孕妇血清25-羟维生素D3水平与妊娠期糖尿病的相关性

Correlation between serum 25-hydroxyvitamin D3 levels and gestational diabetes in pregnant women

目的检测妊娠期妇女血清25-羟维生素D3[25(OH)D3]水平及血糖相关指标,探讨孕妇血清25(OH)D3水平与妊娠期糖尿病(GDM)的相关性,为该地区妊娠妇女维生素D的补充提供依据。方法选取2017年1月-2019年1月在重庆市綦江区人民医院和綦江区妇幼保健院产科门诊产检的2138例孕13~20周单胎妊娠孕妇为研究对象,检测其血清25(OH)D3水平及血糖相关指标,对缺乏者进行补充维生素D,每8周监测维生素D水平,并调整维生素D补充量,在孕24~28周进行75 g葡萄糖耐量试验(OGTT),根据OGTT试验结果将受检孕妇分为GDM组和正常妊娠组,对比两组孕妇血清25(OH)D3水平,分析血清25(OH)D3水平与GDM的相关性。同时选择同期在该院健康体检的200例未妊娠生育期女性作为对照组,对比妊娠女性与未妊娠女性血清25(OH)D3水平。结果GDM组血清25(OH)D3水平显著低于正常妊娠组,差异有统计学意义(P<0.05);妊娠期女性血清25(OH)D3水平与对照组相比,差异无统计学意义(P>0.05);GDM组年龄、体质指数(BMI)、糖尿病家族史、空腹血糖(FPG)、孕早期服用维生素D与正常妊娠组相比,差异均有统计学意义(均P<0.05),两组产次比较差异无统计学意义(P>0.05);GDM组FPG、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)均显著高于正常妊娠组,差异均有统计学意义(均P<0.05);两组空腹胰岛素(FINS)、总胆固醇(TCH)、低密度脂蛋白胆固醇(LDL-C)相比,差异无统计学意义(P>0.05);对血清25(OH)D3水平与糖脂代谢指标的相关性分析结果显示,血清25(OH)D3水平与TG呈负相关(P<0.05);与FPG、FINS、TCH、HDL-C、LDL-C无相关性(P>0.05);对GDM发生相关因素的多因素二元Logistic回归分析结果显示,GDM的发生与年龄、BMI、糖尿病家族史、TG、HDL-C、25(OH)D3相关(P<0.05)。结论孕妇血清25(OH)D3缺乏是GDM发病的高危因素,适当补充维生素D可改善孕妇胰岛素抵抗,对GDM的预防有着积极的作用。

Objective To detect serum 25-hydroxyvitamin D3(25(OH)D3)levels and blood glucose-related indicators in pregnant women,and to explore the correlation between serum 25-hydroxyvitamin D3 levels and gestational diabetes in pregnant women.The supplement of D provides the basis.Methods From Jan 2017 to Jan 2019,2138 pregnant women with single pregnancy of 13-20 weeks pregnant in the obstetrics outpatient department of Chongqing Qijiang District People's Hospital and Chongqing Qijiang District Maternal and Child Health Hospital were selected as subjects to test their serum 25-hydroxyvitamin D levels and blood glucose.Related indicators,vitamin D supplementation for the lack of people,vitamin D levels monitored every 8 weeks,and adjustment of vitamin D supplementation,75g glucose tolerance test(OGTT)test in the 24-28 weeks of pregnancy,according to OGTT test results The pregnant women were divided into gestational diabetes group and normal pregnancy group.The serum levels of 25-hydroxyvitamin D were compared between the two groups.The correlation between serum 25-hydroxyvitamin D3 level and gestational diabetes was analyzed.At the same time,200 women who were not pregnant during the same period in the hospital were selected as the control group to compare the serum 25-hydroxyvitamin D levels between pregnant women and non-pregnant women.Results Serum 25(OH)D3 levels in the gestational diabetes group were significantly lower than those in the normal pregnancy group(P<0.05).There was no significant difference in serum 25(OH)D3 levels between the pregnant women and the control group.Significance(P>0.05);gestational diabetes group age,BMI,family history of diabetes,FPG,early pregnancy vitamin D compared with normal pregnancy group were statistically significant(P<0.05),the difference between the two groups Statistical significance(P>0.05);FPG,TG,HDL-C in gestational diabetes group were significantly higher than normal pregnancy group,the difference was statistically significant(P<0.05);two groups of FINS,TCH,LDL-C phase There was no significant difference in the ratio(P>0.05).Correlation analysis between serum 25(OH)D3 level and glucose and lipid metabolism index showed that serum 25(OH)D3 level was negatively correlated with TG(P<0.05).There was no correlation with FPG,FINS,TCH,HDL-C,LDL-C(P>0.05);multivariate binary logistic regression analysis of GDM related factors,the results showed that GDM occurred with age,BMI,diabetes Family history,TG,HDL-C,and 25(OH)D3 were associated(P<0.05).Conclusion Serum 25(OH)D3 deficiency in pregnant women is a high risk factor for GDM.Appropriate vitamin D supplementation can improve insulin resistance in pregnant women and has a positive effect on the prevention of GDM.