不明原因复发性流产患者孕前维生素D水平与妊娠结局的关系

Study on the relationship between pre-pregnancy vitamin D level and pregnancy outcome in unexplained recurrent spontaneous abortion

目的探讨不明原因复发性流产(URSA)患者孕前维生素D水平与妊娠结局。方法采用前瞻性研究方法,纳入2017年5月至2019年4月在同济大学附属第一妇婴保健院就诊的URSA患者4534例,检测其孕前外周血维生素D水平,观察孕后母婴结局及新生儿情况。结果URSA患者孕前血清维生素D水平为(42.22±16.27)nmol/L,维生素D缺乏、不足和充足的比例分别为72.3%、24.0%和3.7%;维生素D水平与年龄呈正相关(r=0.15,P<0.05);维生素D<50 nmol/L组年龄小于维生素D≥50 nmol/L组(P<0.05);维生素D<50 nmol/L组自然流产≥3次比例高于维生素D≥50 nmol/L组(P<0.05);维生素D水平与外周血CD3^(+)CD4^(+)T细胞比例呈负相关(P<0.05);多因素logistic回归分析,最终模型调整了年龄、流产次数和季节,维生素D<50 nmol/L组妊娠失败风险增高[30.6%(76/248)vs 17.9%(12/67),χ^(2)=3.67,P=0.02],OR值为2.02(95%CI:1.02~3.9);孕前维生素D<50 nmol/L组患者所分娩新生儿进入NICU风险增高,OR值为3.16(95%CI:1.15~8.65)。结论URSA患者孕前维生素D水平缺乏发生率高,并与既往自然流产次数、再次妊娠失败率有关,是复发性流产的高危因素之一,并增加新生儿进入NICU的概率。

Objective To investigate the pre-pregnancy vitamin D level and pregnancy outcome in patients with unexplained recurrent spontaneous abortion(URSA).Methods A prospective study was performed in 4534 patients with URSA from May 2017 to April 2019 at Shanghai First Maternity and Infant Health Hospital Affiliated to Tongji University.The serum Vitamin D levels was obtained before pregnancy.Pregnancy complications and newborns outcomes were recorded after pregnancy.Results The serum vitamin D level of patients with URSA before pregnancy was(42.22±16.27)nmol/L,and the proportions of vitamin D deficiency,insufficiency and sufficiency were 72.3%,24.0%,and 3.7%,respectively.The Vitamin D level was positively correlated with age(P<0.05);The age of vitamin D<50 nmol/L group was lower than that of vitamin D≥50 nmol/L group(P<0.05);patients with vitamin D<50 nmol/L had higher proportion of spontaneous abortions≥3 times than those with the vitamin D≥50 nmol/L(P<0.05);The level of vitamin D was negatively correlated with the ratio of CD3^(+)CD4^(+)T cells in peripheral blood(P<0.05);In multivariate logistic regression analysis,the final model adjusted for age,abortion frequency and season.The risk of pregnancy failure was increased in vitamin D<50 nmol/L group[30.6%(76/248)vs 17.9%(12/67),χ^(2)=3.67,P=0.02],OR=2.02(95%CI:1.02-3.9);In the group of vitamin D<50 nmol/L before pregnancy,the risk of newborns entering NICU was increased,OR=3.16(95%CI:1.15-8.65).Conclusions Vitamin D deficiency is prevalent in URSA patients before pregnancy,which correlates with the times of previous spontaneous abortions and recurrent pregnancy failure.Vitamin D deficiency before pregnancy is one of the high-risk factors for URSA.