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Cord Blood Adiponectin and Insulin-like Growth Factor-I in Term Neonates of Gestational Diabetes Mellitus Mothers: Relationship to Fetal Growth

손진아|조수진|김영주|박혜숙|박은애
대한신생아학회 (THE KOREAN SOCIETY OF NEONATOLOGY)|2011.05|Neonatal medicine|제18권 제1호|pp. 49-58

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AdiponectinInsulin-like growth factor-1Gestational diabetes mellitusCord blood

초록

목적: 임신성 당뇨는 임신의 흔한 합병증 중의 하나이며 임신성 당뇨 산모의 아기는 정상 산모의 아기에 비해서 체지방률이높다. Adiponectin은 인슐린 민감성 조직에서 당과 지방 대사를 조절하는 중요한 물질이며, insulin-like growth factor (IGF)-I은 출생 전후기에 성장을 조절하는 중요한 내분비 조절물질로 알려져 있다. 본 연구에서는 임신성 당뇨 산모의 아기에서 제대혈 adiponectin과 IGF-I 수치와 태아 성장과의 관계 및인슐린 저항성에 대해서 알아보고자 하였다. 방법: 임신성 당뇨 이외에 임신과 관련된 기타 합병증이 동반되지 않은 산모에서 태어난 아기(임신성 당뇨군, N=53)와 정상산모에서 태어난 아기(대조군, N=101)의 제대혈 adiponectin과IGF-Ⅰ 수치를 비교하였다. 신생아는 출생 체중에 따라 부당경량아(N=26), 적정체중아(N=97), 부당중량아(N=31)로 세분하였다. 제대혈 adiponectin, IGF-I 농도와 산모의 나이, 분만력, 임신 전 체질량지수, 공복 혈당 및 75 g 경구당부하검사, 임신 중산모 체중 증가, 태아-태반 무게비, 출생시 재태연령, 아기의 성별, 출생체중, 출생신장과의 관계를 비교하였다. 결과: 대조군보다 임신성 당뇨군에서 제대혈 adiponectin의평균이 의미 있게 낮았다(P<0.001). 임신성 당뇨군에서는 부당경량아군, 적정체중아군, 부당중량아군 사이의 제대혈adiponectin 수치에 유의한 차이를 보이지 않았으나(P=0.228),적정체중아군은 대조군의 적정체중아군에 비해 의미 있게 낮은 adiponectin 수치를 보였다(P<0.001). 제대혈 adiponectin 은 산모의 임신 전 체질량지수, 공복혈당, 75 g 경부당부하검사와 음의 상관관계를 가졌고, 출생시 재태연령, 출생체중, 제대혈IGF-I과 양의 상관관계를 가졌다. 다중선형회귀분석에서 75 g 경부당부하검사가 가장 강력한 예측인자로 나왔다. 임신성 당뇨군과 대조군 사이의 제대혈 IGF-I은 의미 있는 차이를 보이지않았다(P=0.834). 제대혈 IGF-I은 출생체중이 높은 군일수록의미 있게 높았다(P<0.001). 제대혈 IGF-I은 산모의 연령, 분만력, 출생체중, 출생신장, 제대혈 adiponectin과 유의한 양의 상관관계를 보였고, 이 중에서 출생체중과 분만력이 가장 강력한예측인자였다. 결론: 산모의 임신성 당뇨는 제대혈 adiponectin을 낮춘다. 제대혈 adiponectin과 IGF-I 모두 출생체중과 연관성을 보였지만 IGF-I이 태아의 성장에 좀 더 직접적인 영향을 미치며,adiponectin은 성장보다는 인슐린 저항성과 더 연관이 있는 것으로 생각된다. 그러므로 임신성 당뇨를 가진 산모에서 태어난아기는 적정체중아일지라도 생후 성장과 인슐린 저항성의 변화를 추적 관찰하는 것이 중요할 것이다.

Abstract

Purpose: The purpose of this study was to evaluate the relationship between cord blood adiponectin and insulin-like growth factor (IGF)-I and their effect on fetal growth and insulin resistance in mothers with gestational diabetes mellitus (GDM). Methods: Cord blood adiponectin and IGF-I were compared between mothers with GDM (GDM group, N=53) and controls (non-GDM group, N=101). Neonates were classified into three groups of small for gestational age (SGA, N=26), appropriate for gestational age (AGA, N=97), and large for gestational age (LGA, N=31) by birth weight. The association between cord adiponectin and IGF-I levels was evaluated in relation to maternal and neonatal clinical data. Results: Cord adiponectin was lower in the GDM group than in the non-GDM group (P<0.001). There was no significant difference in cord adiponectin among the SGA, AGA, and LGA groups in the GDM group (P=0.228). The cord adiponectin of AGA in the GDM group was significantly lower than that in the non-GDM group (P<0.001). The most powerful predictor affecting cord adiponectin was the result of maternal 75 g OGTT. The cord IGF-I values between the GDM group and the non-GDM group were not different (P=0.834). Neonates with the heavier birth weight had the higher cord IGF-I levels. The most powerful predictor affecting cord IGF-I was birth weight and the next was maternal parity. Conclusion: Both cord blood adiponectin and IGF-I were associated with fetal growth, but IGF-I was a more general and direct factor affecting fetal body size, and adiponectin seemed to have more association with insulin sensitivity than growth.

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제대혈 Adiponectin과 IGF-I이 태아성장에 미치는 영향김지영, 김혜순, 박은애, 박혜숙, 조수진대한신생아학회 · Neonatal medicine2008 · 제15권 제1호임신성 당뇨병 및 임신성 고혈압 산모와 신생아의 임상적 특징과 제대혈 아디포넥틴과 레지스틴 농도의 상관성김은영, 박상기, 송창훈, 이원희대한소아내분비학회 · Annals of Pediatric Endocrinology & Metabolism2010 · 제15권 제1호정상임신 및 임신성 당뇨임신의 제대혈내 adiponectin 농도에 관한 연구김영주, 박미혜, 박은애, 전선희, 조수진, 조아라대한산부인과학회 · Obstetrics & Gynecology Science2011 · 제54권 제09호신생아의 제대 혈액 및 산모의 혈액내 adiponectin 농도와 신생아의 체중과의 연관성에 관한 연구김탁, 강재성, 김선행, 김해중, 나중열, 오민정, 유상욱, 이규완, 조금준, 홍순철대한산부인과학회 · Obstetrics & Gynecology Science2005 · 제48권 제11호저체중아의 출생 시 제대혈에서 adiponectin, IGF-I, IGFBP-1, insulin 및 leptin에 관한 연구김영주, 박미혜, 안정자, 전선희, 최노미대한산부인과학회 · Obstetrics & Gynecology Science2009 · 제52권 제4호정상 신생아의 제대혈 내 렙틴과 성장 호르몬의태아 성장과의 연관성조숙, 김세련, 김종욱, 류기영, 박영준, 박지현, 이병익대한산부인과학회 · Obstetrics & Gynecology Science2005 · 제48권 제12호

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