Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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The influence of some intrauterine growth variables on neonatal blood pressure

태아기 자궁내 성장지표와 신생아 혈압과의 관련성

  • Min, Jungwon (Department of Preventive Medicine, College of Medicine, Ewha Womans University) ;
  • Park, Eun Ae (Department of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Kong, Kyoungae (Department of Preventive Medicine, College of Medicine, Ewha Womans University) ;
  • Park, Bohyun (Department of Preventive Medicine, College of Medicine, Ewha Womans University) ;
  • Hong, Juhee (Department of Preventive Medicine, College of Medicine, Ewha Womans University) ;
  • Kim, Young Ju (Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University) ;
  • Lee, Hwayoung (Department of Anatomy, College of Medicine, Ewha Womans University) ;
  • Ha, EunHee (Department of Preventive Medicine, College of Medicine, Ewha Womans University) ;
  • Park, Hyesook (Department of Preventive Medicine, College of Medicine, Ewha Womans University)
  • 민정원 (이화여자대학교 의과대학 예방의학교실) ;
  • 박은애 (이화여자대학교 의과대학 소아과학교실) ;
  • 공경애 (이화여자대학교 의과대학 예방의학교실) ;
  • 박보현 (이화여자대학교 의과대학 예방의학교실) ;
  • 홍주희 (이화여자대학교 의과대학 예방의학교실) ;
  • 김영주 (이화여자대학교 의과대학 산부인과학교실) ;
  • 이화영 (이화여자대학교 의과대학 해부학교실) ;
  • 하은희 (이화여자대학교 의과대학 예방의학교실) ;
  • 박혜숙 (이화여자대학교 의과대학 예방의학교실)
  • Received : 2006.02.20
  • Accepted : 2006.03.31
  • Published : 2006.09.15
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Abstract

Purpose : 'Programming' describes the process that stimulus at a critical period of development has lifelong effects. The fact that low birth weight links to the risk of elevated blood pressures in adult life is well known. This study aims to examine whether this link is evident in the newborn by investigating the relationship of the intrauterine growth indices and neonatal blood pressure(BP). Methods : We studied 127 neonates who were born at Ewha Womans' Hospital and their mothers enrolled our cohort study during pregnancy. Data on the mothers and details of the birth records were tracked and collected from medical charts. Neonatal BP was measured within 24 hours after birth. Results : Neonatal SBP was positively correlated to intrauterine growth indices; birth weight(BW)(r=0.4), head circumference(HC)(r=0.4), and birth height(r=0.3). However, an inverse relationship existed, between HC/BW ratio and neonatal SBP(r=-0.4). After adjusting for the baby's sex, maternal BP, and gestational age, neonatal SBP still associated with intrauterine growth indices. SBP was 7 mmHg higher in the highest BW group(${\geq}90percentiles$) compared to the lowest group(<10 percentiles). On the other hand, SBP was 17 mmHg lower in the highest HC/BW group(${\geq}90percentiles$) compared in the lowest group(<10 percentiles). Conclusion : This study could not find the evidence that intrauterine growth retardation affect on elevated neonatal BP. It suggests that the initiating events of BP programming may occur during postnatal growth period. To identify the critical starting period that intrauterine growth retardation leads to elevated BP, a study tracking BP changes from birth to childhood is required.

목 적 : 성인의 심혈관질환은 태아발달 동안이나 이른 어린이 시기부터 시작된다는 태아프로그래밍 개념과 출생시 작게 태어난 경우에 성인기에 혈압이 상승된다는 연구들을 고려하여 볼 때, 출생시기부터의 혈압 변화에 대한 연구가 필요함을 느꼈다. 본 연구에서는 신생아의 여러 자궁내 발육 지표와 신생아의 혈압 관련성에 대해 살펴보고자 하였다. 방 법 : 이화여자대학교 목동병원에 내원한 임산부 중 연구참여에 동의한 산모를 대상으로 코호트를 구축하고 이들의 127명의 출생아에 대한 의무기록에 근거하여 자료를 추적, 수집하였고, 생후 24시간 이내에 신생아의 혈압을 측정하였다. 결 과 : 신생아 수축기 혈압과 태내 성장지표는 유의한 양의 상관관계를 보였다; 출생체중(r=0.4), 머리둘레(r=0.4), 출생신장(r=0.3). 그러나 체중대비 머리둘레 비는 신생아 혈압과 유의한 음의 상관관계를 보였다(r=-0.4). 아기의 성과 엄마의 혈압수준, 재태연령을 보정한 상태에서도 신생아 수축기 혈압은 태내 성장지표와 연관성을 보였다. 수축기 혈압은 출생체중이 가장 높은 군에서(90 백분위수 이상) 낮은 군과 비교하여(10 백분위수 미만) 7 mmHg 높았다, 한편 출생체중 대비 머리둘레의 비가 가장 높은 군(90 백분위수 이상)에서 낮은 군(10 백분위수 미만)에 비해 17 mmHg 낮게 나타났다. 결 론 : 우리 연구 결과 자궁내 성장 지연이 신생아의 혈압을 높이는데 영향을 미치는 것을 관찰할 수 없었다. 혈압 프로그래밍은 출생 이후에 성장기간에 시작되는 것으로 생각된다. 자궁내 성장지연으로 인해 혈압이 상승하는 주요 시작 지점이 언제인지 알아보기 위해서 출생 이후부터 따라잡기 성장과 함께 아동기시기 혈압 변화에 대한 지속적인 연구가 필요하다.

Keywords

Acknowledgement

Supported by : 한국학술진흥재단

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