Placental transport and metabolism in fetal overgrowth - A workshop report
Placental transport and metabolism in fetal overgrowth - A workshop report
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DOI：
10.1016/j.placenta.2006.01.017
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发表时间：
2006-04-01
期刊：
影响因子：
3.8
通讯作者：
Sibley, C. P.
中科院分区：
文献类型：
--
作者：
Jansson, T.;Cetin, I.;Sibley, C. P.
妊娠合并糖尿病的胎儿过度生长是由于底物可用性增加，从而刺激胎儿胰岛素分泌和胎儿生长。然而，尽管现代临床对糖尿病孕妇进行了严格的血糖控制，但胎儿过度生长仍然是一个重要的临床问题。最近的体内研究提供了证据，表明即使在严格控制代谢的情况下，妊娠糖尿病（GDM）患者向胎儿输送的氨基酸也会增加。这可能是由于糖尿病妊娠无法达到真正正常的母体底物水平和/或胎盘营养转运和代谢改变所致。体外研究表明，GDM中某些氨基酸的胎盘运输系统上调与胎儿过度生长有关。GDM还以胎盘基因表达的改变为特征，包括炎症介质和瘦素的上调。在伴有胎儿过度生长的1型糖尿病中，胎盘葡萄糖和某些氨基酸转运体以及胎盘脂保护素脂肪酶的体外活性增加。此外，i型糖尿病妊娠的临床观察和初步的动物实验研究表明，即使妊娠早期短暂的代谢紊乱也可能影响妊娠剩余时间的胎盘生长和转运功能，从而导致胎儿过度生长。超声测量胎儿脂肪沉积和腹围以及三维超声评估胎盘体积是胎儿和胎盘过度生长的子宫内诊断的无创技术。这些方法对糖尿病妊娠的临床管理是有价值的补充。总之，胎盘功能的改变可能是糖尿病妊娠中代谢控制明显最佳的胎儿过度生长的机制之一。我们认为，在体外和体内获得的胎盘代谢和转运功能的详细信息代表了一种胎盘表型，它提供了重要的信息，可能有助于胎儿过度生长的诊断和改善临床管理。
Fetal overgrowth in pregnancies complicated by diabetes is the result of an increased substrate availability which stimulates fetal insulin secretion and fetal growth. However, despite strict glycemic control in modern clinical management of the pregnant woman with diabetes, fetal overgrowth remains an important clinical problem. Recent Studies in vivo provide evidence for increased delivery of amino acids to the fetus in gestational diabetes (GDM) even when metabolic control is strict. This could be due to that truly normal maternal substrate levels cannot be achieved in diabetic pregnancies and/or caused by altered placental nutrient transport and metabolism. Studies in vitro demonstrate an up-regulation of placental transport Systems for certain amino acids in GDM associated with fetal overgrowth. GDM is also characterized by changes in placental gene expression, Including upregulation of inflammatory mediators and Leptin. In type-I diabetes with fetal overgrowth the in vitro activity of placental transporters for both glucose and certain amino acids as well as placental lipoprotcin lipase is increased. Furthermore, both clinical observations in type-I diabetic pregnancies and preliminary animal experimental studies suggest that even brief periods of metabolic perturbation early in pregnancy may affect placental growth and transport function for the remainder of pregnancy, thereby contributing to fetal overgrowth. Ultrasound measurements of fetal fat deposits and abdominal circumference as well as 3D ultrasound assessment of placental volume represent non-invasive techniques for In Utero diagnosis of fetal and placental overgrowth. It is proposed that these methods represent valuable additions to the clinical management of the diabetic pregnancy. In conclusion, altered placental function may be a mechanism contributing to fetal overgrowth in diabetic pregnancies with apparent optimal metabolic control. It is proposed that detailed information on placental metabolism and transport functions obtained in vitro and in vivo represent a placental phenotype that provides important information and may facilitate diagnosis and improve clinical management of fetal overgrowth.