孕早期铁缺乏与妊娠和出生结局关系

Relationship between iron deficiency during the first trimester pregnancy and the pregnancy and birth outcomes

目的:探讨妊娠早期铁缺乏与妊娠和出生结局的关系。方法:收集2015年12月-2018年12月本院产科门诊建档并接受检测的孕早期妇女1982例。测量血清铁蛋白、可溶性转铁蛋白受体(sTfR)浓度,并计算总体铁(TBI)。以血清铁蛋白、sTfR和TBI为铁状态标志物,探索不同定义的铁缺乏对妊娠和出生结局影响。结果:1982名孕妇中,血清铁蛋白<20μg/L 390例(19.7%),sTfR>21 nmol/L 301例(15.2%),TBI<0 mg/kg 319例(16.1%)。根据血清铁蛋白<20μg/L定义的铁缺乏,与妊娠期糖尿病的发生风险呈负相关(HR:0.47,95%CI:0.38~0.73),与大于胎龄儿发生风险呈正相关(HR:1.32,95%CI:1.07~1.66)。根据sTfR>21 nmol/L定义的铁缺乏,与妊娠期高血压疾病的发生风险呈正相关(HR:1.31,95%CI:1.17~1.52)。根据TBI<0 mg/kg定义的铁缺乏,与妊娠期糖尿病的发生风险呈负相关(HR:0.36,95%CI:0.17~0.72),与大于胎龄儿的发生风险呈正相关(HR:1.37,95%CI:1.04~1.92)。结论:孕早期铁缺乏降低了发病风险,增加了大于胎龄儿和妊娠期高血压性疾病的发生风险。

Objective:To investigate the relationship between iron deficiency of pregnant women during the first trimester pregnancy and the pregnancy and birth outcomes.Methods:1982 pregnant women during the first trimester pregnancy were selected in this study from December 2015 to December 2018.The levels of serum ferritin,soluble transferrin receptor(sTfR)of all women were measured,and their total body iron(TBI)was calculated based on sTfR and serum ferritin.The levels of serum ferritin,sTfR and TBI were used to evaluate iron status of pregnant women.The influence of iron deficiency(ID)based on different diagnostic criteria during the first trimester pregnancy on pregnancy and birth outcomes of women were explored.Results:Among the 1982 pregnant women,390(19.7%)women with serum ferritin<20μg/L,301(15.2%)women with sTfR>21 nmol/L.and 319(16.1%)women with TBI<0 mg/kg.The ID(defined as serum ferritin<20μg/L)was negatively associated with the risk of gestational diabetes mellitus(GDM)(HR 0.47,95%CI 0.38-0.73),and that was positively associated with the risk of large for gestational age(LGA)(HR 1.32,95%CI 1.07-1.66).The ID(defined as sTfR>21 nmol/L)was positively associated with the risk of pregnancy-induced hypertension(HR 1.31,95%CI 1.17-1.52).And the ID(defined by TBI<0 mg/kg)was negatively associated with the risk of GDM(HR 0.36,95%CI 0.17-0.72),but that was positively associated with the risk of LGA(HR 1.37,95%CI 1.04-1.92).Conclusion:ID during the first trimester pregnancy is negatively associated with the risk of GDM and is positively associated with the risk of LGA and pregnancy-induced hypertension.