补充维生素D预防妊娠糖尿病的随机对照试验的meta分析

Vitamin D supplementation to prevent gestational diabetes:a meta-analysis of randomized controlled trials

目的系统评价补充维生素D对妊娠糖尿病(GDM)的预防作用。方法运用PubMed、Web of Science、中国知网(CNKI)、维普资讯中文期刊服务平台(VIP)、万方医学网、中国生物医学文献服务系统(CBM)等数据库检索国内外发表的有关维生素D预防GDM的随机对照试验。截至时间2021年9月9日。使用Review Manager 5.4.1软件进行系统评价,所有分析均采用随机效应模型。结果最终纳入9项随机对照试验,共3525名孕妇。补充维生素D与GDM低发生率显著相关(优势比=0.41,95%可信区间:0.27~0.62,P=0.0001)。与对照组比较,观察组孕妇早产、剖宫产、低血糖,以及新生儿巨大儿、新生儿窒息发生率均更低,差异均有统计学意义(优势比=0.55、0.50、0.34、0.41、0.24;95%可信区间:0.36~0.85、0.32~0.79、0.19~0.59、0.20~0.83、0.10~0.59;P=0.0070、0.0030、0.0002、0.0100、0.0020)。观察组孕妇妊娠高血压、高胆红素血症发生率与对照组比较,差异均无统计学意义(P>0.05)。结论妊娠期妇女补充维生素D可有效降低GDM发生率,同时可改善多种母婴不良结局。

Objective To systematically evaluate the preventive effects of vitamin D supplementation on gestational diabetes mellitus(GDM).Methods PubMed,Web of Science,China National Knowledge Infrastructure(CNKI),VIP database,and Wanfang database,China Biology Medicine disc(CBM)(as of September 9,2021)were used to search for randomized controlled trials on vitamin D prevention of gestational diabetes at home and abroad.Statistical analysis was performed using Review Manager 5.4.1,and random-effects models were used for all analysis.Results A total of nine randomized controlled trials were included,with a total of 3525 pregnant women.Meta-analysis results showed that vitamin D supplementation was significantly associated with a low incidence of GDM[odds ratio(OR)=0.41,95%confidence interval(CI):0.27-0.62,P=0.0001].Compared with the control group,pregnant women in the vitamin D group had lower incidences of premature delivery(OR=0.55,95%CI:0.36-0.85,P=0.0070),cesarean section(OR=0.50,95%CI:0.32-0.79,P=0.0030),hypoglycemia(OR=0.34,95%CI:0.19-0.59,P=0.0002),neonatal macrosomia(OR=0.41,95%CI:0.20~0.83,P=0.0100),and neonatal asphyxia(OR=0.24,95%CI:0.10-0.59,P=0.0020).In terms of pregnancy-induced hypertension and hyperbilirubinemia,the vitamin D group and the control group had no significant statistical significance(P>0.05).Conclusion Vitamin D supplementation in pregnant women can effectively reduce the incidence of GDM and improve a variety of adverse maternal and infant outcomes.