孕早期补充维生素D对妊娠期糖尿病高危人群的干预作用
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摘要
目的探讨孕早期补充维生素D(VD)对血清25-羟维生素D水平(25-OH-D)与妊娠期糖尿病(GDM)发病风险的影响。方法选取2017年10月至12月,在海淀区妇幼保健院营养门诊进行第一次早孕咨询的孕妇中招募101例具有GDM高危因素的孕妇,随机分为干预组与对照组。干预组从孕早期补充700 U VD和100 mg钙剂,对照组同一时间开始补充100 U VD和100 mg钙剂,干预时间至分娩。结果经干预后,干预组孕中期血清25-OH-D水平为(92.08±29.69)nmol/L,对照组为(69.99±25.10)nmol/L。干预组孕妇孕中期、孕晚期及脐带血血清25-OH-D水平均高于对照组(P<0.05)。干预组GDM发病率为18.37%,对照组发病率为28.85%(P>0.05);与对照组相比,干预组的GDM发病风险OR=0.56(95%CI 0.22～1.42)(P>0.05)。结论孕早期补充VD可明显改善孕期妇女VD营养水平,但并未显著降低GDM的发病率。
OBJECTIVE To investigate the effect of vitamin D supplementation(VD) in early pregnancy on the serum 25-hydroxyvitamin D(25-OH-D) level and the risk of gestational diabetes mellitus(GDM). METHODS From October to December 2017, a total of 101 pregnant women with high risk factors for GDM were enrolled in the first pregnancy consultation at the nutrition clinic of Haidian Maternal and Child Health Hospital, and were randomly divided into intervention group and control group. The intervention group was supplemented with 700 U VD and 100 mg of calcium at the beginning of pregnancy, and the control group was supplemented with 100 U VD and 100 mg of calcium at the same time, and the intervention time was until delivery. RESULTSAfter intervention, the mean serum 25-OH-D level in the intervention group was(92.08±29.69) nmol/L, and that in the control group was(69.99±25.10) nmol/L. The serum levels of 25-OH-D in the pregnant women, gestational age and cord blood were higher than those in the control group(P<0.05). The incidence of GDM in the intervention group was 18.37%, and the incidence rate in the control group was 28.85%(P>0.05). Compared with the control group, the OR value of the risk of GDM in the intervention group was 0.56(95% CI 0.22-1.42)( P<0.05). CONCLUSION The supplementation of VD in early pregnancy can significantly improve the VD nutrition level of pregnant women, but does not significantly reduce the incidence of GDM.
OBJECTIVE To investigate the effect of vitamin D supplementation(VD) in early pregnancy on the serum 25-hydroxyvitamin D(25-OH-D) level and the risk of gestational diabetes mellitus(GDM). METHODS From October to December 2017, a total of 101 pregnant women with high risk factors for GDM were enrolled in the first pregnancy consultation at the nutrition clinic of Haidian Maternal and Child Health Hospital, and were randomly divided into intervention group and control group. The intervention group was supplemented with 700 U VD and 100 mg of calcium at the beginning of pregnancy, and the control group was supplemented with 100 U VD and 100 mg of calcium at the same time, and the intervention time was until delivery. RESULTSAfter intervention, the mean serum 25-OH-D level in the intervention group was(92.08±29.69) nmol/L, and that in the control group was(69.99±25.10) nmol/L. The serum levels of 25-OH-D in the pregnant women, gestational age and cord blood were higher than those in the control group(P<0.05). The incidence of GDM in the intervention group was 18.37%, and the incidence rate in the control group was 28.85%(P>0.05). Compared with the control group, the OR value of the risk of GDM in the intervention group was 0.56(95% CI 0.22-1.42)( P<0.05). CONCLUSION The supplementation of VD in early pregnancy can significantly improve the VD nutrition level of pregnant women, but does not significantly reduce the incidence of GDM.
引文
[1] 中华人民共和国卫生部.妊娠期糖尿病诊断:WS 331—2011 [S].北京:中华人民共和国卫生部,2013:2011.
[2] 杨慧霞.我国妊娠期糖尿病诊治现状和应对措施[J].中国实用妇科与产科杂志,2013(4):241-243.
[3] KAAJA R,RONNEMAA T.Gestational diabetes:pathogenesis and consequences to mother and offspring[J].Rev Diabet Stud,2008,5(4):194-202.
[4] TRIUNFO S,LANZONE A,LINDQVIST P G.Low maternal circulating levels of vitamin D as potential determinant in the development of gestational diabetes mellitus[J].J Endocrinol Invest,2017,40(10):1049-1059.
[5] 关怀,尚丽新.妊娠期糖尿病流行现状[J].中国实用妇科与产科杂志,2015(1):91-94.
[6] PALOMER X,GONZALEZ-CLEMENTE J M,BLANCO-VACA F,et al.Role of vitamin D in the pathogenesis of type 2 diabetes mellitus[J].Diabetes Obes Metab,2008,10(3):185-197.
[7] ALVAREZ J A,ASHRAF A.Role of vitamin d in insulin secretion and insulin sensitivity for glucose homeostasis[J].Int J Endocrinol,2010,2010:351385.
[8] PITTAS A G,DAWSON-HUGHES B,SHEEHAN P R,et al.Rationale and design of the Vitamin D and Type 2 Diabetes (D2d) study:a diabetes prevention trial[J].Diabetes Care,2014,37(12):3227-3234.
[9] AMRAEI M,MOHAMADPOUR S,SAYEHMIRI K,et al.Effects of vitamin D deficiency on incidence risk of gestational diabetes mellitus:a systematic review and meta-analysis[J].Front Endocrinol,2018,9:7.
[10] CLIFTON-BLIGH R J,MCELDUFF P,MCELDUFF A.Maternal vitamin D deficiency,ethnicity and gestational diabetes[J].Diabet Med,2008,25(6):678-684.
[11] ZHANG C,QIU C,HU F B,et al.Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus[J].PLoS One,2008,3(11):e3753.
[12] 中华医学会儿科学分会儿童保健学组,编辑委员会中华儿科杂志.儿童微量营养素缺乏防治建议[J].中华儿科杂志,2010(7):502-509.
[13] 杨慧霞,徐先明,王子莲,等.妊娠合并糖尿病诊治指南(2014)[J].糖尿病天地(临床),2014(11):489-498.
[14] BACON C J,GAMBLE G D,HORNE A M,et al.High-dose oral vitamin D3 supplementation in the elderly[J].Osteoporos Int,2009,20(8):1407-1415.
[15] TRANG H M,COLE D E,RUBIN L A,et al.Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2[J].Am J Clin Nutr,1998,68(4):854-858.
[16] TALWAR S A,ALOIA J F,POLLACK S,et al.Dose response to vitamin D supplementation among postmenopausal African American women[J].Am J Clin Nutr,2007,86(6):1657-1662.
[17] MAZAHERY H,STONEHOUSE W,VON HURST P R.The effect of monthly 50,000 IU or 100,000 IU vitamin D supplements on vitamin D status in premenopausal Middle Eastern women living in Auckland[J].Eur J Clin Nutr,2015,69(3):367-372.
[18] KROLL M H,BI C,GARBER C C,et al.Temporal relationship between vitamin D status and parathyroid hormone in the United States[J].PLoS One,2015,10(3):e118108.
[19] GIUSTI A,BARONE A,PIOLI G,et al.Heterogeneity in serum 25-hydroxy-vitamin D response to cholecalciferol in elderly women with secondary hyperparathyroidism and vitamin D deficiency[J].J Am Geriatr Soc,2010,58(8):1489-1495.
[20] GALLAGHER J C,SAI A,TEMPLIN T N,et al.Dose response to vitamin D supplementation in postmenopausal women:a randomized trial[J].Ann Intern Med,2012,156(6):425-437.
[21] WATERHOUSE M,TRAN B,ARMSTRONG B K,et al.Environmental,personal,and genetic determinants of response to vitamin D supplementation in older adults[J].J Clin Endocrinol Metab,2014,99(7):E1332-E1340.
[22] NG K,SCOTT J B,DRAKE B F,et al.Dose response to vitamin D supplementation in African Americans:results of a 4-arm,randomized,placebo-controlled trial[J].Am J Clin Nutr,2014,99(3):587-598.
[23] WATERHOUSE M,TRAN B,ARMSTRONG B K,et al.Environmental,personal,and genetic determinants of response to vitamin D supplementation in older adults[J].J Clin Endocrinol Metab,2014,99(7):E1332-E1340.
[24] MAZAHERY H,VON HURST P R.Factors affecting 25-hydroxyvitamin D concentration in response to vitamin D supplementation[J].Nutrients,2015,7(7):5111-5142.
[25] LACROIX M,BATTISTA M C,DOYON M,et al.Lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus[J].Acta Diabetol,2014,51(4):609-616.
[26] SHAHGHEIBI S,FARHADIFAR F,POUYA B.The effect of vitamin D supplementation on gestational diabetes in high-risk women:results from a randomized placebo-controlled trial[J].J Res Med Sci,2016,21:2.
[27] TEHRANI H G,MOSTAJERAN F,BANIHASHEMI B.Effect of vitamin D supplementation on the incidence of gestational diabetes[J].Adv Biomed Res,2017,6:79.
[28] SABLOK A,BATRA A,THARIANI K,et al.Supplementation of vitamin D in pregnancy and its correlation with feto-maternal outcome[J].Clin Endocrinol,2015,83(4):536-541.
[29] YAP C,CHEUNG N W,GUNTON J E,et al.Vitamin D supplementation and the effects on glucose metabolism during pregnancy:a randomized controlled trial[J].Diabetes Care,2014,37(7):1837-1844.
[30] HOSSAIN N,KANANI F H,RAMZAN S,et al.Obstetric and neonatal outcomes of maternal vitamin D supplementation:results of an open-label,randomized controlled trial of antenatal vitamin D supplementation in Pakistani women[J].J Clin Endocrinol Metab,2014,99(7):2448-2455.
[2] 杨慧霞.我国妊娠期糖尿病诊治现状和应对措施[J].中国实用妇科与产科杂志,2013(4):241-243.
[3] KAAJA R,RONNEMAA T.Gestational diabetes:pathogenesis and consequences to mother and offspring[J].Rev Diabet Stud,2008,5(4):194-202.
[4] TRIUNFO S,LANZONE A,LINDQVIST P G.Low maternal circulating levels of vitamin D as potential determinant in the development of gestational diabetes mellitus[J].J Endocrinol Invest,2017,40(10):1049-1059.
[5] 关怀,尚丽新.妊娠期糖尿病流行现状[J].中国实用妇科与产科杂志,2015(1):91-94.
[6] PALOMER X,GONZALEZ-CLEMENTE J M,BLANCO-VACA F,et al.Role of vitamin D in the pathogenesis of type 2 diabetes mellitus[J].Diabetes Obes Metab,2008,10(3):185-197.
[7] ALVAREZ J A,ASHRAF A.Role of vitamin d in insulin secretion and insulin sensitivity for glucose homeostasis[J].Int J Endocrinol,2010,2010:351385.
[8] PITTAS A G,DAWSON-HUGHES B,SHEEHAN P R,et al.Rationale and design of the Vitamin D and Type 2 Diabetes (D2d) study:a diabetes prevention trial[J].Diabetes Care,2014,37(12):3227-3234.
[9] AMRAEI M,MOHAMADPOUR S,SAYEHMIRI K,et al.Effects of vitamin D deficiency on incidence risk of gestational diabetes mellitus:a systematic review and meta-analysis[J].Front Endocrinol,2018,9:7.
[10] CLIFTON-BLIGH R J,MCELDUFF P,MCELDUFF A.Maternal vitamin D deficiency,ethnicity and gestational diabetes[J].Diabet Med,2008,25(6):678-684.
[11] ZHANG C,QIU C,HU F B,et al.Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus[J].PLoS One,2008,3(11):e3753.
[12] 中华医学会儿科学分会儿童保健学组,编辑委员会中华儿科杂志.儿童微量营养素缺乏防治建议[J].中华儿科杂志,2010(7):502-509.
[13] 杨慧霞,徐先明,王子莲,等.妊娠合并糖尿病诊治指南(2014)[J].糖尿病天地(临床),2014(11):489-498.
[14] BACON C J,GAMBLE G D,HORNE A M,et al.High-dose oral vitamin D3 supplementation in the elderly[J].Osteoporos Int,2009,20(8):1407-1415.
[15] TRANG H M,COLE D E,RUBIN L A,et al.Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2[J].Am J Clin Nutr,1998,68(4):854-858.
[16] TALWAR S A,ALOIA J F,POLLACK S,et al.Dose response to vitamin D supplementation among postmenopausal African American women[J].Am J Clin Nutr,2007,86(6):1657-1662.
[17] MAZAHERY H,STONEHOUSE W,VON HURST P R.The effect of monthly 50,000 IU or 100,000 IU vitamin D supplements on vitamin D status in premenopausal Middle Eastern women living in Auckland[J].Eur J Clin Nutr,2015,69(3):367-372.
[18] KROLL M H,BI C,GARBER C C,et al.Temporal relationship between vitamin D status and parathyroid hormone in the United States[J].PLoS One,2015,10(3):e118108.
[19] GIUSTI A,BARONE A,PIOLI G,et al.Heterogeneity in serum 25-hydroxy-vitamin D response to cholecalciferol in elderly women with secondary hyperparathyroidism and vitamin D deficiency[J].J Am Geriatr Soc,2010,58(8):1489-1495.
[20] GALLAGHER J C,SAI A,TEMPLIN T N,et al.Dose response to vitamin D supplementation in postmenopausal women:a randomized trial[J].Ann Intern Med,2012,156(6):425-437.
[21] WATERHOUSE M,TRAN B,ARMSTRONG B K,et al.Environmental,personal,and genetic determinants of response to vitamin D supplementation in older adults[J].J Clin Endocrinol Metab,2014,99(7):E1332-E1340.
[22] NG K,SCOTT J B,DRAKE B F,et al.Dose response to vitamin D supplementation in African Americans:results of a 4-arm,randomized,placebo-controlled trial[J].Am J Clin Nutr,2014,99(3):587-598.
[23] WATERHOUSE M,TRAN B,ARMSTRONG B K,et al.Environmental,personal,and genetic determinants of response to vitamin D supplementation in older adults[J].J Clin Endocrinol Metab,2014,99(7):E1332-E1340.
[24] MAZAHERY H,VON HURST P R.Factors affecting 25-hydroxyvitamin D concentration in response to vitamin D supplementation[J].Nutrients,2015,7(7):5111-5142.
[25] LACROIX M,BATTISTA M C,DOYON M,et al.Lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus[J].Acta Diabetol,2014,51(4):609-616.
[26] SHAHGHEIBI S,FARHADIFAR F,POUYA B.The effect of vitamin D supplementation on gestational diabetes in high-risk women:results from a randomized placebo-controlled trial[J].J Res Med Sci,2016,21:2.
[27] TEHRANI H G,MOSTAJERAN F,BANIHASHEMI B.Effect of vitamin D supplementation on the incidence of gestational diabetes[J].Adv Biomed Res,2017,6:79.
[28] SABLOK A,BATRA A,THARIANI K,et al.Supplementation of vitamin D in pregnancy and its correlation with feto-maternal outcome[J].Clin Endocrinol,2015,83(4):536-541.
[29] YAP C,CHEUNG N W,GUNTON J E,et al.Vitamin D supplementation and the effects on glucose metabolism during pregnancy:a randomized controlled trial[J].Diabetes Care,2014,37(7):1837-1844.
[30] HOSSAIN N,KANANI F H,RAMZAN S,et al.Obstetric and neonatal outcomes of maternal vitamin D supplementation:results of an open-label,randomized controlled trial of antenatal vitamin D supplementation in Pakistani women[J].J Clin Endocrinol Metab,2014,99(7):2448-2455.