妊娠早期维生素D缺乏对妊娠期糖尿病发生及妊娠结局的影响

The effect of vitamin D deficiency in early pregnancy on the occurrence of gestational diabetes mellitus and pregnancy outcome

目的探讨妊娠早期维生素D缺乏对妊娘期糖尿病(GDM)发生及妊娠结局的影响。方法收集2018年1月至2019年12月在佛山市妇幼保健院进行产检的孕妇1,516例,均在妊娠11〜14周检测血液总25(OH)D含量和血清Ca^(2+)、Mg^(2+)、碱性磷酸酶、孕妇骨密度值等其它实验室指标,在妊娠24〜28周进行75 g葡萄糖耐量试验,共有264例孕妇诊断为GDM。根据年龄±3岁并按1:2的比例匹配了528例非GDM孕妇进行研究。应用配对二分类logistic回归分析孕早期维生素D缺乏与GDM发生的关系。应用非条件二分类logistic回归分析孕早期维生素D缺乏及GDM发生与妊娠结局的关系。结果单因素及多因素logistic回归分析结果显示,维生素D缺乏[25(OH)D<50nmol/L]与GDM发生无相关,且无统计学意义(P>0.05)。在调整了潜在混杂因素后,妊娠早期维生素D缺乏的早产发生风险较高,OR值为2.124(95%CI:1.111〜4.060,P=0.023)。未发现妊娠早期维生素D缺乏与其他妊娠结局如胎儿窘迫、胎膜早破和低出生体重儿等有关。结论妊娠早期维生素D缺乏可能增加早产发生的风险,定期检测维生素水平,指导维生素D缺乏孕妇积极补充维生素D,可以改善妊娠结局。

Objective To investigate the effect of vitamin D deficiency in early pregnancy on the occurrence of gestational diabetes mellitus(GDM)and pregnancy outcome Methods A total of 1,516 pregnant women who received prenatal examinations in Foshan Matemal and Child Health Hospital from Janimry 2018 to December 2019 were collected.The blood total 25(OH)D content,serum Ca^(2+),Mg^(2+),alkaline phosphatase,bone mineral density and other laboratory indexes of pregnant women were detected at 11 to 14 weeks of gestation.A total of 264 pregnant women were diagnosed with GDM by 75 g glucose tolerance test at 24〜28 weeks of gestation.A total of 528 non-GDM pregnant women were matched according to age ±3 years and the ratio was 1:2.Paired binary Logistic regression was used to analyze the relationship between vitamin D deficiency in early pregnancy and the occurrence of GDM.Unconditional dichotomy Logistic regression was used to analyze the relationship between vitamin D deficiency and GDM in early pregnancy and pregnancy outcome.Results Univariate and multivariate Logistic regression analysis showed that vitamin D deficiency[25(OH)D<50 nmol/L]had no correlation with the occurrence of GDM,and there was no statistical significance(P>0.05).After adjustment for potential confounders,vitamin D deficiency in early pregnancy was associated with a higher risk of preterm delivery,with an OR value of 2.124(95%CI:1.111〜4.060,P=0.023).Vitamin D deficiency in early pregnancy was not associated with other pregnancy outcomes such as fetal distress,premature rupture of membranes,and low birth weight.Conclusion Vitamin D deficiency in early pregnancy may increase the risk of preterm birth.Regular testing of vitamin D levels and guidance on active vitamin D supplementation in pregnant women with vitamin D deficiency may improve pregnancy outcomes.