妊娠中晚期孕妇膳食营养及体内叶酸、维生素D等水平与妊娠期高血压疾病的关系

The Relationship Between PIH and Dietary Nutrition,Folic Acid,Vitamin D Among Pregnant Women in Middle and Third Trimester

目的:了解孕妇在妊娠中晚期的膳食营养状况,分析叶酸、维生素D等水平与妊高症的关系。方法:选取山东大学齐鲁医院青岛市院区2017年8月—2019年8月收治的妊娠期高血压疾病(PIH,简称妊高症)患者106例作为观察组,根据妊高症分型分为三个亚组:妊娠期高血压组(38例)、轻度子痫前期(36例)、重度子痫前期(32例),选取同期在我院住院的正常孕妇126例为对照组。采用24h回忆法统计孕妇膳食状况,观察和比较两组患者血清叶酸、同型半胱氨酸(Hcy)、维生素D、血清钙、体重指数(BMI)等指标,分析影响PIH的相关因素。结果:孕妇不同膳食结构中,谷类、乳类、蔬菜类、鱼虾类、水果类摄入量均不足,豆类和油脂类摄入量适宜,畜禽肉类和蛋类摄入过量;对照组患者血清中叶酸、维生素D以及血清钙水平明显高于观察组中各亚组患者,随着妊娠高血压程度的不断加重,观察组中各亚组血清中叶酸、维生素D以及血清钙水平呈明显降低趋势,各组间比较差异具有统计学意义(P<0.01);重度子痫前期组患者血清Hcy水平最高,正常对照组血清Hcy水平最低,各组间比较具有明显差异(P<0.01);对影响PIH的单因素分析中,两组患者在年龄、BMI、血清叶酸、维生素D、血清Hcy和血清钙水平等方面比较具有统计学意义(P<0.05或P<0.01)。Logistic回归分析显示,孕期BMI、血清Hcy为PIH的独立危险因素,叶酸、维生素D、血清钙为PIH的保护因素。结论:孕妇在妊娠中晚期的膳食营养结构不均衡,谷类、乳类、蔬菜类、鱼虾类、水果类摄入量均不足,畜禽肉类和蛋类摄入过量,营养结构有待改善。PIH的发生与维生素D、叶酸和血清钙水平密切相关,BMI、Hcy是影响PIH发生的独立危险因素,叶酸、维生素D和血清钙是PIH的保护因素。孕妇在妊娠期间补充叶酸、维生素D、血清钙和控制能量过度摄入,对预防和降低PIH的发生具有重要的临床意义。

[Objective]To understand the dietary nutritional status of pregnant women in the middle and third trimester of pregnancy,and to analyze the relationship between PIH and folic acid,vitamin D.[Method]Totally 106 patients with gestational hypertension(PIH)admitted to our hospital from August 2017 to August 2019 were selected as the observation group and divided into three subgroups according to preeclampsia classification:38 patients with gestational hypertension,36 patients with mild preeclampsia and 32 patients with severe preeclampsia.Totally 126 normal pregnant women hospitalized in our hospital during the same period were selected as the control group.The dietary status of pregnant women was calculated by 24-hour recall method.Serum folic acid,homocysteine(Hcy),vitamin D,serum calcium,body mass index(BMI)and other indicators were observed and compared between the two groups,and the relevant factors affecting PIH were analyzed.[Result]The intake of cereals,dairy,vegetables,fish,shrimp and fruits was insufficient,the intake of beans and fats was appropriate,and the intake of meat and eggs was excessive.The serum folate,vitamin D and serum calcium levels of control group patients were significantly higher than those in the observation group,and with gestational hypertension degree of deepening,the serum folate,vitamin D and serum calcium levels in the observation group showed a trend of decrease,comparing differences between groups with statistical significance(P<0.01).The serum Hcy level was the highest in the group with severe preeclampsia,and the serum Hcy level was the lowest in the normal control group.Affecting the single factor analysis of PIH,two groups of patients in age,BMI,serum folate,vitamin D,serum levels of Hcy and serum calcium levels was statistically significant(P<0.05 or P<0.01),by logistic regression analysis showed that prenatal BMI,and serum Hcy as independent risk factors of PIH,folic acid,vitamin D,and serum calcium for the protective factors of PIH.[Conclusion]Pregnant women in the middle and third trimester of pregnancy dietary nutritional structure is not balanced,cereal,milk,vegetables,fish and shrimp,fruits intake are insufficient,livestock and poultry meat and eggs intake too much,the nutritional structure needs to be improved.The occurrence of PIH is closely related to vitamin D,folic acid and serum calcium levels.BMI and Hcy are independent risk factors affecting the occurrence of PIH,while folic acid,vitamin D and serum calcium are protective factors for PIH.Supplementation of folic acid,vitamin D,serum calcium and control of excessive intake of energy during pregnancy have important clinical significance in preventing and reducing the occurrence of PIH.