AIMS/HYPOTHESIS We aimed to assess associations between cord blood metabolic markers and fetal overgrowth, and whether cord markers mediated the impact of maternal adiposity on neonatal anthropometric outcomes among children born to Indigenous and Non-Indigenous Australian women with normal glucose tolerance (NGT), gestational diabetes mellitus (GDM) and pregestational type 2 diabetes mellitus. METHODS From the Pregnancy and Neonatal Outcomes in Remote Australia (PANDORA) study, an observational cohort of 1135 mother-baby pairs, venous cord blood was available for 645 singleton babies (49% Indigenous Australian) of women with NGT (n = 129), GDM (n = 419) and type 2 diabetes (n = 97). Cord glucose, triacylglycerol, HDL-cholesterol, C-reactive protein (CRP) and C-peptide were measured. Multivariable logistic and linear regression were used to assess the associations between cord blood metabolic markers and the outcomes of birthweight z score, sum of skinfold thickness (SSF), being large for gestational age (LGA) and percentage of body fat. Pathway analysis assessed whether cord markers mediated the associations between maternal and neonatal adiposity. RESULTS Elevated cord C-peptide was significantly associated with increasing birthweight z score (β 0.57 [95% CI 0.42, 0.71]), SSF (β 0.83 [95% CI 0.41, 1.25]), percentage of body fat (β 1.20 [95% CI 0.69, 1.71]) and risk for LGA [OR 3.14 [95% CI 2.11, 4.68]), after adjusting for age, ethnicity and diabetes type. Cord triacylglycerol was negatively associated with birthweight z score for Indigenous Australian women only. No associations between cord glucose, HDL-cholesterol and CRP >0.3 mg/l (2.9 nmol/l) with neonatal outcomes were observed. C-peptide mediated 18% (95% CI 13, 36) of the association of maternal BMI with LGA and 11% (95% CI 8, 17) of the association with per cent neonatal fat. CONCLUSIONS/INTERPRETATION Cord blood C-peptide is an important mediator of the association between maternal and infant adiposity, across the spectrum of maternal glucose tolerance.

中文翻译：

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脐带血代谢标记物是整个葡萄糖耐量谱图中孕妇肥胖对孕妇胎儿生长影响的重要调节剂：PANDORA研究。

目的/假设我们旨在评估脐带血代谢指标与胎儿过度生长之间的关联，以及脐带指标是否介导了葡萄糖耐量正常（NGT）的澳大利亚土著和非土著妇女所生孩子的母亲肥胖对新生儿人体测量结果的影响，妊娠糖尿病（GDM）和孕前2型糖尿病。方法：根据偏远澳大利亚的妊娠和新生儿结局（PANDORA）研究，观察性队列为1135对母婴，静脉血可用于645例NGT（n = 129）的单身婴儿（占澳大利亚原住民的49％）， GDM（n = 419）和2型糖尿病（n = 97）。测量脐带葡萄糖，三酰基甘油，HDL-胆固醇，C反应蛋白（CRP）和C肽。多变量logistic和线性回归用于评估脐带血代谢指标与出生体重z评分，皮褶厚度总和（SSF），胎龄大（LGA）和体脂百分比之间的相关性。通路分析评估脐带标记物是否介导母体和新生儿肥胖之间的关联。结果脐带C肽含量升高与出生体重z评分（β0.57 [95％CI 0.42，0.71]），SSF（β0.83 [95％CI 0.41，1.25]），体脂百分比（β1.20 [95]显着相关。调整了年龄，种族和糖尿病类型后，％CI 0.69，1.71]）和LGA风险[OR 3.14 [95％CI 2.11，4.68]）。脐带三酰甘油仅与澳大利亚土著妇女的出生体重z得分呈负相关。脐带葡萄糖之间没有关联，观察到HDL-胆固醇和CRP> 0.3 mg / l（2.9 nmol / l），具有新生儿结局。C肽介导的孕妇BMI与LGA的关联为18％（95％CI 13，36），而与百分之百的新生儿脂肪相关的为11％（95％CI 8，17）。结论/解释脐带血C肽在整个母亲的葡萄糖耐量谱中是母体和婴儿肥胖症之间关联的重要介体。