孕期预防性给予高剂量维生素D对维生素D缺乏肥胖症孕妇妊娠期糖尿病的防治作用及妊娠结局的影响研究

Effect of high-dose vitamin D during pregnancy on the prevention and treatment of gestational diabetes mellitus in obese pregnant women with vitamin D deficiency and pregnancy outcome

目的研究肥胖症孕妇孕期预防性给予高剂量维生素D对妊娠期糖尿病的防治作用及妊娠结局的影响。方法选取2019年10月至2020年10月同济大学附属第一妇婴保健院产科肥胖症孕妇100例,依据随机数字法分为孕16~20周预防性给予肌内注射30万U维生素D3注射液组(高剂量维生素D组)、孕16~20周预防性口服400U维生素D滴剂胶囊组(低剂量维生素D组)两组,各50例,统计分析两组孕妇的体质指数、血糖水平、实验室指标、维生素D缺乏程度、妊娠期糖尿病发生情况、妊娠结局。结果高剂量维生素D组孕妇干预后较干预前的体质指数降低幅度显著高于低剂量维生素D组(P<0.05),血清25(OH)D3、Ca水平升高幅度、PTH水平降低幅度均显著高于低剂量维生素D组(P<0.05),维生素D缺乏、不足比例降低幅度、正常比例升高幅度均显著高于低剂量维生素D组(P<0.05),妊娠期糖尿病发生率显著低于低剂量维生素D组(P<0.05),顺产率显著高于低剂量维生素D组(P<0.05),产钳助产率、剖宫产率均显著低于低剂量维生素D组(P<0.05),巨大儿、早产儿、新生儿窒息、死胎发生率均显著低于低剂量维生素D组(P<0.05)。结论肥胖症孕妇孕期预防性给予高剂量维生素D较低剂量维生素D更能有效防治妊娠期糖尿病,改善妊娠结局。

Objective To study the effect of high-dose vitamin D during pregnancy on the prevention and treatment of gestational diabetes mellitus in obese pregnant women with vitamin D deficiency and pregnancy outcome.Method One hundred of obese pregnant women in our hospital from October 2019 to October 2020 were selected and divided into two groups(50 cases each)according to the random number method:the group given 300000 U of vitamin D3 injection prophylactically at 16-20 weeks of gestation(high-dose vitamin D group)and the group given 400 U of oral vitamin D at 16-20 weeks of gestation(low-dose vitamin D group).The body mass index,blood glucose level,lab test results,serum vitamin D levels,incidence of gestational diabetes mellitus and pregnancy outcome were analyzed.Result The pregnant women in the high-dose vitamin D group had significant greater body mass index decrease;higher increases of serum 25(OH)D3 and Ca levels;and greater decrease of PTH than those in low-dose vitamin D group(P<0.05).The proportion of vitamin D deficiency and vitamin D insufficiency were reduced and the proportion of normal vitamin D was increased significantly in the high-dose vitamin D group than those in the low-dose vitamin D group(P<0.05).The pregnant women in the high-dose vitamin D group had significantly lower incidence of gestational diabetes(P<0.05);higher spontaneous labor rate(P<0.05),lower rates of forceps-assisted delivery and cesarean section(P<0.05),and lower rates of macrosomia,prematurity,neonatal asphyxia,and stillbirth in the high-dose vitamin D group(P<0.05).Conclusion Compared with low-dose vitamin D,high-dose vitamin D can more effectively prevent gestational diabetes mellitus and improve pregnancy outcome in obese pregnant women.