妊娠中期维生素D缺乏与不良妊娠结局的相关性分析

Vitamin D deficiency during the second trimester is associated with adverse pregnancy outcomes

目的探讨妊娠中期维生素D缺乏(vitamin D deficiency,VDD)状况及其与不良妊娠结局的相关性。方法回顾性分析2021年1月至2022年12月于中山大学附属第八医院(深圳福田)行产前检查并分娩的单胎妊娠孕妇2627例,根据妊娠16~28周检测的血清25羟基维生素D_(3)[25(OH)D_(3)]水平分为VDD组[25(OH)D_(3)<50 nmol/L]和非VDD组[25(OH)D_(3)≥50 nmol/L],比较两组孕妇不良妊娠结局。统计学方法采用t检验、χ^(2)检验和logistic回归分析。结果2627例孕妇中,VDD占85.92%(2257例),非VDD占14.08%(370例),25(OH)D_(3)平均水平为(37.99±14.37)nmol/L。(1)营养代谢情况:VDD组空腹血糖(FPG)水平[(4.38±0.36)vs.(4.51±0.46)mmol/L,P=0.005]、高密度脂蛋白(HDL-C)水平[(1.74±0.32)vs.(1.82±0.37)mmol/L,P=0.046]明显低于非VDD孕妇。(2)VDD与不良妊娠结局的关系:单因素分析显示,VDD组巨大儿、产后出血的发生率分别为4.12%(93/2257)、9.66%(218/2257),明显高于非VDD组[分别为1.62%(6/370)、6.22%(23/370)],差异均具有统计学意义(χ^(2)值分别为5.474、4.522,P值分别为0.019、0.033)。logistic回归分析显示,在矫正了母体年龄、孕前体重指数(BMI)和分娩孕周等因素后,VDD孕妇发生巨大儿(OR=3.661,95%CI 1.139~11.766,P=0.029)和产后出血(OR=1.547,95%CI 1.046~2.392,P=0.046)的风险均升高。结论妊娠中期VDD与巨大儿和产后出血发生率升高相关。

Objective To investigate the association between vitamin D deficiency(VDD)in the second trimester and adverse pregnancy outcomes.Methods A retrospective study was conducted among 2627 singleton pregnancy pregnant women who underwent prenatal examinations and delivered at the Eighth Affiliated Hospital of Sun Yat-sen University(Futian,Shenzhen)from January 2021 to December 2022.Pregnant women were tested for 25 hydroxyvitamin D_(3)[25(OH)D_(3)]levels between 16-28 weeks of gestation.According to the level of 25(OH)D_(3),they were divided into VDD group[(25(OH)D_(3)<50nmol/L)]and non-VDD group[(25(OH)D_(3)≥50nmol/L)],and adverse maternal and neonatal outcomes were analyzed.T-tests、Chi-square test and logistic regression analysis were performed by SPSS.Results The average level of 25(OH)D_(3) was(37.99±14.37)nmol/L in the study subjects,of which 85.92%(2257 cases)were VDD,and 14.08%(370 cases)were non-VDD.(1)Evaluation of maternal nutrition and metabolism:compared with the non-VDD group,the VDD group had significantly lower fasting blood glucose levels[(4.38±0.36)vs(.4.51±0.46)mmol/L,P=0.005]and HDL-C levels[(1.74±0.32)vs.(1.82±0.37)mmol/L,P=0.046].(2)The association between VDD and adverse pregnancy outcomes:The incidence of macrosomia and postpartum hemorrhage in the VDD group was 4.12%(93/2257)and 9.66%(218/2257),respectively,significantly higher than that in the non-VDD group[1.62%(6/370)and 6.22%(23/370),respectively],and the differences were statistically significant(Theχ^(2) values were 5.474 and 4.522 respectively,with P values were 0.019 and 0.033).Logistic regression analysis showed that pregnant women with VDD had an increased risk of macrosomia(OR=3.661,95%CI 1.139-11.766,P=0.029)and postpartum hemorrhage(OR=1.547,95%CI 1.046-2.392,P=0.046)after adjusted maternal age、BMI before pregnancy and gestational weeks at delivery.Conclusion VDD during the second trimester is associated with an increased incidence of macrosomia and postpartum hemorrhage.