妊娠早期孕妇25(OH)D水平及其与妊娠期糖尿病的相关性研究

A study on association of serum vitamin D level in early pregnancy and GDM in Nanchong region

摘要

目的 探讨南充地区妊娠早期孕妇血清25-羟基维生素D[25(OH)D]水平及其与发生妊娠期糖尿病(GDM)的关联。方法 回顾性选取2019年1月至2022年12月在川北医学院附属医院早孕建册正规产检且资料完整的3491例孕妇为研究对象,收集孕妇的年龄、孕前及建册时体质量指数(BMI)、既往妊娠及分娩等一般资料,以及孕妇妊娠11~13^＋6周的血清25(OH)D水平和妊娠24~28周的75g口服葡萄糖耐量试验(OGTT)检测值.以OGTT结果将孕妇分为正常组(2916例)与GDM组(575例).再以OGTT结果进行分层分组:①以OGTT空腹血糖水平为依据,将孕妇分为OGTT空腹血糖正常组(3201例)与OGTT空腹血糖异常组(290例);②以OGTT1小时血糖水平为依据,将孕妇分为OGTT1小时血糖正常组(3254例)与OGTT1小时血糖异常组(237例);③以OGTT2小时血糖水平为依据,将孕妇分为OGTT2小时血糖正常组(3296例)与OGTT2小时血糖异常组(195例);④在575例GDM孕妇中,将患者分为单指标组(符合OGTT的三项检测值中一项诊断标准的孕妇,450例)与多指标组(符合OGTT的二项及以上诊断标准的孕妇,125例).比较各组间血清25(OH)D水平等检测指标;采用Spearman相关性分析妊娠早期血清25(OH)D水平与妊娠中期OGTT1小时及OGTT2小时血糖的相关性,通过Logistic回归分析妊娠早期血清25(OH)D水平与GDM发生的关系。结果 研究共纳入3491份孕妇资料,其中正常组2916例(83．5％),GDM组575例(16．5％),GDM的发生率为16．5％.血清25(OH)D的严重缺乏者有1569例(44．9％),轻度缺乏者有1192例(34．2％),正常者有730例(20．9％).正常组孕妇的血清25(OH)D水平中位数为32．3(22．3,46．4)nmol/L,GDM组为30．5(19．8,43．0)nmol/L,经比较差异具有统计学意义(Z＝-3．713,P＜0．001).对OGTT结果进行分层分析,OGTT空腹血糖正常组孕妇血清25(OH)D水平与OGTT空腹血糖异常组比较,差异无统计学意义(Z＝0．746,P＝0．387);OGTT1小时血糖正常组孕妇血清25(OH)D水平与OGTT1小时血糖异常组比较,差异有统计学意义(Z＝21．509,P＜0．001);OGTT2小时血糖正常组孕妇血清25(OH)D水平与OGTT2小时血糖异常组比较,差异有统计学意义(Z＝44．924,P＜0．001);在575例GDM孕妇中,符合OGTT的三项检测值中一项诊断标准(单指标组)的孕妇血清25(OH)D水平与符合二项及以上诊断标准(多指标组)者比较,差异有统计学意义(Z＝58．717,P＜0．001).血清25(OH)D与OGTT空腹血糖无明显相关性(r＝0．009,P＞0．05),而与OGTT1小时和OGTT2小时血糖均呈明显负相关(r值分别为-0．070、-0．085,P＜0．05).妊娠早期严重缺乏25(OH)D的孕妇患GDM的风险是正常者的1．299倍(OR＝1．299,95％CI:1．018~1．657,P＝0．036)。结论 南充地区孕妇妊娠早期血清25(OH)D水平普遍偏低,且严重缺乏25(OH)D的妊娠早期孕妇患GDM的风险显著增加.

Abstract

Objective To investigate serum level of 25-hydroxyvitamin D [25(OH)D] in early pregnancy in Nanchong region, Sichuan and association between serum 25(OH)D and gestational diabetes mellitus (GDM). Methods 3491 pregnant women who received regular prenatal examination in our hospital from January 2019 to December 2022 were selected as study subjects. The information such as maternal age, BMIs before pregnancy and at early pregnancy registration, past pregnancy and delivery histories, as well as serum 25(OH)D level at 11-13⁺⁶ weeks of gestation and 75g glucose OGTT results at 24-28 weeks of gestation were collected. The pregnant women were divided into normal group (n=2916) and GDM group (n=575) according to their OGTT results. Further, they received stratified grouping: ① According to OGTT fasting blood glucose level, they were divided into normal OGTT fasting blood glucose level subgroup (n=3201) and abnormal OGTT fasting blood glucose level subgroup (n=290); ② According to OGTT 1-hour blood glucose level, they were divided into normal OGTT 1-hour blood glucose level subgroup (n=3254) and abnormal OGTT 1-hour blood glucose level subgroup (n=237); ③ According to OGTT 2-hour blood glucose level, they were divided into normal OGTT 2-hour blood glucose level subgroup (n=3296) and abnormal OGTT 2-hour blood glucose level subgroup (n=195); ④ Among 575 pregnant women with GDM, 450 pregnant women with GDM were divided into single abnormal item subgroup (they met GDM diagnosis criteria due to one abnormal item of all 3 items OGTT), and 125 pregnant women with GDM were divided into multi-items abnormal subgroup (they met GDM diagnosis criteria due to abnormal two or above items). The serum 25(OH)D levels of all pregnant women were detected. SPSS 22.0 statistical software was used to process the data. Spearman correlation analysis was employed to analyze relationship between serum 25(OH)D level in early pregnancy and blood glucose level (OGTT 1-hour and OGTT 2-hour) in the second trimester of pregnancy. Logistic regression analysis was used to analyze relationship between serum 25(OH)D level in early pregnancy and development of GDM. Results A total of 3491 pregnant women were enrolled, including 2916 (83.5%) in the normal group and 575 (16.5%) in the GDM group. The incidence of GDM was 16.5%. There were 1569 (44.9%) cases of severe 25(OH)D deficiency, 1192 (34.2%) of mild 25(OH)D deficiency and 730 (20.9%) of normal serum 25(OH)D level respectively. The medians of concentrations of serum 25(OH)D of the pregnant women in the normal group and the GDM group were 32.3 (22.3, 46.4) nmol/L and 30.5 (19.8, 43.0) nmol/L respectively, there was a significant difference between the two groups (Z=-3.713, P<0.001). The stratified analysis for OGTT results showed that in the serum 25(OH)D level, there was no significant difference between the normal OGTT fasting blood glucose group and abnormal OGTT fasting blood glucose group (Z=0.746, P>0.05), while between the normal OGTT 1-hour blood glucose level subgroup and the abnormal OGTT 1-hour blood glucose level subgroup, there was a significant difference (Z=21.509, P<0.001). So did between the normal OGTT 2-hour blood glucose level subgroup and the abnormal OGTT 2-hour blood glucose level subgroup (Z=44.924, P<0.001). Among 575 pregnant women with GDM, in serum 25(OH)D level there was a significant difference between the abnormal single item OGTT subgroup and the abnormal multi-item OGTT subgroup (Z=58.717, P<0.001). The serum 25(OH)D level was not correlated with the OGTT fasting blood glucose (r=0.009, P>0.05), while the serum 25(OH)D level was negatively correlated with OGTT 1-hour/2-hour fasting blood glucose (r=-0.070 and -0.085 respectively, both P<0.05). The risk of GDM of the pregnant women with severe 25(OH)D deficiency in the first trimester of pregnancy was 1.299 times of the risk of GDM of the pregnant women with normal serum 25(OH)D level (OR=1.299, 95%CI: 1.018-1.657, P<0.05). Conclusion The serum 25(OH)D level of the pregnant women in the first trimester of pregnancy is generally low in Nanchong region, and the risk of GDM is significantly increased in those pregnant women with severe 25(OH)D deficiency in the first trimester of pregnancy.

关键词

25-羟基维生素D / 妊娠早期 / 妊娠期糖尿病 / 危险因素

Key words

25-hydroxyvitamin D / early pregnancy / gestational diabetes mellitus / risk factor

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基金资助

中华国际科学交流基金会项目(Z2023JSC003)