孕早期补充维生素D对妊娠期糖尿病高危女性的影响

Effect of Vitamin D Supplementation in Early Pregnancy on High-risk Women with Gestational Diabetes Mellitus

目的探讨孕早期补充维生素D对妊娠期糖尿病高危女性的发病率及糖代谢的影响。方法选取2019年12月~2022年5月在合肥市第一人民医院定期产检的孕早期孕妇,且孕妇血清25(OH)D水平<30ng/ml,预产期年龄≥35岁或孕前体重指数(body mass index,BMI)≥24kg/m2,随机分为干预组(n=86)和对照组(n=94)。干预组从孕早期口服1200IU/d维生素D3胶囊,持续服用至孕中期[孕妇行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)检查日期];对照组不发放维生素D3胶囊,推荐维生素D缺乏或不足的孕妇自行服用维生素D3胶囊或含维生素D的钙片。结果干预组孕早期、孕中期维生素D水平为12.986±5.654ng/ml、31.277±9.856ng/ml,差异有统计学意义(P<0.001)。对照组、干预组妊娠期糖尿病发生率为24.5%、20.9%,差异无统计学意义(P>0.05)。孕中期干预组和对照组空腹血糖、空腹胰岛素、1h血糖、2h血糖、胰岛素抵抗指数(homeostasis model assessment insulin resistance index,HOMR-IR)间的差异均无统计学意义(P>0.05)。结论孕早期补充维生素D仅可以明显提高孕妇体内维生素D水平,并且几乎可使其达到充足状态,对妊娠期糖尿病的发生风险及糖代谢无明显作用。

Objective To investigate the effect of vitamin D supplementation in early pregnancy on the incidence and glucose metabolism of high-risk women with gestational diabetes mellitus.Methods Pregnant women who had regular prenatal examination in Hefei First People′s Hospital from December 2019 to May 2022 with serum 25(OH)D level<30ng/ml,expected date of delivery≥35 years or pre-pregnancy body mass index(BMI)≥24kg/m 2 were selected.They were randomly divided into intervention group(86 cases)and control group(94 cases).The intervention group,took 1200IU/d vitamin D3 capsules orally from the first trimester of pregnancy to the second trimester of pregnancy[the date of oral glucose tolerance test(OGTT)examination for pregnant women];the control group was not given vitamin D3 capsules,and pregnant women with vitamin D deficiency or insufficient were recommended to take vitamin D3 capsules or calcium tablets containing vitamin D.Results The levels of vitamin D in the first and second trimester of pregnancy were 12.986±5.654ng/ml and 31.277±9.856ng/ml in the intervention group,and the difference was statistically significant(P<0.001).The incidence of gestational diabetes mellitus in control group and intervention group was 24.5%and 20.9%,and the difference was not statistically significant(P>0.05).There were no significant difference in fasting blood glucose,fasting insulin,1h blood glucose,2h blood glucose and homeostasis model assessment insulin resistance index(HOMR-IR)between the intervention group and the control group in the second trimester of pregnancy(P>0.05).Conclusion Vitamin D supplementation in early pregnancy can only significantly improve the level of vitamin D in pregnant women,and almost make it reach sufficient state,but has no obvious effect on the risk of gestational diabetes mellitus and glucose metabolism.