醫學營養治療於妊娠糖尿病婦女對其胎兒臍帶血中內皮前趨細胞之數目及活性的影響

妊娠糖尿病定義為懷孕過程中首次發現葡萄糖不耐的現象，會增加許多妊娠相關併發症的風險，盛行率約1-14%。內皮前趨細胞在懷孕過程中扮演重組子宮血管系統的角色。但是在高血糖的環境下，內皮前趨細胞的功能會降低且凋亡增加，造成子宮重組作用受阻。目前有關妊娠糖尿病婦女的高血糖狀況及懷孕期間若實施嚴格的飲食及體重控制對其胎兒臍帶血中內皮前趨細胞之數目及活性的影響尚不清楚。因此，本研究目的是探討醫學營養治療於妊娠糖尿病婦女後對其胎兒臍帶血中內皮前趨細胞之數目及活性的影響。本研究為介入性研究，自2011年9月至2013年5月於台南奇美醫院婦產科募集妊娠24至32週的妊娠糖尿病婦女，依其意願分為醫學營養治療及常規治療兩組，並募集健康懷孕婦女作為參考組。追蹤所有孕婦至其分娩後收集胎兒臍帶血。分析胎兒臍帶血中內皮前趨細胞之數目，並利用熱中風動物模式測驗內皮前趨細胞之活性。結果顯示三組間母體體重變化皆無差異，其新生兒出生狀況亦無差異。妊娠糖尿病婦女其胎兒臍帶血中內皮前趨細胞之數目及活性顯著低於健康懷孕婦女。經醫學營養治療之妊娠糖尿病婦女其胎兒臍帶血中內皮前趨細胞之數目及活性顯著高於常規治療組。醫學營養治療與胎兒臍帶血中內皮前趨細胞之數目及活性呈顯著正相關。醫學營養治療可改善妊娠糖尿病婦女其胎兒臍帶血中內皮前趨細胞之數目及活性下降的情形。

Gestational diabetes mellitus (GDM) is defined as glucose intolerance with first onset during pregnancy, and will increase the adverse effects of perinatal outcomes. The prevalence of GDM ranges from 1 to 14%. Epithelial progenitor cells (EPCs) involve uterine vasculature remodeling during pregnancy. Hyperglycemia would increase apoptosis and impair the function of EPCs. However, the effects of maternal hyperglycemia and strict diet and weight control on the cell number and viability of fetal EPCs in GDM women are not clear. The aim of this study was to investigate the effect of medical nutrition therapy on the cell number and viability of EPCs derived from neonatal umbilical cord blood in GDM woman.This study was an intervention study. GDM women with gestational age 24 to 32 weeks were recruited in Chi-Mei hospital between September, 2011 and May, 2013. They were divided into the GDM-MNT group or the GDM-routine care group based on their intention. Healthy pregnant women were recruited as the reference group. All women were followed to delivery. The neonatal umbilical cord blood was collected after the delivery. We analyzed the cell number of EPCs derived from umbilical cord blood, and tested the cell viability of EPCs derived from umbilical cord blood by heatstroke animal model.No significant differences were found in maternal characteristics and perinatal outcomes among three groups. However, there were more cell number and viability of EPCs derived from neonatal umbilical cord blood in the non-GDM group compared to the GDM group. The cell number and viability of EPCs derived from neonatal umbilical cord blood in the GDM-MNT group were significantly higher than the GDM-routine care group.Our study showed that medical nutrition therapy can attenuate the cell dysfunction and increase the cell number of EPCs derived from neonatal umbilical cord blood in GDM women.