Relationship Between Macrosomia With CTRP3 And CTRP9

In recent years,the incidence of macrosomia has an increasing tendency.Macrosomia increases the risk of adverse birth outcomes such as dystocia,shoulder dystocia,brachial plexus injury,high rate of surgical delivery and cesarean section.In the long term,the risk of overweight and obesity for children is also significantly increased by macrosomia.The occurrence of macrosomia is relevant to genetic factors,post-term pregnancy,overnutrition and metabolic abnormalities,but its mechanism is still unclear.Fetal growth depends mainly on the maternal supply of oxygen and nutrients through the placenta,so the supply of nutrients and metabolism during pregnancy,as well as the use of nutrients for fetus itself,will have a significant impact on the fetal growth and development.Studies have shown that adipose tissue can secrete a variety of active protein named adipokines.As one of adipokines,adiponectin has regulation on glycolipid metabolism and insulin sensitivity,and the adiponectin level in maternal blood and umbilical cord blood is correlated with neonatal birth weight and macrosomia.As two important members of the CTRPs superfamily in adipokines,the structures of CTRP3 and CTRP9 are highly homologous to adiponectin,and they can form heterogeneous polymer composites with adiponectin,so we speculate that they have similar effect with adiponectin in biological functions or have synergy with adiponectin,and are involved in fetal growth and development process.There is no report at home and abroad about whether CTRP3 and CTRP9 are related to fetal growth and macrosomia and whether they can be used as a sensitive index of predicting macrosomia.Objective:1 Detect CTRP3 and CTRP9 levels in maternal and cord venous serum,and analyze its correlation with neonatal birth weight and macrosomia;2 Detect CTRP3 and CTRP9 gene mRNA expression of placental tissues at the molecular,and analyze its correlation with neonatal birth weight and macrosomia;3 Build CTRP influence factor model,and provide theoretical evidence for macrosomia prediction.Methods:Randomly select 31 maternal cases as macrosomia group with fetus birth weight ?4000g of full-term delivery and 31 normal weight newborns' maternal cases as normal birth weight group from December 2015 to December 2016 in Chengde Medical College Affiliated Hospital of obstetrics.Inclusion criteria: normal pregnancy,monocyesis,uterogestation,normal oral glucose tolerance test,no neonatal congenital malformation;Exclusion criteria: pregnant complications,such as hypertension disorders in pregnancy,heart disease,gestational hypothyroidism,placental abnormalities,and other severe diseases before pregnancy.Maternal venous serum,cord venous serum and placental tissue for experiment are collected by the according to the questionnaire,physical examination and access to medical records,maternal general demographic characteristics,common chronic history,pre-pregnancy height and weight,pregnancy complications,prenatal weight,gestational age,delivery method and Delivery related complications,as well as the newborns' gender,birth weight,growth and development situation,etc.Neonatal umbilical cord blood and maternal blood CTRP3 and CTRP9 level are determined by the method of Enzyme-linked immunosorbent assay(ELISA).Reverse transcription polymerase chain reaction(RT-PCR)are Applied to detect the placenta tissue CTRP3 and CTRP9 gene mRNA expression level.After the tests,mean ± standard deviation or the median(25th percentile,75 th percentile)are used to describe the serum levels of CTRP3 and CTRP9.Then comparison between groups are shown by two independent sample t-test and Wilcoxon rank and inspection,the correlation between the two variables are leaded out by Spearman correlation analysis.At last,factors influencing the level of serum CTRP factors are given using multiple linear regression analysis.Results:1 Between macrosomia group and normal birth weight group,difference have no statistical significance in maternal age(Y)(30.26±4.84 vs 29.03±3.87,t=1.101,P=0.275),delivery gestational age(W)(39.78±0.85 vs 39.55±0.99,t=0.987,P=0.328)and have statistical significance in pre-pregnancy BMI(kg/m2)(23.40±3.38 vs 21.57±2.83,t= 2.310,P=0.024),pregnancy weight gain(kg)(19.26±6.00 vs 15.50±5.60,t=2.549,P =0.013).2 Difference have no statistical significance in maternal venous serum CTRP3(ng/ml)(107.54±18.27 vs 108.79±20.01,t=0.256,P=0.799),and have statistical significance in umbilical cord venous serum CTRP3(ng/ml)(102.18±23.66 vs 70.92±25.96,t=4.955,P<0.001).3 Difference have no statistical significance in maternal venous serum CTRP9(pg/ml)[239.96(114.78~443.92)vs 195.67(79.79~383.36),z=0.781,P=0.435),and umbilical cord venous serum CTRP9(pg/ml)[263.10(197.5~ 342.15)vs 284.51(219.58~469.45),z=1.056,P=0.291].4 There were no statistically significant correlation between birth weight and maternal venous serum CTRP3(rs=0.020,P=0.020),birth weight and maternal venous serum CTRP9(rs=0.045,P=0.045),birth weight and umbilical cord venous serum CTRP9(rs=0.134,P=0.134);It was statistically significant correlation between birth weight and umbilical cord venous serum CTRP3(rs=0.599,P<0.001).Maternal venous serum CTRP3 and umbilical cord venous serum CTRP3(rs=0.016,P=0.016),maternal venous serum CTRP9 and umbilical cord venous serum CTRP9(rs=0.205,P=0.205),there were no statistically significant correlation.5 The differences had no statistical significance in different newborns' gender(male vs female)of neonatal umbilical cord venous serum CTRP3(ng/ml)(86.62±30.54 vs.94.78±25.03,t=1.548,P=0.127)and CTRP9(pg/ml)[269.81(195.91~390.99)vs 195.91(219.26~404.90),z =0.550,P =0.583].6 Multiple linear regression analysis results shown that the umbilical vein serum level of CTRP3 was related to whether macrosomia delivery and delivery gestational age,the regression relationship was statistically significant.7 The placenta tissue CTRP3 gene mRNA expression in Macrosomia group were higher than normal birth weight group(2-??Ct=2.27,P<0.001);About placenta CTRP9 gene mRNA expression,there was no statistically significant difference between the two groups(2-??Ct =0.77,P=0.430).Conclusion:1 Umbilical cord venous serum CTRP3 level is correlated with the occurrence of macrosomia.There is not relevance between macrosomia and the CTRP3 level in maternal venous serum?the CTRP9 level in umbilical cord venous serum and maternal venous serum;2 The CTRP3 and CTRP9 gene mRNA expressions exist in the placenta tissue.Upregulation of CTRP3 gene mRNA expression in placenta tissue is closely related to the occurrence of macrosomia.The CTRP9 gene mRNA expression in placenta tissue is not relevant to macrosomia;3 The occurence of macrosomia deliveryand delivery gestational age are independent factors affecting umbilical cord vein serum CTRP3 level.