两种剂量维生素D口服对孕前肥胖孕妇妊娠期并发症和内分泌代谢的影响

Effect of two doses of vitamin D on complications and endocrine metabolism in gravida with pre-pregnancy obesity in gestation period

目的分析两种剂量维生素D口服对孕前肥胖孕妇妊娠期并发症和内分泌代谢的影响。方法前瞻性选取2016年5月至2018年4月上海曙光医院收治的孕前肥胖孕妇154例为研究对象,采用随机数字表法将其分为观察组、对照组,每组77例。对照组孕期予以低剂量维生素D(500 IU),观察组孕期补充高剂量维生素D(30万IU)。比较两组治疗前后临床相关指标[甲状旁激素(PTH)、血钙(Ca)、血磷(P)、空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、体质指数(BMI)]、维生素D水平、内分泌指标[促卵泡成熟激素(FSH)、促黄体生成素(LH)、雌二醇(E2)]、妊娠期并发症及新生儿结局。结果观察组治疗后PTH、FBG、Hb A1c、BMI水平低于对照组,而Ca水平高于对照组(P<0.05);观察组治疗后维生素D水平、维生素D正常率高于对照组(P<0.05);观察组治疗前后FSH、LH、E2水平无明显变化(P>0.05),对照组治疗后FSH、LH、E2高于治疗前(P<0.05),观察组治疗后FSH、LH低于对照组(P<0.05);观察组孕妇妊娠期糖尿病、高血压、胎膜早破、剖宫产率及窒息、巨大儿、高胆红素血症发生率低于对照组,而新生儿Apgar评分高于对照组(P<0.05)。结论孕前肥胖孕妇在产前预防性服用高剂量维生素可改善临床相关指标,有效抑制体重增长,上调维生素D水平,改善妊娠结局和新生儿结局,且不影响内分泌代谢,值得在临床推广实践。

Objective To analyze the effects of two doses of vitamin D on complications and endocrine metabolism in gravida with pre-pregnancy obesity in gestation period.Methods 154 pre-pregnancy obese gravida in our hospital from May 2016 to April 2018 were chosen in the study.They were divided into observation group and control group by the random number table,77 cases in each group.The control group was given lower dose of vitamin D(500 IU)during pregnancy,the observation group was supplemented with high dose of vitamin D(300,000 IU)during pregnancy,the clinical related indicators[parathyroid hormone(PTH),blood calcium(Ca),blood phosphorus(P),fasting blood glucose(FBG),glycosylated hemoglobin(HbA1 c),body mass index(BMI)],vitamin D levels,endocrine indicators[follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2)],gestational complications and neonatal outcomes of the two groups before and after treatment were compared.Results The levels of PTH,FBG,HbA1 c and BMI in the observation group were lower than those in the control group after treatment,while the Ca level was higher than that in the control group(P<0.05).The vitamin D level and the normal rate of vitamin D in the observation group were higher than those in the control group(P<0.05).There was no significant change in FSH,LH and E2 levels before and after treatment in the observation group(P>0.05).FSH,LH and E2 were higher in the control group than those before treatment(P<0.05).The FSH and LH in the observation group after treatment were lower than those in the control group(P<0.05).The incidence of gestational diabetes,hypertension,premature rupture of membranes,cesarean section,asphyxia,macrosomia and hyperbilirubinemia of gravida during the pregnancy in the observation group was lower than that in the control group,while the Apgar score of the newborn was higher than that in the control group(P<0.05).Conclusion The high dose vitamin D for pre-pregnancy obese pregnant women can prevent weight gain,up-regulated vitamin D levels,reduce complications during pregnancy,it does not affect endocrine metabolism,worthy of clinical practice.