妊娠期血清维生素 D 水平的影响因素及与妊娠结局的关系

Survey on serum vitamin D level, influencing factors and analysis of their relationships with pregnancy outcome in pregnant women

摘要

目的 了解唐山地区孕妇血清维生素 D(VD)水平,探讨其影响因素及与妊娠结局的相关性。方法 纳入2022年7月-2024年6月于唐山市妇幼保健院妇产科进行妊娠期体检的16 138例孕妇作为研究对象,整理研究对象首诊时的基本信息和临床资料,以化学发光法检测血清25-羟基维生素 D₃[25-(OH)D₃]水平。结果 孕妇血清 VD 水平缺乏11 981例(74.24%),不足3 387例(20.99%),充足770例(4.77%)。妊娠中期、妊娠晚期血清25-(OH)D₃ 水平低于妊娠早期( t=16.595、9.155,P＜0.05);≤36岁孕妇血清25-(OH)D₃ 水平较低,各年龄段间营养状况均较差(F=31.202,P＜0.05),＞36岁血清25-(OH)D₃ 水平较高,且随年龄增加呈逐渐升高趋势。春季血清25-(OH)D₃ 水平最高,1~12 月份中血清25-(OH)D₃ 水平4 月(17.02±7.38)ng/mL和10月(17.17±7.85)ng/mL 高于其他组(F=2.153,P ＜0.05),VD 缺乏率(71.78%、71.69%)均低于其他组(χ²=45.063,P＜0.05);血清25-(OH)D₃ 水平在妊娠期糖尿病和子痫前期均低于正常组,其中子痫前期组最低( t=7.63、3.06,P＜0.05);孕妇就诊时血清25-(OH)D₃ 水平对后续胎儿发育不同情况(自然流产、胎儿停育、早产、胎儿发育延迟和正常)间均无统计学差异(P＞0.05)。结论 孕妇血清维生素 D 水平偏低,夏秋冬季节、妊娠中期和晚期、年龄≤36岁、妊娠期糖尿病和子痫前期最为显著。建议医生积极指导本地区孕妇合理补充维生素 D。

Abstract

Objective To investigate serum vitamin D (VD) level of pregnant women in Tangshan region,and to analyze relationships of serum VD levels and their influencing factors with pregnancy outcomes. Methods A total of 16 138 pregnant women who underwent prenatal examination in Department of Gynecology and Obstetrics of Tangshan Municipal Maternal and Child Health Hospital from July 2022 to June 2024 were collected as survey subjects.The basic information and clinical data of the surveyed subjects at initial visit were collected and sorted.Chemiluminescence method was used to detected serum 25-(OH)D₃ levels of the pregnant women. Results The serum VD levels of 11 981 pregnant women (74.24%) were deficient,those of 3 387 pregnant women (20.99%) were insufficient and those of 770 pregnant women (4.77%) were appropriate.The serum 25-(OH)D₃ levels of the pregnant women in the second trimester and the third trimester of pregnancy were lower than those in the first trimester of pregnancy ( t=16.595 and 9.155 respectively,both P＜0.05).The serum 25-(OH)D₃ levels of the pregnant women in all ≤36 years age groups were lower and the nutritional statuses were poor in all ≤36-year age groups (F=31.202,P＜0.05). The serum 25-(OH)D₃ levels of the pregnant women in all ＞36 years age groups were higher,and showed an upward trend with increase in age of the pregnant women.The serum 25-(OH)D ₃ levels of the pregnant women were the highest in spring,and in a year,the serum 25-(OH)D₃ levels of the pregnant women in April (17.02±7.38)ng/mL and October (17.17±7.85)ng/mL were higher than in other months (F=2.153,P＜0.05),and VD deficiency rates in April (71.78%) and October (71.69%) were lower than other months (χ²=45.063,P ＜0.05).The serum 25-(OH)D ₃ levels of the pregnant women in both gestational diabetes mellitus (GDM) group and preeclampsia group were lower than in the normal group ( t=7.63 and 3.06 respectively,both P＜0.05),of which that in the preeclampsia group was the lowest among the three groups.There was no statistically significant difference in serum 25-(OH)D₃ level among pregnant women with different fetal development conditions (spontaneous abortion,fetal arrest,premature delivery,fetal developmental delay and normal development) (P＞0.05). Conclusion The serum VD level of the pregnant women in Tangshan region is low,and the most significantly lowered serum VD level is seen in summer,autumn and winter,and in those pregnant women in the second trimester and the third trimester of pregnancy,aged ≤36 years and in those with pregnancy complications such as GDM and preeclampsia.It is recommended that the physicians in this region should actively guide the pregnant women to supplement VD reasonably.

关键词

孕妇 / 维生素 D / 营养状况 / 妊娠结局

Key words

pregnant women / vitamin D / nutritional status / pregnancy outcome

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基金资助

河北医学科学研究课题计划项目(20240875)