超重肥胖和非肥胖妊娠期糖尿病孕妇母血及脐血维生素D水平及影响因素研究

Study on Vitamin D Levels of Maternal and Umbilical Cord Blood in Overweight/Obese and Nonobese Pregnant Women with Gestational Diabetes

目的:比较超重肥胖和非肥胖妊娠期糖尿病(GDM)孕妇及新生儿脐血血清维生素D水平,探讨可能影响因素。方法:选取2015年1月—2017年4月南京医科大学附属常州妇幼保健院住院足月分娩的孕妇为研究对象,分为糖耐量正常组(NGT)70例和GDM组70例,依据体质量指数(BMI)再将其分为NGT不伴肥胖组(N1组)、NGT伴超重肥胖组(N2组)、GDM不伴肥胖组(G1组)、GDM伴超重肥胖组(G2组),各35例,检测母亲外周血和新生儿脐血血清25羟维生素D水平,同时检测空腹血糖(FBG)、空腹胰岛素(FINS)水平,并计算稳态模型胰岛素抵抗指数(HOMAIR)。结果:4组孕妇的年龄、孕次、产次、孕周、钙剂和维生素D补充及平均日晒时间比较,差异均无统计学意义(均P>0.05)。母血维生素D水平GDM孕妇低于NGT孕妇(G1组低于N1组,G2组低于N2组),超重肥胖孕妇低于非肥胖孕妇(N2组低于N1组,G2组低于G1组),GDM伴超重肥胖孕妇最低,差异均有统计学意义(P<0.05);新生儿脐血维生素D水平GDM组低于NGT组(G1组低于N1组,G2组低于N2组),NGT组超重肥胖孕妇低于非肥胖孕妇(N2组低于N1组),差异均有统计学意义(P<0.05)。孕妇维生素D水平与FBG、孕前BMI呈负相关,与孕期维生素D补充、日晒时间呈正相关,脐血维生素D水平与母血维生素D水平呈正相关(均P<0.05)。结论:GDM孕妇普遍维生素D水平低,GDM伴超重肥胖孕妇更明显,新生儿脐血维生素D水平受母血影响,母血维生素D水平受FBG、孕前BMI、孕期维生素D摄入与日晒时间影响。

Objective: This study aims to compare the serum vitamin D (VD) levels in maternal and umbilical cord blood between obese and overweight-obese pregnant women with gestational diabetes (GDM). The possible influencing factors were analyzed. Methods: Pregnant women with full term deliveries in Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University from Jan. 2015 to Apr. 2017 were selected as study objects. The patients were divided into two groups: normal glucose tolerance group(NGT, 70 cases) and GDM group(70 cases). They were divided into four subgroups according to BMI further: NGT without obesity group (N1) , NGT with overweight-obese group (N2) , GDM without obese group (G1) and GDM with overweight-obese group (G2), with 35 cases respectively. The levels of serum 25(OH)D in maternal peripheral blood and umbilical cord blood were tested. The maternal fasting blood glucose (FBG), fasting insulin (FINS) were also tested and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Results: There was no statistical difference in maternal age, gravidity and parity history, gestational age, calcium and VD intake, time of sun exposure between these 4 groups(both P>0.05). The VD levels of GDM were significantly lower than NGT group (G1 was lower than N1, G2 was lower than N2), the VD levels of obese pregnant women were significantly lower than non-obese pregnant women (N2 was lower than N1, G2 was lower than G1), the VD level of GDM with obese women was the lowest (P<0.05). The level of VD in cord blood of neonates in GDM group was lower than that in NGT group (G1 was lower than that in N1, G2 was lower than that in N2), and the VD level of overweight and obese pregnant women in NGT group was lower than that in non-obese pregnant women (N2 was lower than that in N1), the difference was statistically significant (P<0.05). Maternal VD level was negatively correlated with FBG and BMI before pregnancy, positively correlated with VD intake and duration of sun exposure in pregnancy, and umbilical cord blood VD level was positively correlated with maternal VD (P<0.05). Conclusions: The VD levels of GDM pregnant women are generally low, which is more obviously seen in overweight and obese pregnant women. The blood vitamin D level of neonates is affected by maternal blood, while the maternal blood VD level is affected by FBG, BMI before pregnancy, VD intake during pregnancy and sun exposure time.