超重肥胖和非肥胖妊娠期糖尿病患者母血及脐血维生素D水平研究

Research of maternal blood and umbilical cord blood vitamin D levels in overweight,obese and non-obese gestational diabetic patients

目的观察超重肥胖和非肥胖妊娠期糖尿病(GMD)患者母血及脐血维生素D水平。方法选择该院2016年9月至2017年8月该院住院足月分娩孕妇501例,根据糖耐量结果,分成糖耐量正常(NGT)组250例和GDM组251例。再按体质量指数(BMI),分成NGT非肥胖组(N1组)125例、NGT超重肥胖组(N2组)125例、GDM非肥胖组(G1组)125例、GDM超重肥胖组(G2组)126例。取孕妇外周血和新生儿脐血,对其血清维生素D水平,并检测空腹血糖(FBG)、空腹胰岛素(FINS)水平,计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果GDM组维生素D水平低于NGT组(G1组<N1组,G2组<N2组),超重肥胖孕妇低于非肥胖孕妇(N2组<N1组,G2组<G1组),G2组维生素水平最低(P<0.05)。四组维生素D缺乏相比,差异无统计学意义(P>0.05),而G2组高于N1组,差异有统计学意义(P<0.05)。GDM组新生儿脐血维生素D水平低于NGT组,差异有统计学意义(P<0.05),但G1、G2组相比,差异无统计学意义(P>0.05)。四组新生儿脐血维生素D缺乏率相比(P>0.05)。G2组FBG、FINS、HOMA-IR水平最高,差异有统计学意义(P<0.05)。多元逐步线性回归分析,结果显示:孕期维生素D补充、日晒时间是母血维生素D水平的保护因素,FBG、孕前BMI是其危险因素(P<0.05);母血维生素D水平是脐血维生素D水平的保护因素(P<0.05)。结论GDM孕妇维生素D缺乏现象较普遍,特别是超重肥胖GDM孕妇,母血维生素水平受到FBG、孕前BMI、孕期维生素D补充、日晒时间的影响,新生儿脐血维生素D水平受到母血的影响。

Objective To Observe the vitamin D levels of maternal blood and umbilical cord blood in overweight,obese and non-obese gestational diabetes mellitus(GMD)patients.Methods A total of 501 pregnant women(September 2016-August 2017)were enrolled in the hospital and divided into 250 cases in the normal glucose tolerance(NGT)group and 251 cases in the GDM group according to the results of glucose tolerance.According to body mass index(BMI),125 cases were divided into NGT non-obese group(N1 group),125 cases in NGT overweight and obesity group(N2 group),125 cases in GDM non-obese group(G1 group),and 126 cases in GDM overweight and obesity group(G2 group).Maternal peripheral blood and neonatal cord blood were taken,serum vitamin D levels were measured,fasting blood glucose(FBG)and fasting insulin(FINS)levels were measured,and the steady-state model insulin resistance index(HOMA-IR)was calculated.Results The vitamin D level in the GDM group was lower than that in the NGT group(G1 group<N1 group,G2 group<N2 group),the overweight and obese pregnant women were lower than those in the non-obese pregnant women(N2 group<N1 group,G2 group<G1 group),and the vitamin level in the G2 group was the lowest(P<0.05).Compared with vitamin D deficiency in the four groups,and the difference was not statistically significant(P>0.05),the G2 group was higher than that in the N1 group,and the difference was statistically significant(P<0.05).Neonatal vitamin D levels in the GDM group were lower than those in the NGT group(P<0.05),but compared with G1 and G2 groups(P>0.05),the difference was not statistically significant.Rates of vitamin D deficiency in cord blood in four neonatal groups(P>0.05),and the difference was statistically significant.The G2 group had the highest levels of FBG,FINS,HOMA-IR(P<0.05),and the difference was statistically significant.In multiple stepwise linear regression analysis,the results showed that vitamin D supplementation and sun exposure time during pregnancy were the protective factors for maternal blood vitamin D level,FBG and pre-pregnancy BMI were the risk factors(P<0.05);maternal blood vitamin D level was the protective factor for cord blood vitamin D level(P<0.05).Conclusion Vitamin D deficiency is common in pregnant women with GDM,especially in overweight and obese pregnant women with GDM,maternal blood vitamin levels are affected by FBG,preconception BMI,pre-pregnancy vitamin D supplementation,and sun exposure time,and neonatal cord blood vitamin D levels are affected by maternal blood.