J]. 中国全科医学, 2024, 27(6): 670-678.
[10] Lu, J., Gong, Y., Wei, X., Yao, Z., Yang, R., Xin, J., et al. (2021) Changes in Hepatic Triglyceride Content with the Activation of ER Stress and Increased FGF21 Secretion during Pregnancy. Nutrition & Metabolism, 18, Article No. 40. [Google Scholar] [CrossRef] [PubMed]
[11] Zhang, Y., Kallenberg, C., Hyatt, H.W., Kavazis, A.N. and Hood, W.R. (2017) Change in the Lipid Transport Capacity of the Liver and Blood during Reproduction in Rats. Frontiers in Physiology, 8, Article 517. [Google Scholar] [CrossRef] [PubMed]
[12] Melchior, J.T., Swertfeger, D.K., Morris, J., Street, S.E., Warshak, C.R., Welge, J.A., et al. (2021) Pregnancy Is Accompanied by Larger High Density Lipoprotein Particles and Compositionally Distinct Subspecies. Journal of Lipid Research, 62, Article 100107. [Google Scholar] [CrossRef] [PubMed]
[13] Yang, X., Zhang, M., Zhang, Y., Wei, H., Guan, Q., Dong, C., et al. (2023) Ecological Change of the Gut Microbiota during Pregnancy and Progression to Dyslipidemia. npj Biofilms and Microbiomes, 9, Article No. 14. [Google Scholar] [CrossRef] [PubMed]
[14] 王海俊, 李小庆, 徐相蓉, 等. 分娩前后巨大儿对母婴的影响研究[J]. 中国生育健康杂志, 2019, 30(2): 121-126.
[15] Pan, X., Tang, L., Lee, A.H., Binns, C., Yang, C., Xu, Z., et al. (2019) Association between Fetal Macrosomia and Risk of Obesity in Children under 3 Years in Western China: A Cohort Study. World Journal of Pediatrics, 15, 153-160. [Google Scholar] [CrossRef] [PubMed]
[16] Yu, M., Wang, W. and Wang, H. (2020) The Late-Gestational Triglyceride to High-Density Lipoprotein Cholesterol Ratio Is Associated with Neonatal Macrosomia in Women without Diabetes Mellitus. International Journal of Endocrinology, 2020, 1-7. [Google Scholar] [CrossRef] [PubMed]
[17] Yuan, X., Han, X., Jia, C., Long, W., Wang, H., Yu, B., et al. (2022) Investigation and Application of Risk Factors of Macrosomia Based on 10,396 Chinese Pregnant Women. Frontiers in Endocrinology, 13, Article 837816. [Google Scholar] [CrossRef] [PubMed]
[18] Lu, S., Fu, Y., Wu, Y., Mao, A., Xu, M., Zheng, G., et al. (2020) Mediating Effects of Maternal Blood Triglycerides on the Relationship between Prepregnancy Body Mass Index and Fetal Macrosomia. The Journal of Pediatrics, 226, 118-122. [Google Scholar] [CrossRef] [PubMed]
[19] Guay, S., Houde, A., Breton, E., Baillargeon, J., Perron, P., Gaudet, D., et al. (2019) DNA Methylation at LRP1 Gene Locus Mediates the Association between Maternal Total Cholesterol Changes in Pregnancy and Cord Blood Leptin Levels. Journal of Developmental Origins of Health and Disease, 11, 369-378. [Google Scholar] [CrossRef] [PubMed]
[20] Wang, Y., Xu, X., Sun, H., Han, Y., Lei, Z., Wang, Y., et al. (2019) Cord Blood Leptin DNA Methylation Levels Are Associated with Macrosomia during Normal Pregnancy. Pediatric Research, 86, 305-310. [Google Scholar] [CrossRef] [PubMed]
[21] Mishra, J.S. and Kumar, S. (2023) Placental Fatty Acid Metabolism and Transport in a Rat Model of Gestational Diabetes Mellitus. Journal of Women’s Health and Development, 6, 56-67.
[22] 多中心大于胎龄儿新生儿期死亡原因及风险的病例对照研究[J]. 中国循证儿科杂志, 2019, 14(6): 401-405.
[23] 张扬扬, 李欢. 妊娠中期母体三酰甘油水平与大于胎龄儿的相关性分析[J]. 世界临床药物, 2022, 43(6): 762-766.
[24] 蔡文竹, 杨美英, 莫小跃. 孕前体质指数及妊娠期血糖水平与大于胎龄儿发生风险的相关性[J]. 临床医学研究与实践, 2021, 6(17): 31-33.
[25] Wang, D., Ding, W., Ding, C., Chen, H., Zhao, W., Sun, B., et al. (2021) Higher Peripheral Cholesterol and a Positive Correlation with Risk for Large-for-Gestational-Age Neonates in Pre-Pregnancy Underweight Women. Frontiers in Endocrinology, 12, Article 760934. [Google Scholar] [CrossRef] [PubMed]
[26] Wang, Y., Gong, Y., Xu, Y., Wang, X., Shan, S., Cheng, G., et al. (2024) Maternal Age-Specific Risks for Adverse Birth Weights According to Gestational Weight Gain: A Prospective Cohort in Chinese Women Older than 30. BMC Pregnancy and Childbirth, 24, Article No. 36. [Google Scholar] [CrossRef] [PubMed]
[27] Chen, K., Lin, S., Lee, C., Wu, H., Kuo, C., Kuo, H., et al. (2021) Maternal Plasma Lipids during Pregnancy, Insulin-Like Growth Factor-1, and Excess Fetal Growth. The Journal of Clinical Endocrinology & Metabolism, 106, e3461-e3472. [Google Scholar] [CrossRef] [PubMed]
[28] 张方圆, 翟淑芬, 花少栋, 等. 不同胎龄层住院新生儿疾病谱及死亡分析[J]. 发育医学电子杂志, 2021, 9(3): 220-227.
[29] 陈来梅, 赵青云, 孙静如, 等. 妊娠晚期血脂与分娩孕周及新生儿出生体重的关系研究[J]. 现代医药卫生, 2021, 37(16): 2783-2785.
[30] 周清, 袁德丽, 傅晓冬. 高龄产妇孕中期血脂水平对妊娠并发症的影响[J]. 成都医学院学报, 2021, 16(4): 468-472.
[31] 张琴, 黄丽群, 俞生林. 孕晚期母亲脂质代谢紊乱对早产儿视网膜病变的影响[J]. 国际眼科杂志, 2022, 22(1): 135-138.
[32] Borkowski, K., Newman, J.W., Aghaeepour, N., Mayo, J.A., Blazenović, I., Fiehn, O., et al. (2020) Mid-Gestation Serum Lipidomic Profile Associations with Spontaneous Preterm Birth Are Influenced by Body Mass Index. PLOS ONE, 15, e0239115. [Google Scholar] [CrossRef] [PubMed]
[33] 王晓庆, 刘九月, 姚光. 小于胎龄儿早期脑发育及18~24月龄时神经发育状况的前瞻性队列研究[J]. 中国儿童保健杂志, 2023, 31(4): 353-358.
[34] 张伟, 王翔, 赵益伟. 早产小于胎龄儿与早产适于胎龄儿住院期间生长代谢的差异分析[J]. 中国妇幼保健, 2023, 38(24): 4832-4835.
[35] Kuentzel, K.B., Bradić, I., Mihalič, Z.N., Korbelius, M., Rainer, S., Pirchheim, A., et al. (2022) Dysregulation of Placental Lipid Hydrolysis by High-Fat/High-Cholesterol Feeding and Gestational Diabetes Mellitus in Mice. International Journal of Molecular Sciences, 23, Article 12286. [Google Scholar] [CrossRef] [PubMed]
[36] Chen, Q., Chen, H., Xi, F., Sagnelli, M., Zhao, B., Chen, Y., et al. (2020) Association between Maternal Blood Lipids Levels during Pregnancy and Risk of Small-for-Gestational-Age Infants. Scientific Reports, 10, Article No. 19865. [Google Scholar] [CrossRef] [PubMed]
[37] Sáez, T., Pageé, A., Kirschenman, R., Quon, A., Spaans, F. and Davidge, S.T. (2023) A High Cholesterol Diet during Late Pregnancy Impairs Long-Term Maternal Vascular Function in Mice. Arteriosclerosis, Thrombosis, and Vascular Biology, 43, 120-132. [Google Scholar] [CrossRef] [PubMed]
[38] Lin, X., Gao, L., Tian, S., Klausen, C., Guo, M., Gao, Q., et al. (2021) Maternal High-Fat-Diet Exposure Is Associated with Elevated Blood Pressure and Sustained Increased Leptin Levels through Epigenetic Memory in Offspring. Scientific Reports, 11, Article No. 316. [Google Scholar] [CrossRef] [PubMed]
[39] Catov, J.M., McNeil, R.B., Marsh, D.J., Mercer, B.M., Bairey Merz, C.N., Parker, C.B., et al. (2021) Early Pregnancy Atherogenic Profile in a First Pregnancy and Hypertension Risk 2 to 7 Years after Delivery. Journal of the American Heart Association, 10, e017216. [Google Scholar] [CrossRef] [PubMed]
[40] Adank, M.C., Benschop, L., Peterbroers, K.R., Smak Gregoor, A.M., Kors, A.W., Mulder, M.T., et al. (2019) Is Maternal Lipid Profile in Early Pregnancy Associated with Pregnancy Complications and Blood Pressure in Pregnancy and Long Term Postpartum? American Journal of Obstetrics and Gynecology, 221, 150-151. [Google Scholar] [CrossRef] [PubMed]

为你推荐