孕妇妊娠早晚期血清维生素D水平现状分析

Analysis of serum vitamin D levels in pregnant women in early and late pregnancy

目的了解张家港地区孕妇妊娠早期和妊娠晚期血清维生素D水平变化及营养状况。方法募集2020年11月—2022年10月在张家港市妇幼保健所建卡并定期产检的孕妇257名,根据建卡入组时自愿选择早孕建卡时或者孕32周左右测定血清25-羟维生素D[25-(OH)D]浓度,分为妊娠早期组(136名)和妊娠晚期组(121名),分析不同妊娠时期维生素D水平及营养状况,且分层分析两组孕妇在不同季节、不同户外时间、不同超声骨密度骨量状况下维生素D变化。结果257名孕妇的维生素D平均水平为(28.497±7.125)ng/ml,妊娠早期和妊娠晚期维生素D水平分别为(27.341±7.662)ng/ml、(29.796±6.248)ng/ml,无论是妊娠早期还是妊娠晚期,孕妇的血清维生素D均达不到充足水平。妊娠早期血清维生素D水平明显低于妊娠晚期血清维生素D水平,差异具有统计学意义(t=-2.827,P<0.05);妊娠早期的总不足和缺乏率为61.765%,高于妊娠晚期的44.628%,差异有统计学意义(χ^(2)=7.563,P<0.05)。在冬春季节或户外活动<1 h或超声骨密度骨量正常(T值>-1)时,妊娠早期维生素D水平低于妊娠晚期,总不足和缺乏率高于妊娠晚期,差异均有统计学意义(均P<0.05)。超声骨密度骨量低下(T值≤-1)时,妊娠早期和妊娠晚期维生素D均处于不足水平,差异无统计学意义(P>0.05)。结论张家港地区孕妇妊娠早晚期的维生素D水平不足,建议从妊娠早期起积极检测并及时补充维生素D,尤其是冬春季节、户外活动不足时。无论妊娠早期超声骨密度正常与否,均应积极补充维生素D,以提高孕妇血清维生素D水平。

Objective To investigate the changes in serum vitamin D levels and nutritional status of pregnant women in the first and third trimesters of pregnancy in Zhangjiagang.Methods A total of 257 pregnant women were included in this study,which was from November 2020 to October 2022 at Zhangjiagang Maternal and Child Health Care Hospital.They were divided into two groups,including 136 in the first trimester group and 121 in the third trimester group.To measure the serum 25-hydroxyvitamin[25-(OH)D]concentration in the first trimester or at about 32 weeks of pregnancy.The levels of vitamin D in different gestation periods were analyzed,and the changes of vitamin D in the two groups were analyzed stratified under different seasons,different outdoor times and different Quantitative Ultrasound.Results The vitamin D level of 257 pregnant women was(28.497±7.125)ng/ml.The level in the first trimester was(27.341±7.662)ng/ml,and it was(29.796±6.248)ng/ml in the third trimester.Whether in the first or third trimester of pregnancy,the serum vitaminD of pregnant women couldn't reach the sufficient level.The serum vitamin D level in the first trimester was significantly lower than that in the third trimester(t=-2.827,P<0.05),and the total deficiency rate in the first trimester was 61.765%,which was higher than that in the third trimester(44.628%)(χ^(2)=7.563,P<0.05).In winter and spring or when outdoor time was less than one hour or when Quantitative Ultrasound was high(T value>-1),the serum vitamin D level in the first trimester was lower than that in the third trimester,the total deficiency rate was higher than that in the third trimester.The differences were statistically significant(P<0.05).When Quantitative Ultrasound was low(T value≤-1),vitamin D was insufficient in both pregnancy,with no statistical significance(P>0.05).Conclusion The level of vitamin D is insufficient in the first and third trimester of pregnancy in Zhangjiagang area.It is recommended to detect the serum 25-hydroxyvitamin concentration and timely supplement vitamin D from the first trimester,especially in winter and spring,or when outdoor activities are insufficient.Regardless of Quantitative Ultrasound in early pregnancy,vitamin D should be actively supplemented to increase serum vitamin D levels in pregnant women.