女性肥胖与早产的研究进展-国际妇产科研究-CSCIED科技核心评价数据库-手机版

女性肥胖与早产的研究进展

Research progress on obesity and premature birth in women

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DOI	10.12208/j.ijog.20240015
刊名	国际妇产科研究 International Journal of Obstetrics and Gynecology
年，卷(期)	2024, 4(2)
作者	闵瑜, 王嘉伟,
作者单位	南通大学附属医院江苏南通
摘要	目的随着经济水平的提高及生活水平的提高，肥胖已成为全球性的重大挑战，肥胖孕妇的数量逐年攀升，对母体和子代健康均构成了显著威胁。而早产作为新生儿死亡的重要原因，让不少研究者关注到肥胖与早产存在关联。本文就孕妇肥胖与早产之间的关系、可能存在的作用机制以及如何监测干预进行阐述。方法将最近二十年提及的涉及女性肥胖与早产的联系的文献进行分类汇总。结果 1.肥胖对女性及其子代存在种种负面影响，同时不同危险因素对肥胖与早产的联系存在异质性；2.尽管肥胖导致早产的确切机制尚未明确，但研究表明，肥胖可能通过引发胎盘炎症来增加早产风险。肥胖会增加脂肪组织中活性氧（ROS）的产生，激活炎症途径，导致炎性细胞因子如肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）的水平上升,这些炎症因子参与胎盘结构和功能的改变，从而可能引发早产。3.通过实施有效的监测和干预措施，可以显著降低肥胖对早产风险的影响。结论本文详细阐述了女性肥胖与早产之间的联系，并提出了通过多元性干预措施可以有效降低肥胖女性早产率。未来研究应进一步探索孕前肥胖导致早产的生物学机制，为肥胖女性的早产预防和治疗提供更加有效的干预手段。
Abstract	Objective With the improvement of economic level and living standards, obesity has become a major global challenge. The number of obese pregnant women has increased year by year, posing a significant threat to the health of both mothers and offspring. As an important cause of neonatal death, premature birth has attracted the attention of many researchers to the association between obesity and premature birth. This article describes the relationship between obesity and premature birth in pregnant women, possible mechanisms of action, and how to monitor and intervene. Methods The literature on the relationship between obesity and premature birth in women mentioned in the past two decades was classified and summarized. Results 1. Obesity has various negative effects on women and their offspring, and different risk factors have heterogeneous effects on the relationship between obesity and premature birth; 2. Although the exact mechanism of obesity leading to premature birth has not yet been clarified, studies have shown that obesity may increase the risk of premature birth by inducing placental inflammation. Obesity increases the production of reactive oxygen species (ROS) in adipose tissue, activates inflammatory pathways, and leads to increased levels of inflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). These inflammatory factors are involved in changes in placental structure and function, which may induce premature birth. 3. The impact of obesity on the risk of premature birth can be significantly reduced by implementing effective monitoring and intervention measures. Conclusion This article elaborates on the relationship between obesity and premature birth in women, and proposes that multivariate intervention measures can effectively reduce the premature birth rate in obese women. Future studies should further explore the biological mechanism of preterm birth caused by pre-pregnancy obesity, and provide more effective intervention methods for the prevention and treatment of premature birth in obese women.
关键词	孕前肥胖；孕前超重；早产
KeyWord	Pre-pregnancy obesity; Pre-pregnancy overweight; Premature birth
基金项目
页码	22-30

参考文献
相关文献

[1] WHO. Obesity and Overweight. 2024. Available online: https://www.who.int/news-room/fact-sheets/detail/obesity and overweight(accessed on 1 March 2024)

[2] Seravalle G, Grassi G. Obesity and hypertension. Pharmacol Res. 2017 Aug; 122:1-7.

[3] Zhang Z, et al. Insulin resistance assessed by estimated glucose disposal rate and risk of incident cardiovascular diseases among individuals without diabetes: findings from a nationwide, population based, prospective cohort study. Cardiovasc Diabetol. 2024 Jun 6;23(1):194.

[4] Jin S, Liu J, Jia Y, Sun C, Na L. Temporal relationships between blood glucose, lipids and BMI, and their impacts on atherosclerosis: a prospective cohort study. BMJ Open. 2024 Jun 5;14(6):e079521.

[5] Mikkola U, Rissanen I, et al. Overweight in Adolescence and Young Adulthood in Association With Adult Cerebrovascular Disease: The NFBC1966 Study. Stroke. 2024 Jun 6.

[6] Obesity Update—OECD. 2017. Available online: https://www.oecd.org/health/obesity-update.htm

[7] Broughton DE, Moley KH. Obesity and female infertility: potential mediators of obesity's impact. Fertil Steril. 2017 Apr;107(4):840-847.

[8] Dornelles VC, et al.Influence of overweight and obesity on perinatal outcomes in assisted reproduction: a retrospective cohort study. BMC Pregnancy Childbirth. 2022 Jul 28;22(1):603.

[9] O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003 May;14(3):368-74.

[10] 马翔,刘嘉茵.肥胖对妊娠的影响
[J].实用妇产科杂志,2011,27(05):330-332.

[11] Aslam, H.M.; Saleem, et al. Risk factors of birth asphyxia. Ital. J. Pediatr. 2014, 40, 94.

[12] Alonso-Alconada, D.; Hassell, K.J.; Robertson, N.J. Birth Asphyxia: Prevalence, Causes, Clinical Progression and Neuroprotection. In Asphyxia: Risk Factors, Prevalence and Neurological Impacts; Santos, A.R., Ed.; Nova Science Publishers: New York, NY, USA, 2015; pp. 5–20.

[13] Goodwin, T.M.; Belai, I.; Hernandez, P.; Durand, M.; Paul, R.H. Asphyxial complications in the term newborn with severe umbilical acidemia. Am. J. Obstet. Gynecol. 1992, 167, 1506–1512.

[14] Heller, G.; Schnell, R.; Misselwitz, B.; Schmidt, S. Umbilical blood pH, Apgar scores, and early neonatal mortality. Zeitschr Geburtshilfe Neonatol. 2003, 207, 84–89.

[15] Gaillard R, Felix JF, Duijts L, et al. Childhood consequences of maternal obesity and excessive weight gain during pregnancy
[J]. Acta Obstet Gynecol Scand,2014, 93(11):1085-1089.

[16] 赵涵,张乐,刘聪.孕妇肥胖对子代结局影响的研究进展
[J].疑难病杂志,2019,18(02):200-203+207.

[17] Tano S, Kotani T, Ushida T, et al. Optimal annual body mass index change for preventing spontaneous preterm birth in a subsequent pregnancy. Sci Rep. 2022 Oct 19;12(1):17502.

[18] Belizán JM, Hofmeyr J, Buekens P, Salaria N. Preterm birth, an unresolved issue. Reprod Health. 2013 Nov 15;10(1):58.

[19] Walani SR. Global burden of preterm birth. Int J Gynaecol Obstet. 2020 Jul;150(1):31-33. doi: 10.1002/ijgo.13195. PMID: 32524596.

[20] Michael S. Kramer, Aris Papageorghiou, Jennifer Culhane, Zulfiqar Bhutta, et al. Challenges in defining and classifying the preterm birth syndrome,American Journal of Obstetrics and Gynecology, Volume 206, Issue 2, 2012, Pages 108-112, ISSN 0002-9378, https://doi.org/10.1016/j.ajog.2011.10.864.

[21] R Romero, J Espinoza, J Kusanovic, et al.The preterm parturition syndromeBJOG, 113 (2006), pp. 17-42

[22] Robert L Goldenberg, Jennifer F Culhane, Jay D Iams, Roberto Romero. Epidemiology and causes of preterm birth, The Lancet, Volume 371, Issue 9606, 2008, Pages 75-84, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(08)60074-4.

[23] 徐书生.早产儿临床与死亡相关因素分析
[J].实用妇产科杂志,2002(06):354-355.

[24] 夏颖丽,陈颖,郑卫红,等.早产相关因素及早产儿结局临床分析
[J].中国妇产科临床杂志,2008(02):114-117+134.

[25] Oltman P S ,Chambers D B ,Baer J R , et al.479: One-year mortality risk by complication for Black compared to White preterm infants
[J].American Journal of Obstetrics and Gynecology,2019,220(1):S320-S320.

[26] 吴新萍,谷传丽,韩树萍,等.极早产儿存活率和并发症的多中心回顾性研究
[J].中国当代儿科杂志,2021,23(08): 814-820.

[27] Rosenberg TJ, Garbers S, Lipkind H, Chiasson MA. Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups. Am J Public Health. 2005 Sep;95(9):1545-51.

[28] Kim SS, Mendola P, Zhu Y, Hwang BS, Grantz KL. Spontaneous and indicated preterm delivery risk is increased among overweight and obese women without prepregnancy chronic disease. BJOG. 2017 Oct;124(11): 1708-1716.

[29] NCD Countdown 2030 collaborators. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet. 2018 Sep 22;392(10152):1072-1088.

[30] Berger H, Melamed N, Murray-Davis B, et al. Diabetes, Obesity and Hypertension in Pregnancy Research Network (DOH-NET) and the Southern Ontario Obstetrical Network (SOON) Investigators. Prevalence of Pre-Pregnancy Diabetes, Obesity, and Hypertension in Canada. J Obstet Gynaecol Can. 2019 Nov;41(11):1579-1588.e2.

[31] Berger H, Melamed N, Davis BM, Hasan H, Mawjee K, Barrett J, McDonald SD, Geary M, Ray JG. Impact of diabetes, obesity and hypertension on preterm birth: Population-based study. PLoS One. 2020 Mar 25;15(3):e0228743.

[32] Wei YM, Yang HX, Zhu WW, Liu XY, Meng WY, et al. Risk of adverse pregnancy outcomes stratified for pre-pregnancy body mass index. J Matern Fetal Neonatal Med. 2016;29(13):2205-9.

[33] Cnattingius S, Villamor E, Johansson S, Edstedt Bonamy AK, et al. Maternal obesity and risk of preterm delivery. JAMA. 2013 Jun 12;309(22):2362-70.

[34] Liu K, Chen Y, Tong J, Yin A, Wu L, Niu J. Association of maternal obesity with preterm birth phenotype and mediation effects of gestational diabetes mellitus and preeclampsia: a prospective cohort study. BMC Pregnancy Childbirth. 2022 Jun 1;22(1):459.

[35] Lucy T. Brink, Drucilla J. Roberts, Colleen A. Wright, Daan G. Nel, et al. Placental pathology in spontaneous and iatrogenic preterm birth: Different entities with unique pathologic features, Placenta, Volume 126, 2022, Pages 54-63, ISSN 0143-4004, https://doi.org/10.1016/j.placenta.2022.06.004.

[36] Santos S, Voerman E, Amiano P, et al. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European North American and Australian cohorts. BJOG. 2019;126(8):984–95. https://doi.org/10.1111/1471-0528.15661.

[37] Zong X, Wang H, Yang L, et al. Maternal pre-pregnancy body mass index categories and infant birth outcomes: A population-based study of 9 Million mother-infant pairs. Front Nutr. 2022;9: 789833. https://doi.org/10.3389/2Ffnut.2022.789833.

[38] Khandre V, Potdar J, Keerti A (December 27, 2022) Preterm Birth: An Overview. Cureus 14(12): e33006.

[39] Palatnik A, Miller ES, Son M, Kominiarek MA. Association among Maternal Obesity, Cervical Length, and Preterm Birth. Am J Perinatol. 2017 Apr;34(5):471-479.

[40] Cornish RP, Magnus MC, et al. Maternal pre-pregnancy body mass index and risk of preterm birth: a collaboration using large routine health datasets. BMC Med. 2024 Jan 5;22(1):10.

[41] Tsur A, Mayo JA, Wong RJ, Shaw GM, Stevenson DK, Gould JB. 'The obesity paradox': a reconsideration of obesity and the risk of preterm birth. J Perinatol. 2017 Oct;37(10):1088-1092.

[42] Liu K, Chen Y, Tong J, Yin A, Wu L, Niu J. Association of maternal obesity with preterm birth phenotype and mediation effects of gestational diabetes mellitus and preeclampsia: a prospective cohort study. BMC Pregnancy Childbirth. 2022 Jun 1;22(1):459.

[43] Cnattingius S, Villamor E, et al. Maternal obesity and risk of preterm delivery. JAMA. 2013 Jun 12;309(22):2362-70.

[44] Gould JB, Mayo J, Shaw GM, Stevenson DK. March of Dimes Prematurity Research Center at Stanford University School of Medicine. Swedish and American studies show that initiatives to decrease maternal obesity could play a key role in reducing preterm birth. Acta Paediatr. 2014 Jun;103(6):586-91.

[45] Marseglia, L., et al. Oxidative stress in obesity: a critical component in human diseases. Int J Mol Sci, 2014. 16(1): p. 378-400.

[46] Lopez-Yañez Blanco, A., et al. Diet and Maternal Obesity Are Associated with Increased Oxidative Stress in Newborns: A Cross-Sectional Study. Nutrients, 2022. 14(4).

[47] Mandò, C., et al. Impact of Obesity and Hyperglycemia on Placental Mitochondria. Oxid Med Cell Longev, 2018. 2018: p. 2378189.

[48] Zhang, C.X.W., A.A. Candia, and A.N. Sferruzzi-Perri. Placental inflammation, oxidative stress, and fetal outcomes in maternal obesity. Trends Endocrinol Metab, 2024. 35(7): p. 638-647.

[49] Musa, E., et al. Obesity and gestational diabetes independently and collectively induce specific effects on placental structure, inflammation and endocrine function in a cohort of South African women. J Physiol, 2023. 601(7): p. 1287-1306.

[50] Nogues, P., et al. Maternal Obesity Influences Placental Nutrient Transport, Inflammatory Status, and Morphology in Human Term Placenta. J Clin Endocrinol Metab, 2021. 106(4): p. e1880-e1896.

[51] Sferruzzi-Perri, A.N., J. Lopez-Tello, and E. Salazar-Petres. Placental adaptations supporting fetal growth during normal and adverse gestational environments. Exp Physiol, 2023. 108(3): p. 371-397.

[52] XU Yidan, ZHANG Qianren, et al. Effect of maternal high-fat diet on placental phenotype in mice
[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(4): 397-405

[53] 徐一丹, et al.高脂饮食孕鼠胎盘微环境特征及其意义. 上海交通大学学报（医学版）, 2023. 43(4): p. 397-405.

[54] Mandò, C., et al. Impact of Obesity and Hyperglycemia on Placental Mitochondria. Oxid Med Cell Longev, 2018. 2018: p. 2378189.

[55] Brand, C., et al. Relationship between insulin resistance and adipocytokines: the mediator role of adiposity in children. Ann Hum Biol, 2020. 47(3): p. 244-249.

[56] Dai, J., et al. Metabolome-Wide Associations of Gestational Weight Gain in Pregnant Women with Overweight and Obesity. Metabolites, 2022. 12(10).

[57] 妊娠期糖尿病妇女体重增长推荐值标准
[J].全科医学临床与教育,2024,22(01):5-6.

[58] Kim SY, Oh SY, Sung JH, Choi SJ, et al. Validation of a Strict Obesity Definition Proposed for Asians to Predict Adverse Pregnancy Outcomes in Korean Pregnant Women. J Korean Med Sci. 2021 Nov 15;36(44):e281.

[59] Song Z, Cheng Y, Li T, et al. Effects of obesity indices/GDM on the pregnancy outcomes in Chinese women: A retrospective cohort study. Front Endocrinol (Lausanne). 2022 Nov 18;13:1029978.

[60] Mustafa HJ, Seif K, et al. Gestational weight gain below instead of within the guidelines per class of maternal obesity: a systematic review and meta-analysis of obstetrical and neonatal outcomes. Am J Obstet Gynecol MFM. 2022 Sep;4(5):100682.

[61] Isabel L G O ,Luis H O , et al.Association of pre-pregnancy body mass index and rate of weight gain during pregnancy with maternal indicators of cardiometabolic risk
[J]. Nutrition & Diabetes,2021,11(1):36-36.

[62] Fakhraei R, Denize K, et al. Predictors of Adverse Pregnancy Outcomes in Pregnant Women Living with Obesity: A Systematic Review. Int J Environ Res Public Health. 2022 Feb 12;19(4):2063.

[63] 赵金荣,李萍,李玉芳,等.运动饮食干预对肥胖孕妇母婴结局及子代的影响
[J].现代中西医结合杂志,2016,25(35): 3926-3928.

[64] 吕超,赵晨晨,曲桂玉.饮食和运动干预对妊娠期糖尿病病人血糖控制和妊娠结局影响的Meta分析
[J].护理研究,2018,32(17):2753-2758.

[65] McDonald SM, Mouro S, et al. Influence of prenatal exercise on the relationship between maternal overweight and obesity and select delivery outcomes. Sci Rep. 2022 Oct 15;12(1):17343.

[66] Chen Y, Ma G , et al. Effects of Maternal Exercise During Pregnancy on Perinatal Growth and Childhood Obesity Outcomes: A Meta-analysis and Meta-regression. Sports Med. 2021 Nov;51(11):2329-2347. doi: 10.1007/s40279-021-01499-6. Epub 2021 Jun 18. Erratum in: Sports Med. 2021 Nov;51(11):2349.

[67] 袁思梅.步行运动对肥胖孕妇妊娠结局的影响
[J].护士进修杂志,2015,30(10):909-910.

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闵瑜, 王嘉伟. 女性肥胖与早产的研究进展 [J]. 国际妇产科研究. 2024; 4; (2). 22 - 30.

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