高剂量维生素D防治肥胖症孕妇妊娠期糖尿病的作用研究

Effect of high-dose vitamin D on prevention and treatment of gestational diabetes mellitus in obese pregnant women

目的探讨孕期预防性给予高剂量维生素D(VD)对肥胖症孕妇妊娠期糖尿病的防治作用。方法选择2016年6月—2017年6月于温州市中西医结合医院初产、单胎肥胖孕妇118例,随机分为试验组和对照组,每组各59例。试验组于孕16~20周给予维生素D_3注射液30万IU,肌肉注射。对照组于孕16~20周给予VD滴剂胶囊400 IU(1粒),口服,每日1次。比较2组一般资料、25(OH)D_3、甲状旁腺激素(PTH)、血钙(Ca)、血磷(P)、糖化血红蛋白(HbA1c)及BMI等临床相关指标及维生素D缺乏的改善情况、妊娠期糖尿病的发生情况及妊娠结局。结果经干预后,试验组25(OH)D_3和血清Ca较治疗前显著升高,PTH浓度显著下降(P<0.01)。试验组在治疗后维生素D缺乏和不足患者的比率均显著下降(P<0.01)。而对照组治疗后缺乏和不足患者的比率虽略有下降,但与治疗前比较,差异不具有统计学意义(P>0.05)。试验组孕妇GDM的发生平均孕周显著晚于对照组(P<0.01),孕妇GDM的发生率均显著低于对照组(P<0.05)。试验组顺产率显著高于对照组、剖宫产率显著低于对照组(P<0.01)。试验组新生儿死胎、新生儿窒息、早产儿、巨大儿的发生率显著低于对照组(P<0.05)。结论通过单次负荷剂量治疗可有效改善肥胖孕妇VD缺乏状态,安全性较好,可有效降低肥胖孕妇GDM的发生率,降低剖宫产率,减少不良妊娠结局的发生风险,这可能与VD有效调节了肥胖患者的体脂分布,降低了胰岛素抵抗,减少了妊娠期糖尿病的发生风险有关。

Objective To investigate the preventive and therapeutic effects of high dose vitamin D( VD) during gestation on gestational diabetes mellitus in obese women. Methods One hundred and eighteen pregnant women were randomly divided into two groups: the experimental group and the control group,59 cases in every group. The experimental group were given vitamin D 30 million IU intramuscular injection in the pregnant 16-20 weeks. In the control group,VD drops capsule( 400 IU) was orally administered once a day for 16-20 weeks. The clinical data of 25( OH) D_3,PTH,Ca,P,Hb A1 c and BMI and the improvement of vitamin D deficiency were compared between the two groups. Results After intervention,the levels of 25( OH) D_3 and serum Ca in test group were significantly higher than those before treatment,PTH concentration was significantly decreased( P < 0. 01). In the trial group,the ratio of patients with moderate to severe vitamin D deficiency was significantly lower after treatment( P < 0. 01). The incidence of GDM in pregnant women was significantly lower than that in the control group( P < 0. 05),and the incidence of GDM in pregnant women was significantly lower than that in the control group( P < 0. 01). The cesarean section was significantly lower in the test group than in the control group( P < 0. 01). The incidence of neonatal stillbirth,neonatal asphyxia,premature infants and macrosomia in the experimental group was significantly lower than that in the control group( P < 0. 05). Conclusion The single dose can effectively improve the VD deficiency state of obese pregnant women,and can effectively reduce the incidence of GDM of obese pregnant women,reduce the rate of cesarean section,reduce the risk of adverse pregnancy outcome.