妊娠早中期妇女维生素D营养现状分析

Status of vitamin D in women at the first and second trimesters of pregnancy

目的 了解上海部分地区妊娠早中期妇女25-羟基维生素D[25（OH）D]水平，为临床指导孕妇合理补充维生素D（VitD）提供依据。方法 采用酶联免疫吸附试验（ELISA）检测13440例常规产检孕妇[妊娠早期（<12周）10400例、妊娠中期（12～27周）3040例]和205名体检健康女性（正常对照组）血清25（OH）D水平。以血清25（OH）D<25nmol/L为VitD严重缺乏、25～<50nmol/L为VitD缺乏、50～<75nmol/L为VitD不足、75～<250nmol/L为VitD充足、250～375nmol/L为VitD过量、>375nmol/L为VitD中毒。结果正常对照组血清25（OH）D水平为（58.07±14.64）nmol/L，其中VitD严重缺乏、缺乏、不足和充足者分别为4例（1.95%）、97例（47.32%）、80例（41.95%）和18例（8.78%）。妊娠早中期组血清25（OH）D水平为（45.05±15.79）nmol/L，其中VitD严重缺乏、缺乏、不足、充足者分别为1029例（7.66%）、7485例（55.69%）、4544例（33.81%）和382例（2.84%）。正常对照组血清25（OH）D水平明显高于妊娠早中期组（P<0.05）。妊娠早期和中期妇女血清25（OH）D水平分别为（44.66±15.36）和（46.40±17.05）nmol/L，VitD严重缺乏率分别为7.72%和7.43%、缺乏率分别为56.67%和52.34%、不足率分别为33.17%和36.02%、充足率分别为2.44%和4.21%；妊娠早期与中期妇女之间VitD缺乏率、不足率和充足率差异均有统计学意义（P<0.05）。冬春季孕妇血清25（OH）D水平[（44.27±15.98）nmol/L]低于夏秋季孕妇[（45.76±15.55）nmol/L]（P<0.01）。结论妊娠早中期妇女普遍存在VitD缺乏或不足现象，且妊娠早期比妊娠中期更严重；春冬季更易出现25（OH）D缺乏。建议在孕早期进行血清25（OH）D检测，以便科学、合理地指导孕妇补充VitD。

Objective To study the level of 25-hydroxyvitamin D [25(OH)D] in women at the first and secondtrimesters of pregnancy in Shanghai,and to provide a reference for the supplement of vitamin D(Vit D) for pregnantwomen. Methods A total of 13 440 pregnant women [10 400 cases at the first trimester(<12 weeks) and 3 040cases at the second trimester(12-27 weeks)] and 205 healthy subjects(healthy control group) were enrolled.The level of serum 25(OH)D was determined by enzyme-linked immunosorbent assay(ELISA). Serum25(OH)D levels <25,25-<50,50-<75,75-<250,250-375 and >375 nmol/L were as Vit D famine,deficiency,insufficiency,sufficiency overdose and poisoning. Results The level of serum 25(OH)D in healthy control groupwas(58.07±14.64) nmol/L,and the proportions of Vit D famine,deficiency,insufficiency and sufficiency were1.95%(4 cases),47.32%(97 cases),41.95%(80 cases) and 8.78%(18 cases),respectively. The levelof serum 25(OH)D in pregnancy group was(45.05±15.79) nmol/L,and the proportions of Vit D famine,deficiency,insufficiency and sufficiency were 7.66%(1 029 cases),55.69%(7 485 cases),33.81%(4 544cases) and 2.84%(382 cases).The level of serum 25(OH)D in healthy control group was higher than that in pregnancy group(P<0.05). The serum 25(OH)D levels at the first and second trimesters of pregnancy were(44.66±15.36) and(46.40±17.05) nmol/L. In the 2 groups,the proportions of Vit D famine were 7.72% and7.43%,the proportions of deficiency were 56.67% and 52.34%,the proportions of insufficiency were 33.17% and36.02%,and the proportions of sufficiency were 2.44% and 4.21%. The differences of Vit D deficiency,insufficiencyand sufficiency proportions were significant statistically between the 2 groups(P<0.05). The level of serum25(OH)D in winter-spring [(44.27±15.98) nmol/L] was lower than that in summer-autumn [(45.76±15.55) nmol/L](P<0.01). Conclusions The deficiency or insufficiency of Vit D is common in women at the firstand second trimesters of pregnancy.The Vit D deficiency at the first trimester of pregnancy is more serious comparedwith that at the second trimester of pregnancy,which is more common in winter-spring. It would be good for pregnantwomen to have a determination of serum 25(OH)D at the first trimester of pregnancy,and the determination canprovide a scientific and appropriate Vit D supplement.