懷孕能不能運動？需不需要運動？這是很多孕媽都很關(guān)心的話題。有證據(jù)表明，孕媽在孕期是可以運動的，并且適量適當(dāng)?shù)倪\動還會有益孕媽和胎兒的健康。

　　但是，其中有個很少有研究涉及的關(guān)鍵部位——胎盤，愛思唯爾旗下全醫(yī)學(xué)信息平臺ClinicalKey中，期刊Tissue and Cell上發(fā)表了一篇綜述[1]，讓我們得以了解運動對胎盤造成的直接影響。

胎盤的結(jié)構(gòu)與作用

　　母胎界面器官之間的交流對于成功懷孕至關(guān)重要。胎盤分為兩側(cè)：胎盤的胎兒部分是絨毛膜，而母體部分是基底蛻膜。母胎界面具有抵御局部病原體感染的能力[2,3]。它介導(dǎo)了氧氣、二氧化碳和營養(yǎng)物質(zhì)的轉(zhuǎn)移[4]，發(fā)揮免疫保護(hù)作用，并產(chǎn)生各種激素、酶和細(xì)胞因子，在建立和維持成功懷孕方面發(fā)揮著至關(guān)重要的作用[5]。

運動對母胎整體

健康的益處

　　產(chǎn)前鍛煉已被證明可以降低剖腹產(chǎn)率，降低妊娠并發(fā)癥的發(fā)生率[8-12]。此外，產(chǎn)前鍛煉被發(fā)現(xiàn)可以減少產(chǎn)后體重滯留，減輕背部和骨盆疼痛，減少疲勞、壓力和分娩并發(fā)癥，預(yù)防和控制尿失禁[13,14]。圖2總結(jié)了母體和胎兒的益處。

運動如何影響胎盤？

讓胎盤血供更佳

　　胎盤血液循環(huán)是哺乳動物的一個獨特特征。胎盤內(nèi)有母體和胎兒兩套血循環(huán)。胎兒的靜脈血經(jīng)臍動脈及其分支流入絨毛毛細(xì)血管，與絨毛間隙內(nèi)的母體血進(jìn)行物質(zhì)交換后，成為動脈血，又經(jīng)臍靜脈回流到胎兒。母體動脈血從子宮螺旋動脈流入絨毛間隙，在此與絨毛內(nèi)毛細(xì)血管的胎兒血進(jìn)行物質(zhì)交換后，由子宮靜脈回流入母體。

　　有研究證實懷孕期間運動可以提高胎盤效率以及子宮胎盤灌注[15,16]，增加胎盤的生長[17,18]，增加胎盤的血管容量和毛細(xì)血管表面積，提高胎盤血流量[22-24]，并增加血管生成因子 VEGF 及其受體 VEGFR1 [25]。

短暫缺氧再恢復(fù)

胎盤經(jīng)歷練才能成長

　　在一項對妊娠最后三個月的孕婦進(jìn)行5分鐘短時間運動的研究中，多普勒超聲檢查發(fā)現(xiàn)運動會增加子宮胎盤血管阻力[26]。這表明子宮胎盤血流量短暫減少。子宮胎盤血流量的短暫減少可能會造成短暫的缺氧環(huán)境，在運動后立即促進(jìn)子宮胎盤血流量，從而導(dǎo)致絨毛間隙突然再充氧。因此，絨毛在產(chǎn)前運動期間會在胎盤絨毛間隙中經(jīng)歷間歇性缺氧/復(fù)氧的情況。

　　在妊娠11周前正常胎盤發(fā)育期間，胎盤PO2（Partial Pressure of Oxygen，PO2）比蛻膜PO2低 2.5 倍[27]。在妊娠 10-12 周之間，隨著母胎循環(huán)的建立，流入絨毛間隙的母體血流量導(dǎo)致絨毛間隙中PO2的增加。PO2的這些變化有助于胎盤的正常發(fā)育。運動導(dǎo)致絨毛間隙缺氧/復(fù)氧情況就類似于懷孕第 10-12 周正常胎盤發(fā)育中發(fā)生的情況。通過調(diào)節(jié)缺氧誘導(dǎo)因子1ɑ （HIF-1）來支持胎盤血管發(fā)育并增強細(xì)胞抗氧化防御能力[28]。因此，運動誘發(fā)的絨毛間隙中PO2的潛在變化可能會影響胎盤血管生成，并最終影響母體-胎盤-胎兒循環(huán)（圖3）。

運動還能影響

胎盤激素水平

　　胎盤作為母胎之間的關(guān)鍵界面，促進(jìn)氧氣和氣體的交換，負(fù)責(zé)合成各種對妊娠發(fā)育和維持必不可少的激素（圖 5）。這個臨時器官的內(nèi)分泌功能在整個懷孕期間至關(guān)重要。

胎盤雌激素由雌酮（E1）、17β-雌二醇（E2）、雌三醇（E3）和雌甾醇（E4）組成。一項研究報告表明，在前 10 分鐘運動期間，妊娠晚期孕婦的循環(huán) E3 顯著增加，運動后一小時后下降至略低于基線水平[29]。另一組報告在中等強度的自行車運動 30 分鐘后，孕婦體內(nèi) E3 的循環(huán)水平顯著增加[30]。目前尚不清楚運動是否會改變胎盤雌激素的產(chǎn)生或分泌，但運動可能會增加流向子宮胎盤循環(huán)的富含雌激素的血流量。

結(jié)語

胎盤是成功妊娠結(jié)果的核心，并在許多妊娠疾病或并發(fā)癥的發(fā)病機制中發(fā)揮重要作用。懷孕期間的體育運動可能通過血管生成途徑、血流供氧、胎盤雌激素分泌等影響胎盤生物學(xué)，從而對母親和后代產(chǎn)生各種益處。

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