孕早期维生素D水平与妊娠期糖尿病发生风险关系

The relationship between vitamin D level during the first trimester of pregnancy and the occurrence of maternal gestational diabetes mellitus

目的:分析妊娠早期维生素D水平与妊娠期糖尿病(GDM)发生的相关性。方法:选择2018年1月-2020年1月本院行产前检查的妊娠早期孕妇1074例临床资料及口服葡萄糖耐量试验(OGTT)检测结果。化学发光免疫法检测血清25(OH)D。根据VD缺乏程度分组,比较孕妇血糖水平及GDM发生风险。结果:GDM孕妇血清25(OH)D水平低于血糖正常孕妇(P<0.05);VD严重缺乏孕妇空腹、OGTT1h、OGTT2h血糖水平均高于VD轻度缺乏及VD正常孕妇,VD轻度缺乏OGTT1h、OGTT2h血糖水平高于VD正常孕妇(均P<0.05),VD轻度缺乏与VD正常孕妇空腹血糖无差异(P>0.05);VD正常、VD轻度缺乏、VD严重缺乏孕妇GDM发生率逐渐升高,VD轻度缺乏及VD严重缺乏孕妇GDM的发生风险升高,VD严重缺乏风险最高(均P<0.05)。25(OH)D对GDM具有预测效能(P<0.001,95%CI 0.126~0.310);VD正常、VD轻度缺乏、VD严重缺乏孕妇OGTT 1项异常比例逐渐降低,OGTT 2项、OGTT 3项异常比例逐渐升高(P<0.05)。VD轻度缺乏不增加OGTT多项异常风险(P>0.05),而VD严重缺乏孕妇OGTT多项异常风险升高(P<0.05)。结论:妊娠早期VD缺乏会增加GDM的风险,对GDM有预测价值,且与OGTT结果异常类型有关。

Objective:To analyze the relationship between maternal vitamin D(VD)level during the first trimester of pregnancy and the occurrence of maternal gestational diabetes mellitus(GDM).Methods:The clinical data and the results of oral glucose tolerance test(OGTT)of 1074 pregnant women during the first trimester of pregnancy from January 2018 to January 2020 were selected.The serum 25(OH)D levels of these women were detected by chemiluminescence immunoassay.These women were divided into different groups according to their degree of VD deficiency.The blood glucose level and risk of GDM occurrence of the women were compared among these groups.Results:The serum 25(OH)D level of the women with GDM was significant lower than that of the women with normal blood glucose(P<0.05).The blood glucose levels of fasting,OGTT 1h and OGTT 2h of the women with severe VD deficiency were significant higher than those of the women with mild VD deficiency and those of the women with normal VD.The blood glucose levels in OGTT 1h and OGTT 2h of the women with mild VD deficiency were significant higher than those of the women with normal VD(all P<0.05).There was no significant difference in fasting blood glucose level between the women with mild VD deficiency and the women with normal VD(P>0.05).The incidence of GDM of the women with normal VD,the women with mild VD deficiency,and the women with severe VD deficiency had increased gradually.The risk of GDM occurrence the women with mild or severe VD deficiency had increased,and which of the women with severe VD deficiency was the highest(all P<0.05).The 25(OH)D level of the pregnant women had predictive efficiency for their GDM occurrence(P<0.001,95%CI 0.126-0.310).The incidence of 1 result of OGTT of the women with normal VD level,the women with mild VD deficiency,and the women with severe VD deficiency had decreased gradually.The incidence of 2 or 3 results of OGTT of the women with normal VD level,the women with mild VD deficiency,and the women with severe VD deficiency had increased gradually(P<0.05).Conclusion:VD deficiency of the pregnant women during the first trimester of pregnancy may increase the risk of GDM occurrence,which has some predictive value for GDM,and is related to the abnormal types of OGTT results.