孕中期孕妇血清3种维生素水平的年龄、季节变化及其对妊娠期糖尿病的影响

Age and seasonal changes of three vitamins levels in middle pregnancy and their effects on gestational diabetes mellitus

目的探讨孕中期孕妇血清25羟维生素D[25-(OH)D]、叶酸和维生素B 12水平的年龄、季节变化,以及其对妊娠期糖尿病(GDM)的影响。方法选择2021年1-12月于上海市嘉定区妇幼保健院产检的4830例孕妇作为研究对象。按年龄段分为≤25岁827例,>25~30岁2069例,>30~35岁1550例,>35岁387例;按照孕中期检测维生素水平时所处的季节划分,春季1137例,夏季1422例,秋季1149例,冬季1125例;根据孕中期口服葡萄糖耐量试验(OGTT)结果将孕妇分为对照组(健康妊娠,n=4015)和GDM组(n=815)。于孕中期检测血清25-(OH)D、叶酸和维生素B_(12)水平,比较不同年龄段、不同季节这3种维生素水平,并通过Logistic回归分析年龄及这3种维生素水平对GDM发病的影响。结果与其他年龄段相比,≤25岁孕妇血清中25-(OH)D、叶酸和维生素B_(12)水平均最低,差异均有统计学意义(P<0.05);四季中25-(OH)D、叶酸、维生素B 12水平比较,差异均有统计学意义(P<0.05)。25-(OH)D水平在夏季最高,在冬季最低;叶酸水平在秋季最高,在冬春季节最低;维生素B 12水平在秋季最高,在春季最低。GDM组孕妇年龄大于对照组(P<0.05),25-(OH)D水平低于对照组(P<0.05),叶酸高于对照组(P<0.05)。Logistic回归分析显示,孕妇年龄及血清中25-(OH)D、叶酸水平均是发生GDM的影响因素(P<0.05)。结论不同年龄段、不同季节孕妇体内25-(OH)D、叶酸和维生素B_(12)水平不同,孕妇年龄及血清中25-(OH)D、叶酸水平均是发生GDM的影响因素,应根据孕妇年龄及季节及时调整维生素的补充,有利于降低GDM的发生。

Objective To investigate the age and seasonal changes of serum 25-(OH)D,folic acid and vitamin B 12 levels in pregnant women during the second trimester,and their influence on gestational diabetes mellitus(GDM).Methods A total of 4830 pregnant women with prenatal examination in this hospital from January to December 2021 were selected as the study subjects and divided into 827 cases in≤25 years old,2069 cases in>25-30 years old,1550 cases in>30-35 years old,and 387 cases in>35 years old according to the age group.There were 1137 cases in spring,1422 cases in summer,1149 cases in autumn and 1125 cases in winter according to the season in which the vitamin levels were measured during the second trimester.According to the results of oral glucose tolerance test(OGTT)during the second trimester,the pregnant women were divided into the control group(healthy pregnancy,n=4015)and GDM group(n=815).The levels of serum 25-(OH)D,folic acid and vitamin B 12 were detected in the second trimester.The levels of these three vitamins were compared among the different age groups and seasons,and the influence of age and these three vitamin levels on the GDM onset were analyzed by Logistic regression.Results Compared with the other age groups,the levels of serum 25-(OH)D,folic acid and vitamin B 12 in the pregnant women≤25 years old were the lowest,and the differences were statistically significant(P<0.05).There were statistically significant differences in the levels of 25-(OH)D,folic acid and vitamin B 12 among four seasons(P<0.05).The level of 25-(OH)D was highest in summer and lowest in winter.The folic acid level was highest in autumn and lowest in winter and spring.The vitamin B 12 level was highest in autumn and lowest in spring.The age of pregnant women in the GDM group was greater than that in the control group(P<0.05),the level of 25-(OH)D was lower than that in the control group(P<0.05),and folic acid was higher than that in the control group(P<0.05).The Logistic regression analysis showed that pregnant women′s age,serum 25-(OH)D and folic acid levels were the independent influencing factors for the occurrence of GDM(P<0.05).Conclusion The levels of 25-(OH)D,folic acid and vitamin B 12 in pregnant women are different in different ages and seasons.The age of pregnant women and the levels of serum 25-(OH)D and folic acid are all the influencing factors for the occurrence of GDM.Vitamin supplementation should be timely adjusted according to the age and season of pregnant women,which is conducive to reduce the occurrence of GDM.