孕妇不同孕期血清维生素D的水平变化及影响因素:前瞻性队列研究

The changes in serum Vitamin D levels and influencing factors in different stages of pregnancy: a prospective cohort study

摘要

目的 调查规范维生素D补充基础下,北京某三甲医院建档孕妇不同孕期维生素D的水平变化及其影响因素。方法 采用连续抽样法,选取2020年12月至2021年12月在首都医科大学附属北京友谊医院建立档案并规范保健的孕妇,根据孕早期维生素D水平推荐每日维生素D补充剂量.收集一般信息(包括身高、体重、年龄、孕周、孕产次)及孕早期、中期、晚期血清25-羟维生素D[25-(OH)D]检查结果,并采用单因素方差分析与多元线性回归分析对可能影响维生素D水平的因素进行分析。结果 本研究共纳入2082名孕妇,孕早期平均维生素D水平(16.80±5.94)ng/ml,维生素D缺乏比例74.6%,不足比例22.5%,充足比例仅为2.9%.多因素分析发现,年龄、体质指数(BMI)、季节是血清维生素D水平的影响因素(P<0.001);在规范维生素D补充基础下,孕妇血清维生素D水平随孕周增加而显著升高(F=147.35,P<0.001),维生素D缺乏率显著下降(孕早期:77.2%,孕中期32.3%,孕晚期30.6%;χ²=207.95,P<0.001);孕晚期维生素D缺乏率仍较高,进一步分析发现冬季可能是影响孕晚期补充效果的因素。结论 孕妇维生素D缺乏率高,超重/肥胖、冬季是维生素D缺乏的危险因素;经规范性补充后,维生素D水平随妊娠孕周增加而增加,但冬季可能需要更高剂量的补充以维持充足的维生素D水平.

Abstract

Objective To investigate the changes in serum vitamin D levels and its influencing factors in pregnant women during different stages of pregnancy at a tertiary hospital in Beijing, under standardized vitamin D supplementation. Methods A consecutive sampling method was used to select pregnant women who established their health records and followed standardized prenatal care at Beijing Friendship Hospital, Capital Medical University, between December 2020 and December 2021. Based on the vitamin D levels in early pregnancy, daily vitamin D supplementation doses were recommended. General information (including height, weight, age, gestational weeks, and pregnancy history) as well as serum 25-hydroxyvitamin D [25-(OH)D] test results in the first, second and third trimesters of pregnancy were collected. One-way analysis of variance (ANOVA) and multiple linear regression analysis were used to analyze the factors that might influence vitamin D levels. Results A total of 2082 pregnant women were included in the study. The average vitamin D level in early pregnancy was (16.80±5.94)ng/ml, with 74.6% of participants having vitamin D deficiency, 22.5% with insufficient levels, and only 2.9% with sufficient levels. Multivariate analysis showed that age, body mass index (BMI), and season were factors influencing serum vitamin D levels (P<0.001). Under standardized vitamin D supplementation, serum vitamin D levels significantly increased as gestational weeks progressed (F=147.35, P<0.001), and the rate of vitamin D deficiency significantly decreased (77.2% in the first trimester, 32.3% in the second trimester, 30.6% in the third trimester; χ²=207.95, P<0.001). However, the deficiency rate of vitamin D in late pregnancy remained high, and further analysis suggested that winter might be a factor affecting supplementation effectiveness in late pregnancy. Conclusion The deficiency rate of vitamin D is high in pregnant women. Overweight/obesity and winter are risk factors for vitamin D deficiency. After standardized supplementation, vitamin D levels increased with gestational weeks, but higher doses of supplementation may be required during winter to maintain adequate vitamin D levels.

关键词

妊娠期 / 维生素D / 动态变化 / 影响因素

Key words

pregnant / Vitamin D deficiency / dynamic change / influencing factor

参考文献

[1] Rosen C J, Adams J S, Bikle D D, et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement[J]. Endocr Rev, 2012, 33(3): 456-492.

[2] Holick M F, Binkley N C, Bischoff-Ferrari H A, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline[J]. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930.

[3] Durá-Travé T, Gallinas-Victoriano F. Pregnancy, breast-feeding, and Vitamin D[J]. Int J Mol Sci, 2023, 24(15): 11881.

[4] Dovnik A, Mujezinovic F. The association of Vitamin D levels with common pregnancy complications[J]. Nutrients, 2018, 10(7): 867.

[5] Curtis E M, Moon R J, Harvey N C, et al. Maternal vitamin D supplementation during pregnancy[J]. Br Med Bull, 2018, 126(1): 57-77.

[6] Lewis S, Lucas R M, Halliday J, et al. Vitamin D deficiency and pregnancy: from preconception to birth[J]. Mol Nutr Food Res, 2010, 54(8): 1092-1102.

[7] Agarwal S, Kovilam O, Agrawal D K. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: a critical review[J]. Crit Rev Food Sci Nutr, 2018, 58(5): 755-769.

[8] Liu W, Hu J, Fang Y, et al. Vitamin D status in mainland of China: a systematic review and meta-analysis[J]. E Clinical Medicine, 2021, 38: 101017.

[9] 胡贻椿, 陈竞, 李敏, 等. 2010-2012年中国城市孕妇贫血及维生素A、维生素D营养状况[J]. 中华预防医学杂志, 2017, 51(2): 125-131.

[10] 中国医药教育协会. «围孕期维生素D管理规范»: T/CMEAS 007-2023[S]. 2023.

[11] Schöttker B, Hagen L, Zhang Y, et al. Serum 25-hydroxy vitamin D levels as an aging marker: strong associations with age and all-cause mortality independent from telomere length, epigenetic age acceleration, and 8-Isoprostane levels[J]. J Gerontol A Biol Sci Med Sci, 2019, 74(1): 121-128.

[12] Earthman C P, Beckman L M, Masodkar K, et al. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications[J]. Int J Obes (Lond), 2012, 36(3): 387-396.

[13] Roizen J D, Long C, Casella A, et al. Obesity decreases hepatic 25-hydroxylase activity causing low serum 25-hydroxyvitamin D[J]. J Bone Miner Res, 2019, 34(6): 1068-1073.

[14] Yang C, Jing W, Ge S, et al. Vitamin D status and vitamin D deficiency risk factors among pregnancy of Shanghai in China[J]. BMC Pregnancy Childbirth, 2021, 21(1): 431.

[15] Shen Y, Pu L, Si S, et al. Vitamin D nutrient status during pregnancy and its influencing factors[J]. Clin Nutr, 2020, 39(5): 1432-1439.

[16] Kift R C, Webb A R. Globally estimated UVB exposure times required to maintain sufficiency in Vitamin D levels[J]. Nutrients, 2024, 16(10): 1489.

[17] Llopis M, Ventura P S, Brachowicz N, et al. Sociodemographic, lifestyle, and environmental determinants of vitamin D levels in pregnant women in Spain[J]. Environ Int, 2023, 182: 108293.

[18] Díaz-López A, Jardí C, Villalobos M, et al. Prevalence and risk factors of hypovitaminosis D in pregnant Spanish women[J]. Sci Rep, 2020, 10(1): 15757.

[19] Xiang F, Jiang J, Li H, et al. High prevalence of vitamin D insufficiency in pregnant women working indoors and residing in Guiyang, China[J]. J Endocrinol Invest, 2013, 36(7): 503-507.