研究者詳細 - 池ノ上　学

論文 - 池ノ上　学

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日本人妊娠糖尿病既往女性における産後糖代謝異常発症予測因子に関する後方視的検討

春日義史, 宮越敬, 税所芳史, 池ノ上学, 荒田尚子, 田中守

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 19 （ 2 ） S - 67 2019年08月

ISSN 1347-9172

日本人妊娠糖尿病(Gestational Diabetes Mellitus:GDM)既往女性における産後糖代謝異常(Postpartum Abnormal Glucose Tolerance:pAGT)発症予測因子を検討した。対象は日本人GDM合併単胎妊婦のうち、分娩後1年以内に75gOGTTを受けた女性である(pAGT[n=59]、正常耐糖能型[n=154])。GDM診断時OGTT血糖値ならびに遺伝因子とpAGTとの関連解析を行ったところ、OGTT2時間値のpAGT発症予測能が高かった(AUC=0.72)。遺伝因子では4遺伝子がpAGT群においてリスクアレルを多く持つ傾向にあり、検出された4遺伝子中、3遺伝子はインスリン分泌関連遺伝子であった。日本人GDM既往女性において、GDM診断時OGTT 2時間値がpAGT発症予測に有用であり、遺伝学的にインスリン分泌不全の関与が示唆された。(著者抄録)

妊娠糖尿病における抗Glutamic Acid Decarboxylase抗体と周産期事象との関連

池ノ上学, 宮越敬, 遠藤豊英, 大石真希, 税所芳史, 田中守

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 19 （ 2 ） S - 84 2019年08月

ISSN 1347-9172

抗Glutamic Acid Decarboxylase(GAD)抗体は、自己免疫性1型糖尿病の診断や発症予知に用いられる膵島関連自己抗体であるが、妊娠糖尿病(Gestational diabetes mellitus:GDM)との関連に関する知見は乏しい。今回、抗GAD抗体の測定を行ったGDM妊婦172例を対象とし、GDM妊婦におけるGAD抗体の陽性率と、その母体背景および周産期予後との関連について検討した。GDMにおけるGAD抗体陽性率は3.5%であり、抗GAD抗体陽性例では妊娠高血圧腎症が有意に高率であった。その他の周産期事象や母体背景には有意差を認めなかった。GDM妊婦において、抗GAD抗体は妊娠高血圧腎症のリスク因子となる可能性が示唆された。(著者抄録)

性分化疾患を含む多発先天異常を胎内診断し周産期管理を行った1例

明石一浩, 池ノ上学, 遠藤豊英, 大石真希, 落合大吾, 宮越敬, 田中守, 長谷川奉延, 飛彈麻里子, 有光威志, 高橋萌, 若林大樹, 玉岡哲, 黒田達夫

日本周産期・新生児医学会雑誌（(一社)日本周産期・新生児医学会） 55 （ 2 ） 591 - 591 2019年06月

ISSN 1348-964X

子宮内膜異型増殖症および早期子宮体癌に対する高用量黄体ホルモン療法後妊娠の産科的予後に関する検討

大石真希, 宮越敬, 遠藤豊英, 池ノ上学, 落合大吾, 田中守

日本周産期・新生児医学会雑誌（(一社)日本周産期・新生児医学会） 55 （ 2 ） 485 - 485 2019年06月

ISSN 1348-964X

ヒト羊水幹細胞投与はLPS誘発性新生仔炎症モデルラットの予後を改善する

佐藤佑, 落合大吾, 大谷利光, 福武麻里絵, 池ノ上学, 宮越敬, 田中守

日本周産期・新生児医学会雑誌（(一社)日本周産期・新生児医学会） 55 （ 2 ） 551 - 551 2019年06月

ISSN 1348-964X

Changes in bone metabolic profile associated with pregnancy or lactation

Miyamoto T., Miyakoshi K., Sato Y., Kasuga Y., Ikenoue S., Miyamoto K., Nishiwaki Y., Tanaka M., Nakamura M., Matsumoto M.

Scientific Reports （Scientific Reports） 9 （ 1 ） 6787 - 6787 2019年05月

ISSN 2045-2322

© 2019, The Author(s). Calcium and nutrients are transferred from mothers to fetuses or infants during pregnancy or lactation, respectively, promoting metabolic changes in the mother, many uncharacterized. To evaluate these changes, we undertook two parallel studies. In one we analyzed fourteen clinical cases of vertebral fragility fractures, at or before three months after partum, in mothers who breastfed their infants. In the other, we enrolled 79 additional pregnant subjects, some who chose to breastfeed and others who did not, and analyzed changes in bone metabolic status starting between 34 and 36 weeks of gestation and ending one month after partum. In the larger group, bone-resorbing and bone-forming parameters such as serum TRACP5b and osteocalcin, respectively, significantly increased after partum. Among parameters that changed after partum, serum PTH and the bone-resorbing markers serum TRACP5b and urine NTX were significantly higher in mothers who only breastfed infants compared to mothers who fed infants formula or a mix of both. However, bone-forming parameters were comparable between breastfeeding and non-breast-feeding groups after partum, suggesting that elevated bone-resorption occurs only in the breastfeeding group. Radiographic analysis after partum demonstrated that no subject among the 79 analyzed showed vertebral fractures, even those who breastfed exclusively. Among fracture cases analyzed, subjects exhibited significantly lower bone mineral density than did non-fracture cases in breastfeeding-only subjects. We conclude that bone metabolic status significantly changes over the period between pregnancy and post-partum lactation, and that low bone mineral density seen in a small subset of breastfeeding-only cases likely causes post-partum vertebral fragility fractures.

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Glycemic and metabolic features in gestational diabetes: singleton versus twin pregnancies

Akiba, Y., Miyakoshi, K., Ikenoue, S., Saisho, Y., Kasuga, Y., Ochiai, D., Matsumoto, T. and Tanaka, M.

Endocr J 66 （ 7 ） 647 - 651 2019年04月

ISSN 1348-4540

A number of data on gestational diabetes mellitus (GDM) in singleton pregnancy is available, however, little is known about the glycemic characteristics of twin pregnancy with GDM. The aim of this study was to compare the severity of dysglycemia between twin and singleton pregnancies with GDM (T-GDM and S-GDM). We retrospectively analyzed pregnancies with GDM defined by the Japan Diabetes Society criteria (T-GDM, n = 20; S-GDM, n = 451) in our hospital. During the study period, women with GDM underwent self-monitoring of blood glucose measurements as well as dietary management. Insulin treatment was initiated when dietary treatment did not achieve the glycemic goal. The glycemic and metabolic characteristics were compared between T-GDM and S-GDM, as follows: gestational week at the diagnosis of GDM, 75 g oral glucose tolerance test (OGTT) results, HbA1c, insulin secretion (i.e. insulinogenic index [IGI] and Insulin Secretion-Sensitivity Index-2 [ISSI-2]), and insulin requirement before delivery. The rate of one abnormal OGTT value in T-GDM was similar to that in S-GDM (60% vs. 71%). There were no significant differences in gestational week and levels of HbA1c at diagnosis, levels of IGI and ISSI-2 between T-GDM and S-GDM (median, 20 weeks vs. 17 weeks, 5.0% vs. 5.2%, 0.58 vs. 0.71, 1.7 vs. 1.8, respectively). The rate of insulin treatment and a median dosage of insulin needed before delivery was comparable between the two groups (T-GDM vs. S-GDM: 45% vs. 32% and 14 vs. 13 unit/day). Our data suggested that the severity of dysglycemia in T-GDM was similar to that in S-GDM during pregnancy.

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分娩後に急性腎不全を発症し非典型溶血性尿毒症症候群(aHUS)と診断した1例

竹田将人, 池ノ上学, 坂井健良, 遠藤豊英, 大石真希, 落合大吾, 宮越敬, 田中守, 青木大輔

東京産科婦人科学会会誌（(一社)東京産科婦人科学会） 68 （ 2 ） 339 - 343 2019年04月

ISSN 2186-0599

血栓性微小血管症(TMA)は溶血性貧血、血小板減少、臓器機能障害を三徴とする病態であり、非典型溶血性尿毒症症候群(atypical hemolytic uremic syndrome:aHUS)はその一つである。今回、分娩後経過から早期にaHUSを診断し、良好な予後を得た症例を経験したため報告する。症例は33歳、1妊1産。妊娠経過は良好で、妊娠38週に自然経腟分娩となった。分娩後、弛緩出血に対して輸血および子宮内バルーンタンポナーデを行い止血を得たが、産後2日目より腎機能障害、肝機能障害を認め当院へ搬送となった。TMAの三徴を認め、ADAMTS-13活性は正常値でありaHUSと診断した。血液透析と血漿補充により腎機能は改善し、産後22日目に退院となった。溶血性貧血と血小板減少を伴う急激な腎機能障害を認めた場合、早期からaHUSを鑑別疾患に挙げることが肝要である。(著者抄録)

三次元スフェア培養はヒト羊水幹細胞の抗炎症性サイトカイン分泌と未分化マーカー発現を増強する

佐藤佑, 落合大吾, 阿部雄志, 遠藤豊英, 大石真希, 大谷利光, 福武麻里絵, 池ノ上学, 升田博隆, 宮越敬, 田中守, 青木大輔

日本産科婦人科学会雑誌（(公社)日本産科婦人科学会） 71 （臨増） S - 382 2019年02月

ISSN 0300-9165

Maternal Daily Intake of Polyphenol-Rich Dark Chocolate and Premature Closure of Ductus Arteriosus

Anko, Mayuka, Ikenoue, Satoru, Kawamura, Makoto, Yakubo, Kazumi

Biomed J Sci & Tech Res 21 （ 2 ） 2019年

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Impaired fetal growth in mothers with inadequate gestational weight gain: a retrospective study in Japanese uncomplicated pregnancy.

Ikenoue S, Miyakoshi K, Kasuga Y, Ochiai D, Matsumoto T, Tanaka M

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians （Journal of Maternal-Fetal and Neonatal Medicine） 33 （ 13 ） 1 - 5 2018年12月

ISSN 1476-4954

Introduction: The average birth weight in Japan has gradually decreased and the number of low birth weight infant has increased over the last 30 years. Japanese pregnant women are characterized with lower prevalence of obesity than those in other developed countries, and maternal underweight before pregnancy is independently associated with low birth weight. However, the association between maternal inadequate gestational weight gain (GWG) and the risk of small for gestational age (SGA) in Japanese uncomplicated pregnant women has not been fully understood. This study aimed to examine the effect of maternal inadequate GWG on the risk of SGA in Japanese uncomplicated pregnancies. Methods: We retrospectively analyzed uncomplicated Japanese singleton pregnancies that delivered at term gestation in our institution from 2006 to 2016. The association between GWG and birth weight was analyzed by multiple linear regression. Potential confounding factors included maternal age, parity, prepregnancy BMI, and neonatal sex. The association between inadequate GWG and SGA was also examined by logistic regression. Results: A total of 3837 mother–neonate dyads were analyzed. Maternal GWG was 10.1 ± 3.7 kg (mean ± SD), and 2529 (66%) had inadequate GWG. After adjusting for confounding factors, GWG significantly correlated with birth weight (standardized β = 0.199, p <.001). Inadequate GWG increased the risk of delivering SGA neonate (adjusted odds ratio (aOR) = 1.97 [1.45–2.68], p <.001). This association was particularly pronounced in underweight (aOR = 2.95 [1.38–6.29], p =.005) and normal weight mothers (aOR = 1.79 [1.27–2.52], p =.001), and not in overweight/obese mothers (p =.115). Conclusion: Maternal GWG is associated with birth weight in Japanese women with uncomplicated singleton pregnancies. Inadequate GWG is an important risk factor of SGA, particularly in non-obese women. The present finding would potentially provide further evidence that promoting adequate gestational weight gain in Japanese underweight and normal weight mothers would reduce SGA, as well as metabolic dysfunction in later life.

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多胎妊娠と糖代謝異常　より良い管理を目指して　双胎妊娠における妊娠糖尿病の糖代謝異常重症度に関する検討

秋葉洋平, 宮越敬, 税所芳史, 佐藤佑, 池ノ上学, 落合大吾, 松本直, 田中守

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 18 （ 2 ） S - 46 2018年08月

ISSN 1347-9172

双胎妊娠における妊娠糖尿病(GDM)の糖代謝異常重症度に関する知見は少ない。本研究の目的は双胎GDMにおける糖代謝異常重症度の解析である。自施設で周産期管理を行ったGDM例を双胎(n=20)と単胎(n=451)に分類し、両群の糖代謝異常重症度を比較検討した(リトドリン使用例は除外)。まず、両群の母体背景(年齢、非妊時BMI、GDM既往、糖尿病家族歴、初期随時血糖)は同等であった。また、インスリン療法導入率および導入週数、投与量について両群間に有意差を認めなかった。したがって、双胎GDMの糖代謝異常重症度は単胎と同等であることが示唆された。(著者抄録)

妊娠中の母体体重増加不良と出生体重に関する後方視的検討

池ノ上学, 宮越敬, 佐藤佑, 秋葉洋平, 大谷利光, 福武麻里絵, 春日義史, 落合大吾, 松本直, 田中守

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 18 （ 2 ） S - 86 2018年08月

ISSN 1347-9172

本邦では近年、やせ妊婦の増加と妊娠中の体重増加不良が指摘されている。今回、当院で単胎正期産分娩に至った3837例について、米国Institute of Medicine基準による母体体重増加不良と、在胎期間別出生時体格標準値(日本小児科学会)によるlight-for-date(LFD:出生体重<10パーセンタイル)との関連を年齢、経産数、非妊時BMI、児の性別を交絡因子として解析した。体重増加不良群では、LFDが有意に高率であり(adjusted odds ratio:1.94)、とくにやせ群(BMI < 18.5)と標準群(18.5 ≦ BMI< 25)でのみ有意差を認めた。やせ群と標準群では母体体重増加不良がLFDのリスク因子であることが示された。(著者抄録)

妊娠関連乳癌の骨転移による脊髄圧迫のため緊急帝王切開術を施行した1例

遠藤豊英, 村上功, 小泉和恵, 白橋真由, 池ノ上学, 横田めぐみ, 天方朋子, 池田俊之, 矢久保和美

埼玉産科婦人科学会雑誌（埼玉産科婦人科学会） 48 （ 1 ） 11 - 14 2018年03月

ISSN 2186-4349

近年、妊娠関連乳癌(Pregnancy Associated Breast Cancer:PABC)は、出産年齢の高齢化に伴い増加傾向である。今回我々は、PABCの骨転移による脊髄圧迫のため緊急帝王切開術を施行した症例を経験した。症例は36歳0経妊0経産の生来健康な女性である。妊娠30週より腰痛及び下肢の痺れを自覚し、妊娠32週1日、歩行困難のため当院へ搬送となった。MRIで多発骨転移による腰椎圧迫骨折および脊髄圧迫を疑う所見を認め、単純CTにて右乳腺腫瘍、右腋窩リンパ節腫大を認めた。PABCの骨転移による脊髄圧迫に対し、緊急放射線照射が必要なOncologic Emergencyであった。妊娠週数を考慮し、ベタメタゾン投与を施行し、妊娠32週4日、緊急帝王切開術及び右乳腺腫瘍針生検を施行した。術後緊急放射線照射を施行したが、下肢麻痺及び膀胱直腸障害は残存した。一方、児は経過良好であった。本症例は転移性脊髄圧迫のため妊娠中にも関わらず緊急放射線照射を要するOncologic Emergencyであった。今後増加が予想されるPABCに対して妊娠前後の乳癌検診の啓蒙が望まれる。(著者抄録)

Discordant fetal phenotype of hypophosphatasia in two siblings

Ikenoue S., Miyakoshi K., Ishii T., Sato Y., Otani T., Akiba Y., Kasuga Y., Ochiai D., Matsumoto T., Ichihashi Y., Matsuzaki Y., Tachikawa K., Michigami T., Nishimura G., Ikeda K., Hasegawa T., Tanaka M.

American Journal of Medical Genetics, Part A （American Journal of Medical Genetics, Part A） 176 （ 1 ） 171 - 174 2018年01月

ISSN 1552-4825

© 2017 Wiley Periodicals, Inc. Hypophosphatasia (HPP) is an autosomal recessive metabolic disorder with impaired bone mineralization due to mutations in the ALPL gene. The genotype-phenotype correlation of this disorder has been widely described. Here, we present two affected siblings, whose fetal phenotypes were discordant. A 31-year-old Japanese woman, G0P0, was referred to our institution because of fetal micromelia. After obstetric counseling, the pregnancy was terminated at 21 weeks’ gestation. Post-mortem radiographs demonstrated severely defective mineralization of the skeleton. The calvarial, spinal, and tubular bones were mostly missing. Only the occipital bones, mandible, clavicles, ribs, one thoracic vertebra, ilia, and tibia were relatively well ossified. The radiological findings suggested lethal HPP. Genetic testing for genomic DNA extracted from the umbilical cord identified compound heterozygous mutations in the ALPL gene (c.532T>C, p.Y178H; c.1559delT, p.Leu520Argfs*86). c.532T>C was a novel variant showing no residual activity of the protein by the functional analysis. The parents were heterozygous carriers. In the next pregnancy, biometric values on fetal ultrasonography at 20 and 26 weeks’ gestation were normal. At 34 weeks, however, a small chest and shortening of distal long bones came to attention. The neonate delivered at 41 weeks showed serum ALP of <5U/L. Radiological examination showed only mild thoracic hypoplasia and metaphyseal mineralization defects of the long bones. ALP replacement therapy was introduced shortly after birth, and the neonate was discharged at day 22 without respiratory distress. Awareness of discordant fetal phenotypes in siblings with HPP precludes a diagnostic error, and enables early medical intervention to mildly affected neonates.

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Clinical and genetic characteristics of abnormal glucose tolerance in Japanese women in the first year after gestational diabetes mellitus

Kasuga Y., Miyakoshi K., Tajima A., Saisho Y., Ikenoue S., Ochiai D., Matsumoto T., Arata N., Hata K., Tanaka M.

Journal of Diabetes Investigation （Journal of Diabetes Investigation） 10 （ 3 ） 817 - 826 2018年01月

ISSN 2040-1116

© 2018 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd Aims/Introduction: Risk factors of type 2 diabetes mellitus in Japanese women with recent gestational diabetes mellitus are unknown. The objective of the present study was to investigate the clinical and genetic characteristics associated with postpartum abnormal glucose tolerance in Japanese women with gestational diabetes mellitus. Materials and Methods: A total of 213 Japanese women with recent gestational diabetes mellitus who underwent a postpartum 2-h oral glucose tolerance test were investigated. The association between antepartum clinical characteristics and postpartum abnormal glucose tolerance (diabetes or prediabetes based on the Japan Diabetes Society criteria) was examined. Frequencies of 45 known type 2 diabetes mellitus-associated genetic variants were also compared between women with and without postpartum abnormal glucose tolerance. Results: A total of 59 women showed postpartum abnormal glucose tolerance (prediabetes, n = 51; diabetes, n = 8). Plasma glucose levels at 1 or 2 h, the insulinogenic index and the insulin secretion-sensitivity index-2 of the antepartum oral glucose tolerance test were independent of postpartum abnormal glucose tolerance risk factors (P = 0.006, P = 0.00002, P = 0.01 and P = 0.006, respectively). Four genetic variants (rs266729 [ADIPOQ], rs6017317 [HNF4A], rs5215 [KCNJ11] and rs7177055 [HMG20A]) showed a nominally significant association with postpartum abnormal glucose tolerance (P < 0.05, respectively). Among these, three were related to insulin secretion. Postpartum abnormal glucose tolerance risk significantly increased with increasing risk-allele number (P = 0.0005; odds ratio 1.91). Conclusions: Clinical features and genetic variants related to impaired insulin secretion are risk factors of postpartum abnormal glucose tolerance in Japanese women with recent gestational diabetes mellitus.

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Cover Image, Volume 176A, Number 1, January 2018

American journal of medical genetics. Part A （American journal of medical genetics. Part A） 176 （ 1 ） i 2018年01月

ISSN 1552-4825

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Association between supraclavicular brown adipose tissue composition at birth and adiposity gain from birth to 6 months of age

Entringer Sonja, Rasmussen Jerod, Cooper Dan M., Ikenoue Satoru, Waffarn Feizal, Wadhwa Pathik D., Buss Claudia

Pediatric Research 82 （ 6 ） 1017 - 1021 2017年12月

ISSN 0031-3998

<p>BackgroundBrown adipose tissue (BAT) is associated with higher energy expenditure and lower adiposity in adults. However, the relationship between BAT composition and adiposity in early life is unknown. The objective of this study was to test the hypothesis that brown fat composition at birth is prospectively associated with adiposity gain during the first 6 months of postnatal life.MethodsN=35 healthy infants were followed up prospectively from intrauterine life and birth through 6 months of age. Dixon magnetic resonance imaging (MRI) scans were conducted during the neonatal period to characterize supraclavicular BAT composition. Dual-energy X-ray absorptiometry to assess total body composition was performed within the first and sixth months of life.ResultsAfter adjusting for potential confounding factors, a more brown-like composition (smaller fat fraction) of the supraclavicular BAT depot was associated with a smaller increase in percent body fat over the first 6 months of postnatal life.ConclusionsA more brown-like BAT composition at birth appears to be protective against excess adiposity gain in early life. Newborn BAT tissue may constitute a target for prevention strategies against the subsequent development of obesity.</p>

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Prospective association of fetal liver blood flow at 30 weeks gestation with newborn adiposity

Ikenoue S., Waffarn F., Ohashi M., Sumiyoshi K., Ikenoue C., Buss C., Gillen D., Simhan H., Entringer S., Wadhwa P.

American Journal of Obstetrics and Gynecology （American Journal of Obstetrics and Gynecology） 217 （ 2 ） 204.e1 - 204.e8 2017年08月

ISSN 0002-9378

© 2017 Elsevier Inc. Background The production of variation in adipose tissue accretion represents a key fetal adaptation to energy substrate availability during gestation. Because umbilical venous blood transports nutrient substrate from the maternal to the fetal compartment and because the fetal liver is the primary organ in which nutrient interconversion occurs, it has been proposed that variations in the relative distribution of umbilical venous blood flow shunting either through ductus venosus or perfusing the fetal liver represents a mechanism underlying this adaptation. Objective The objective of the present study was to determine whether fetal liver blood flow assessed before the period of maximal fetal fat deposition (ie, the third trimester of gestation) is prospectively associated with newborn adiposity. Study Design A prospective study was conducted in a cohort of 62 uncomplicated singleton pregnancies. Fetal ultrasonography was performed at 30 weeks gestation for conventional fetal biometry and characterization of fetal liver blood flow (quantified by subtracting ductus venosus flow from umbilical vein flow). Newborn body fat percentage was quantified by dual energy X-ray absorptiometry imaging at 25.8 ± 3.3 (mean ± standard error of the mean) postnatal days. Multiple regression analysis was used to determine the proportion of variation in newborn body fat percentage explained by fetal liver blood flow. Potential confounding factors included maternal age, parity, prepregnancy body mass index, gestational weight gain, gestational age at birth, infant sex, postnatal age at dual energy X-ray absorptiometry scan, and mode of infant feeding. Results Newborn body fat percentage was 13.5% ± 2.4% (mean ± standard error of the mean). Fetal liver blood flow at 30 weeks gestation was significantly and positively associated with newborn total fat mass (r=0.397; P<.001) and body fat percentage (r=0.369; P=.004), but not with lean mass (r=0.100; P=.441). After accounting for the effects of covariates, fetal liver blood flow explained 13.5% of the variance in newborn fat mass. The magnitude of this association was pronounced particularly in nonoverweight/nonobese mothers (prepregnancy body mass index, <25 kg/m2; n=36) in whom fetal liver blood flow explained 24.4% of the variation in newborn body fat percentage. Conclusion Fetal liver blood flow at the beginning of the third trimester of gestation is associated positively with newborn adiposity, particularly among nonoverweight/nonobese mothers. This finding supports the role of fetal liver blood flow as a putative fetal adaptation underlying variation in adipose tissue accretion.

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Association of ultrasound-based measures of fetal body composition with newborn adiposity

Ikenoue S., Waffarn F., Sumiyoshi K., Ohashi M., Ikenoue C., Buss C., Gillen D., Simhan H., Entringer S., Wadhwa P.

Pediatric Obesity （Pediatric Obesity） 12 86 - 93 2017年08月

ISSN 2047-6302

© 2016 World Obesity Federation Background: Newborns exhibit substantial variation in gestational age-adjusted and sex-adjusted fat mass proportion. The antecedent characteristics of fetal body composition that are associated with newborn fat mass proportion are poorly understood. Objective: The aim of this study was to determine whether a composite measure of fetal fat mass is prospectively associated with newborn adiposity. Methods: In a longitudinal study of 109 low-risk pregnancies, fetal ultrasonography was performed at approximately 12, 20 and 30 weeks gestation. Estimated fetal adiposity (EFA) was derived by integrating cross-sectional arm and thigh per cent fat area and anterior abdominal wall thickness. Newborn per cent body fat was quantified by Dual Energy X-Ray Absorptiometry. The association between EFA and newborn per cent body fat was determined by multiple linear regression. Results: After controlling for confounding factors, EFA at 30 weeks was significantly associated with newborn per cent body fat (standardized β = 0.41, p < 0.001) and explained 24.0% of its variance, which was substantially higher than that explained by estimated fetal weight (8.1%). The observed effect was driven primarily by arm per cent fat area. Conclusions: A composite measure of fetal adiposity at 30 weeks gestation may constitute a better predictor of newborn per cent body fat than estimated fetal weight by conventional fetal biometry. Fetal arm fat deposition may represent an early indicator of newborn adiposity. After replication, these findings may provide a basis for an improved understanding of the ontogeny of fetal fat deposition, thereby contributing to a better understanding of its intrauterine determinants and the development of potential interventions.

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