Placental Growth Response to Maternal Insulin in Early Pregnancy
Placental Growth Response to Maternal Insulin in Early Pregnancy
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DOI：
10.1210/jc.2014-3281
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发表时间：
2015-01-01
影响因子：
5.8
通讯作者：
Catalano, Patrick
中科院分区：
文献类型：
--
作者：
O'Tierney-Ginn, Perrie;Presley, Larraine;Catalano, Patrick
背景：胎盘对母体胰岛素的敏感性仍然存在争议。妊娠早期可能是胎盘对母体胰岛素敏感性增加的时期，因为妊娠前三个月合体滋养层上的胰岛素受体丰富，但足月时则少得多。假设：妊娠早期而非晚期的母体胰岛素分泌反应与胎盘生长呈正相关。设计：这是对怀孕前招募的一组妇女 (n = 40) 进行的二次分析。 结果测量：在怀孕前和妊娠早期进行静脉内葡萄糖耐量测试。 （12-14 周）和妊娠晚期（34-36 周）。记录整个妊娠期的胎盘体积（部分女性通过三维超声检查）和出生时的体重。结果：妊娠早期总胰岛素分泌反应与妊娠早期胎盘体积（R = 0.79，P = 0.04）和足月胎盘重量（R = 0.42，P = 0.007）呈正相关。妊娠前和妊娠晚期的胰岛素分泌反应与胎盘生长没有显着相关性。虽然新生儿脂肪量与足月胎盘重量密切相关（R = 0.449，P = 0.0003），但男性后代的母体胰岛素分泌反应仅与出生时的新生儿脂肪量相关（R = 0.59，P = 0.008）。结论：妊娠早期母体胰岛素分泌反应与出生时胎盘重量密切相关。因此，在妊娠早期，肥胖和妊娠糖尿病中母体胰岛素反应的增加可能是对胎盘生长的关键影响，这可能是由于妊娠早期母体绒毛膜上胎盘胰岛素受体的增强。
Context: The sensitivity of the placenta to maternal insulin remains controversial. Early pregnancy may be a time of increased placental sensitivity to maternal insulin because insulin receptors are abundant on the syncytiotrophoblast in the first trimester but are far fewer at term.Hypothesis: Maternal insulin secretory response in early, but not late, pregnancy is positively associated with placental growth.Design: This is a secondary analysis of a cohort of women (n = 40) recruited before pregnancy.Outcome Measures: An iv glucose tolerance test was administered before pregnancy and in early (12-14 weeks) and late (34-36 weeks) pregnancy. Placental volume throughout gestation (in a subset of women via 3-dimensional ultrasound) and weight at birth were recorded.Results: Total insulin secretory response in early pregnancy was positively associated with placental volume in early pregnancy (R = 0.79, P = 0.04) and placental weight at term (R = 0.42, P = 0.007). Insulin secretory response before and in late pregnancy was not significantly associated with placental growth. Although neonatal fat mass was strongly correlated with placental weight at term (R = 0.449, P = 0.0003), maternal insulin secretory response was related to neonatal fat mass only at birth in male offspring (R = 0.59, P = 0.008).Conclusions: Maternal insulin secretory response in early pregnancy was strongly related to placental weight at birth. Thus, in early pregnancy, increased maternal insulin response as seen in obesity and gestational diabetes mellitus may be a key influence on placental growth, possibly due to the enhanced presence of placental insulin receptors on the maternal villous membrane early in gestation.