早期妊娠妇女维生素D水平的研究

Vitamin D levels in women at early pregnancy

目的评价早期妊娠妇女的维生素D水平及其对妊娠结局的影响。方法选取2017年6至11月在嵊州市妇幼保健院妇科就诊的难免流产患者70例(难免流产组),正常早孕女性75例(正常早孕组)作为研究对象,用高效液相色谱——串联质谱法检测25-羟基维生素D[25-(OH)D]水平,并比较两组25-(OH)D水平的差异。结果难免流产组25-(OH)D水平中位数16.9ng/mL,其中充足(≥30ng/mL)0例,不足(20～<30ng/mL)11例,占15.71%,缺乏(<20ng/mL)59例,占84.29%。正常早孕组25-(OH)D水平中位数17.30ng/mL,其中充足(≥30ng/mL)2例,占2.67%,不足(20～<30ng/mL)24例,占32.00%,缺乏(<20ng/mL)49例,占65.33%;难免流产组的25-(OH)D水平明显低于正常早孕组(Z=5.960,P=0.014),正常早孕组在孕7～8周、>8～9周及>9～10周维生素D缺乏率呈下降趋势,但差异无统计学意义(χ~2=1.871,P=0.394),难免流产组维生素D缺乏率在不同孕期差异有统计学意义(χ~2=7.644,P=0.029),妊娠9周以后,维生素D缺乏率不但没有随着孕周增加而降低,反而有明显的升高。结论嵊州本地早期妊娠妇女普遍存在维生素D不足和缺乏的现象,难免流产患者的维生素D水平明显低于正常早孕妇女,维生素D低水平的孕妇更易发生自然流产,对于维生素D的补充应贯穿于孕前及早孕期。

Objective To evaluate the vitamin D levels of pregnant women at first trimester and their influence on pregnancy outcomes.Methods From June to November in 2017,70 cases of inevitable abortion（inevitable abortion group）and 75 cases of normal pregnancy（normal pregnant group）were selected in Shengzhou Maternal and Child Health Hospital,and their 25-hydroxy vitamin D [25-（OH）D]levels were detected by high performance liquid chromatography-tandem mass spectrometry and compared between two groups.Results The median 25-（OH）D level of inevitable abortion group was 16.9 ng/mL,of which there was 0 case with sufficient（≥30 ng/mL）level,11 cases with insufficient（20-30 ng/mL）level,accounting for 15.7%,and 59 cases with deficient（20 ng/mL）level,accounting for 84.3%.In normal pregnant group,the median 25-（OH）D level was 17.30 ng/mL.The 25-（OH）D levels of 2 cases were sufficient（≥30 ng/mL）,accounting for 2.67%,of 24 cases were insufficient（20-30 ng/mL）,accounting for 32.0%,and of 49 cases were deficient（20 ng/mL）,accounting for 65.33%.The 25-（OH）D level of inevitable abortion group was significantly lower than normal pregnant group（Z=5.960,P=0.014）.Vitamin D deficiency rate declined during 7-8 weeks,8-9 weeks and 9-10 weeks in normal pregnant group without statistical significance（χ~2=1.871,P=0.394）,but that in inevitable abortion group was statistically different in different pregnancy periods（χ~2=7.644,P=0.029）.After 9 weeks of gestation,vitamin D deficiency rate increased with increasing gestational age.Conclusion Vitamin D deficiency is widespread in early pregnant women in Shengzhou.Vitamin D levels in patients with inevitable abortion are significantly lower than normal pregnant women.Spontaneous abortion is more likely to occur in women with low levels of vitamin D,so vitamin D should be supplemented before pregnancy and at the first trimester of pregnancy.