摘要
目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)产妇母乳中n-3多不饱和脂肪酸(polyunsaturated fatty acids,PUFA)的含量变化及其与婴儿早期生长发育的关系。方法2016年6月至2017年12月,在广州市花都区人民医院产科住院分娩的产妇中,纳入50对GDM产妇及其新生儿为GDM组,50对无妊娠期并发症的产妇及其新生儿为对照组。收集初乳(产后2~3 d内)、过渡乳(12~14 d)、1月成熟乳、3月成熟乳,采用母乳分析仪测定母乳中能量、碳水化合物、脂肪、蛋白质值,气相色谱法测定乳汁中EPA、DHA及ɑ-ALA的含量。采用24 h膳食回顾法,调查母体各类食物及营养素的摄入情况。采用盖泽尔发育诊断量表进行婴儿智能行为发育水平的测定。统计学方法采用t检验、χ2检验、Spearman相关性分析。结果1、2、3月龄时,GDM组婴儿的身长净增值、体重净增值、头围净增值均低于对照组(P﹤0.05)。1月龄时,GDM组婴儿的适应性、大运动、个人社交的发育商得分低于对照组(P﹤0.05);3月龄时GDM组婴儿的大运动、精细运动、语言发育商得分低于对照组(P﹤0.05);GDM组1月龄及3月龄时的总发育商均低于对照组(P﹤0.05)。两组母乳中ɑ-ALA和EPA含量随月龄逐渐增高,DHA的含量则随月龄降低;各时间段GDM组DHA、EPA和ɑ-ALA含量均低于对照组,差异有统计学意义(P﹤0.05)。产后3个月时,GDM组母乳中DHA含量与婴儿身长净增值、体重净增值、头围净增值及总发育商均呈正相关(P﹤0.05),EPA含量与婴儿体重净增值、头围净增值和总发育商呈正相关(P﹤0.05),ɑ-ALA含量与婴儿体重净增值呈正相关(P﹤0.05);但对照组各指标与DHA、EPA、ɑ-ALA均无显著相关性(P﹥0.05)。结论GDM母亲产后早期的乳汁中n-3PUFA含量偏低,婴儿生长发育指标偏低,母乳中n-3PUFA含量与婴儿生长发育的部分指标呈正相关。
Objective To investigate the relation between the changes of n-3 polysaturated fatty acid content(PUFA)in breast milk of parturients with gestational diabetes mellitus(GDM)and the early growth and development of infants.Methods From June 2016 to December 2017,50 pairs of parturients with GDM and their newborns were admitted in the Guangzhou Huadu District People's Hospital as GDM group,50 pairs of parturients without gestational complications and their newborns were selected as the control group.Colostrum(within 2~3 d after delivery),transitional milk(12~14 d),and mature milk(1 month,3 months)were collected.The energy,carbohydrate,fat and protein in breast milk were determined by breast milk analyzer.The contents of EPA,DHA andɑ-ALA in breast milk were determined by gas chromatography.The intake of various foods and nutrients for the mothers were investigated by the 24-hour diet review method.The development level of infants'intelligence and behavior was measured by Gesell Development Diagnostic Scale.The t test,χ2 test,and Spearman correlation analysis were used for statistical analysis.Results At the age of 1,2 and 3 months,the net increment of body length,body weight and head circumference for infants in GDM group were lower than those in control group(P﹤0.05).At the age of 1 month,the scores of adaptability,gross motor movements and individual social contact development quotient in GDM group were lower than those in control group(P﹤0.05).At the age of 3 months,the scores of gross motor movements,fine movements and language development quotient in GDM group were lower than those in control group(P﹤0.05).The total of developmental quotient at the age of 1 month and 3 months in GDM group was lower than that in control group(P﹤0.05).The contents ofɑ-ALA and EPA in the breast milk for the two groups gradually increased by month.But the content of DHA gradually decreased by month.The contents of DHA,EPA andɑ-ALA in breast milk in GDM group were lower than those in the control group at each time with statistical significance(P﹤0.05).At 3 months after delivery,the content of DHA in breast milk was positively correlated with the net increment of body length,weight,head circumference and total development quotient in GDM group(P﹤0.05);EPA content was positively correlated with net increment of infant's body weight,head circumference and total development quotient(P﹤0.05),ɑ-ALA content was positively correlated with the net increment of infant's body weight(P﹤0.05).However,those indexes showed no significant correlation with the DHA,EPA andɑ-ALA in the control group(P﹥0.05).Conclusions The low content of n-3PUFA in breast milk of GDM mothers in early postpartum period leads to the poor growth and development index of infants.The content of n-3PUFA in breast milk is positively correlated with some indexes of infant growth and development.
作者
何素健
刘喜红
杨波
罗红凤
黎常红
肖妮蓉
徐明枝
HE Su-jian;LIU Xi-hong;YANG Bo;LUO Hong-feng;LI Chang-hong;XIAO Ni-rong;XU Ming-zhi(Department of Clinical Nutrition,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangdong,Guangzhou 510623,China;Department of Nutrition,Guangzhou Huadu District People's Hospital,Guangdong,Guangzhou 510800,China;Child Healthcare Department,Guangzhou Huadu District People's Hospital,Guangdong,Guangzhou 510800,China;Department of Obstetrics,Guangzhou Huadu District People's Hospital,Guangdong,Guangzhou 510800,China)
出处
《发育医学电子杂志》
2019年第4期274-281,共8页
Journal of Developmental Medicine (Electronic Version)
基金
广东省科技厅项目（2017ZC0390）
广州市花都区科技计划项目(16-HDWS-003)
关键词
妊娠期糖尿病
N-3多不饱和脂肪酸
婴儿
生长发育
母乳
膳食摄入
Gestational diabetes mellitus
n-3 polyunsaturated fatty acids
Infant
Growth and development
Breast milk
Dietary intake
