孕早期维生素D缺乏与妊娠期糖尿病及围产结局的临床分析

Clinical analysis of vitamin D deficiency in early pregnancy,gestational diabetes mellitus and perinatal outcomes

目的探讨孕早期维生素D与妊娠期糖尿病(GDM)及围产结局的相关性。方法回顾性分析2173名孕妇的临床资料,根据不同的孕早期25羟维生素D[25(OH)D]水平分为研究组(n=494),空白对照组(n=1280)和正常对照组(n=399)三组。研究组为孕早期25(OH)D<30ng/mL并口服维生素D制剂,空白对照组为孕早期25(OH)D<30ng/mL但未口服维生素D制剂,正常对照组为孕早期25(OH)D≥30ng/mL无口服维生素D制剂。比较三组间GDM发病率、羊水量异常、胎膜早破、初产妇剖宫产率、产后出血、胎儿窘迫、早产、巨大儿、低出生体重儿、新生儿窒息及新生儿高胆红素血症的发生率。结果研究组与空白对照组GDM发病率均高于正常对照组,但三组间比较差异均无统计学意义(P>0.05);三组GDM发生率、羊水过多发生率及羊水过少发生率比较,差异均无统计学意义(P>0.05);空白对照组胎膜早破发生率高于正常对照组(P<0.05);三组间分娩方式及初产妇剖宫产、产后出血、胎儿迫、早产发生率两两比较,差异均无统计学意义(P>0.05);研究组低出生体重儿发生率高于空白对照组(P<0.05);空白对照组低出生体重儿发生率低于正常对照组(P<0.05);三组间新生儿高胆红素血症、巨大儿及新生儿窒息发生率比较,差异均无统计学意义(P>0.05)。结论孕早期25(OH)D可能不是GDM发病的主要危险因素。对于孕早期维生素D缺乏的女性,补充维生素D制剂可有效降低胎膜早破及新生儿高胆红素血症的发生率。

Objective To investigate the correlation between vitamin D in early pregnancy and gestational diabetes mellitus(GDM)and perinatal outcomes.Methods The clinical data of 2173 pregnant women were retrospectively analyzed and divided into study group(n=494),blank control group(n=1280)and normal control group(n=399)according to different levels of 25(OH)D in the first trimester.The study group had 25(OH)D<30 ng/mL and oral vitamin D preparation in the first trimester,the blank control group had 25(OH)D<30 ng/mL but no oral vitamin D preparation,and the normal control group had 25(OH)D≥30 ng/mL without oral vitamin D preparation in the first trimester.The incidence of GDM,abnormal amniotic fluid volume,premature rupture of membranes,puerperal cesarean section rate,postpartum hemorrhage,fetal distress,premature delivery,macrosomia,low birth weight infants,neonatal asphyxia and neonatal hyperbilirubinemia were compared among the three groups.Results The incidence of GDM in the study group and the blank control group was higher than that in the normal control group,but there was no statistical significance among the three groups(P>0.05).There was no significant difference in the incidence of GDM,oligohydramnios and polyhydramnios among the three groups(P>0.05).The incidence of premature rupture of membrane in blank control group was higher than that in normal control group(P<0.05).There were no significant differences in the modes of delivery and the incidence of cesarean section,postpartum hemorrhage,fetal distress and premature delivery among the three groups(P>0.05).The incidence of low birth weight infants in the study group was higher than that in the control group(P<0.05).The incidence of low birth weight infants in blank control group was lower than that in normal control group(P<0.05).There was no significant difference in the incidence of neonatal hyperbilirubinemia,macrosomia and neonatal asphyxia among the three groups(P>0.05).Conclusion 25(OH)D in the first trimester may not be the main risk factor for GDM.For women with vitamin D deficiency in early pregnancy,vitamin D supplementation can effectively reduce the incidence of premature rupture of membranes and neonatal hyperbilirubinemia.