【BMC Med】新型非侵入性测试将可预测早产


导读:早产和胎儿生长受限已被证明会增加胎儿成长过程中患代谢和心血管疾病。根据发表在开放获取期刊BMC Medicine上的一项研究证实:测试存在于孕妇尿液中的某些特定分子可以给出一个指示,预测宝宝是否会早产或胎儿会受到生长不良。在怀孕早期识别这些情况可能会有助于减少并发症和控制任何困难,但在研究结果转化到临床上之前还需要更多的研究工作。

 

来自伦敦帝国学院和克里特大学研究人员分析了438名孕妇代谢物(尿中排出的小分子)。他们发现,尿中赖氨酸升高水平与自发性早产有关。相反,N-乙酰化的糖蛋白水平提高与非自发性早产(临床上的诱导性早产)相关。

第三组分子水平的降低:乙酸盐,甲酸盐,酪氨酸和三甲胺均与胎儿发育不良相关。女性尿液这些代谢物水平的下降也显示胎儿糖尿病风险增加的迹象。

Hector Keun研究员说:虽然我们知道母亲代谢在怀孕期间极大地发生改变,以帮助提供成长中的胎儿所需的营养物质,但我们惊讶在怀孕早期就能监测到代谢物变化与早产以及生长受限之间的联系。

我们的研究结果意味着,在怀孕早期使用非侵入性的代谢分析技术能识别妇女早产风险。接下来,进一步的研究需要把重点放在是否这些代谢产物变化是由怀孕引起的。如果这些结果想要应用到更广泛的人群中,还需要更多的研究。

Urinary metabolic profiles in early pregnancy are associated with preterm birth and fetal growth restriction in the Rhea mother–child cohort study

Léa Maitre, et al.

Background
Preterm birth (PB) and fetal growth restriction (FGR) convey the highest risk of perinatal mortality and morbidity, as well as increasing the chance of developing chronic disease in later life. Identifying early in pregnancy the unfavourable maternal conditions that can predict poor birth outcomes could help their prevention and management. Here we used an exploratory metabolic profiling approach (metabolomics) to investigate the association between birth outcomes and metabolites in maternal urine collected early in pregnancy as part of the prospective mother–child cohort Rhea study. Metabolomic techniques can simultaneously capture information about genotype and its interaction with the accumulated exposures experienced by an individual from their diet, environment, physical activity or disease (the exposome). As metabolic syndrome has previously been shown to be associated with PB in this cohort, we sought to gain further insight into PB-linked metabolic phenotypes and to define new predictive biomarkers.

Methods
Our study was a case–control study nested within the Rhea cohort. Major metabolites (n?=?34) in maternal urine samples collected at the end of the first trimester (n?=?438) were measured using proton nuclear magnetic resonance spectroscopy. In addition to PB, we used FGR in weight and small for gestational age as study endpoints.

Results
We observed significant associations between FGR and decreased urinary acetate (interquartile odds ratio (IOR)?=?0.18 CI 0.04 to 0.60), formate (IOR?=?0.24 CI 0.07 to 0.71), tyrosine (IOR?=?0.27 CI 0.08 to 0.81) and trimethylamine (IOR?=?0.14 CI 0.04 to 0.40) adjusting for maternal education, maternal age, parity, and smoking during pregnancy. These metabolites were inversely correlated with blood insulin. Women with clinically induced PB (IPB) had a significant increase in a glycoprotein N-acetyl resonance (IOR?=?5.84 CI 1.44 to 39.50). This resonance was positively correlated with body mass index, and stratified analysis confirmed that N-acetyl glycoprotein and IPB were significantly associated in overweight and obese women only. Spontaneous PB cases were associated with elevated urinary lysine (IOR?=?2.79 CI 1.20 to 6.98) and lower formate levels (IOR?=?0.42 CI 0.19 to 0.94).

Conclusions
Urinary metabolites measured at the end of the first trimester are associated with increased risk of negative birth outcomes, and provide novel information about the possible mechanisms leading to adverse pregnancies in the Rhea cohort. This study emphasizes the potential of metabolic profiling of urine as a means to identify novel non-invasive biomarkers of PB and FGR risk.

来源:互联网

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