维生素D与妊娠

维生素D不仅参与了钙磷代谢，与细胞分化、生长发育和免疫调节也有明显的关系。维生素D缺乏在妊娠期妇女非常普遍，并会导致先兆子痫、妊娠期糖尿病、牙周病及细菌性阴道病的发生增加，并影响胎儿宫内生长发育，增加予代患自身免疫性疾病、过敏性疾病的风险，使呼吸道抗感染能力下降。妊娠期妇女发生维生素D缺乏的风险较高，监测和补充维生素D很有必要，合适的剂量还需进一步研究。     

维生素D与妊娠期高血压疾病 子痫前期及妊娠结局的相关性研究

目的 探讨妊娠晚期孕妇体内维生素D水平与妊娠期高血压疾病(Hypertensive disorders of pregnancy, HDP)、子痫前期(Preeclampsia, PE)及不同妊娠结局的关系。方法 选取2018年1月—2019年12月在吉林大学第一医院产科住院分娩的666例妊娠晚期孕妇作为研究对象,其中观察组为HDP患者(210例,其中PE患者167例),同期妊娠期无合并症孕妇作为对照组(329例)。比较两组间的基本临床资料及维生素D水平。采用logistic回归分析探讨孕妇体内维生素D水平与HDP、PE发生的相关性。应用受试者工作特征曲线分析维生素D水平对HDP、PE的预测价值。同时比较不同维生素D水平与妊娠结局的关系。结果 HDP组、PE组的维生素D水平(17.15 ng/ml、16.40 ng/ml)均显著低于对照组(26.40 ng/ml),差异均有统计学意义(均P<0.05);维生素D水平升高与HDP、PE的发生呈负相关性(P<0.05)。维生素D预测HDP的ROC曲线下面积为0.75,截断值为22.75,灵敏度为0.74,特异度为0.62。预测P...     

维生素D与妊娠期糖尿病相关性及作用研究

目的研究维生素D和妊娠期糖尿病的相关性。方法对2016年8月-2017年9月收治的86例妊娠期糖尿病患者临床资料进行回顾性分析,将其设为观察组,选取同期接收的86例正常孕妇为对照组,所有孕妇均进行维生素D检测,分析妊娠期糖尿病与维生素D水平的相关性。结果两组孕妇孕周、糖尿病家族史各项基线资料相比,差异无统计学意义(P>0.05),观察组年龄相比对照组更大,观察组体质量(BMI)、空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)水平与对照组相比,相对更高;观察组维生素D、β细胞功能指数(HOMA-IS)水平与对照组相比,相对更低且差异具有统计学意义(P<0.05);将维生素D作为因变量,将年龄、BMI、FPG、2 hPBG、FINS、HOMA-IR、HOMA-IS作为自变量进行Pearson相关性分析,结果显示,FPG、2 hPBG、FINS、HOMA-IR、HOMA-IS均与维生素D有相关性,其中FPG、2 hPBG、FINS、HOMA-IR与维生素D呈负相关,HOMA-IS与维生素D呈正相关(P<0.05)。结论维生素D与妊娠期糖尿病具有相关性,妊娠期糖尿病孕妇血清内维生素D水平相比正常孕妇较低,维生素D缺乏可参与妊娠期糖尿病发生及发展中,分析其机制可能为增加胰岛素抵抗。     

妊娠期血清维生素D水平及对母婴结局的影响

目的 探讨妊娠期维生素D(Vit D)水平及对母婴结局的影响。方法 选取2016—2021年在温州市中心医院就诊的妊娠期女性20 282例,采用质谱法测定受试者血清25-羟维生素D含量,分析Vit D缺乏的影响因素及其与母婴不良结局的关系。结果 妊娠期Vit D水平为22.00(16.10～29.40) ng/ml, Vit D缺乏(<20 ng/ml)检出率为41.93%,Vit D不足(20 ng/ml≤Vit D<30 ng/ml)检出率34.75%。Vit D缺乏风险随检测孕周和年龄增大而下降;孕次>2次、产次>1次及检测时期BMI值过高是Vit D缺乏的危险因素(OR>1,P<0.05)。相对于春季和冬季,夏季与秋季是Vit D缺乏的保护因素(OR<1,P<0.05)。Vit D缺乏可显著增加子痫前期的发病风险(OR=2.29,95%CI:1.23～4.25,P<0.05)。结论 妊娠期Vit D缺乏或不足现象较为严重,Vit D水平受年龄、孕/产次、季节等多种因素影响,Vit D缺乏是子痫前期的危险因素,需加强妊娠期Vi...     

25-羟基维生素D与妊娠期高血压的相关性研究

目的探讨孕11～13周25-羟基维生素D(25-OH VitD)水平与妊娠期高血压及子痫前期间的相关性。方法采用化学发光微粒子免疫法检测222例妊娠期高血压及子痫前期患者,其中,A组(妊娠期高血压组)93例,B组(轻度子痫前期组)81例,C组(重度子痫前期组)48例和5 958名正常妊娠孕妇在孕11～13(12.7±0.5)周时血清25-OH VitD的水平,分析25-OH VitD水平与各组间的相关性。结果在孕11～13周时,正常妊娠组25-OH VitD水平为(44.4±17.0)nmol/L;A组为(40.5±12.7)nmol/L;B组为(39.5±11.9)nmol/L;C组为(37.3±11.5)nmol/L;A组与正常妊娠组的25-OH VitD水平差异有统计学意义(P0.05),B、C两组与正常妊娠组的25-OH VitD水平差异有显著统计学意义(P0.01)。四组孕妇25-OH VitD缺乏率、不足率和充足率间比较,差异有统计学意义(P0.05)。合计缺乏和不足率之间比较,差异有统计学意义(P0.01)。结论孕11～13周低水平的25-OH VitD与妊娠期高血压及子痫前期的发病相关,25-OH VitD的水平越低,其病情越严重,有预测妊娠期高血压及子痫前期发生的作用。     

妊娠中期口服维生素D对妊娠期糖尿病发生的临床研究

目的:探讨妊娠中期妇女血清维生素D水平与妊娠期糖尿病的相关性.方法:研究时间为2018年10月至2020年9月;研究对象为此期间昆山市常驻且前来本单位产筛门诊就诊的400例孕中期妇女,随机将其分为常规组和干预组,其中对常规组孕妇给予常规指导,对干预组孕妇在常规指导基础上给予800单位维生素D进行口服补充,对比两组孕妇治...     

妊娠妇女孕中后期维生素D缺乏对婴儿体D格生长及智力发育的影响

目的探讨妊娠妇女孕中后期维生素D缺乏对婴儿体格生长及智力发育的影响。方法选取武汉市某妇幼保健院收治的孕中后期维生素D缺乏妊娠妇女所分娩的90例婴儿为观察组,同时选取孕中后期维生素D水平正常妊娠妇女所分娩的60例婴儿为对照组。所有婴儿分别于出生、6月龄、12月龄时对其身长、头围、体质量、骨超声波传导速度(SOS)等指标进行检查,同时通过儿童发育筛查测验(DST)评价2组婴儿6月龄、12月龄时的智力发育情况。结果 2组婴儿6月龄及12月龄时身长、头围、体质量均高于出生时,差异有统计学意义(P0.05);2组婴儿相同时间点身长、头围、体质量、SOS比较,差异无统计学意义(P0.05)。观察组婴儿6月龄及12月龄时发育商数(DQ)、智力指数(MI)评分均低于对照组,差异有统计学意义(P0.05);观察组婴儿12月龄时的DQ落后率高于对照组,差异有统计学意义(P0.05)。结论妊娠妇女孕中后期维生素D缺乏对婴儿体格生长发育无明显影响,但会影响其智力发育。     

维生素D与糖尿病

维生素D缺乏与糖尿病的发生关系密切，而补充足量的维生素D可减少糖尿病的发生，并可改善血糖控制情况，其机制可能与维生素D抑制免疫炎症反应、减轻胰岛素抵抗、促进胰岛素的合成分泌等有关。     

门冬胰岛素联合维生素D治疗妊娠期糖尿病的临床研究

目的考察门冬胰岛素联合维生素D治疗妊娠期糖尿病(GDM)的临床效果。方法选取2015年2月-2017年3月在该院产科接受治疗的105例GDM患者为研究对象,按治疗方法的不同分为对照组(49例)与观察组(56例),对照组采用门冬胰岛素注射液行脐周皮下注射治疗,观察组在对照组基础上辅以维生素D滴剂进行治疗。结果治疗后观察组维生素D水平正常患者比例显著增加,与对照组比较差异有统计学意义(Z=-5.615,P=0.000);治疗后两组患者的血清全段甲状旁腺激素(iPTH)、血清钙、磷及钙磷乘积等指标均不同程度降低,对照组的血磷与血磷钙乘积以及观察组的iPTH、血磷与血磷钙乘积显著降低(P<0.05),治疗后观察组的iPTH、血磷与血磷钙乘积与对照组对比降低程度更大(P=0.000);治疗后两组患者的空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)等几项指标均降低,除对照组HOMA-IR外,与治疗前比较,差异均有统计学意义(均P<0.01),治疗后两组患者的稳定模型胰岛β细胞功能指数(HOMA-β)、胰岛素敏感指数(ISI)、混合胰岛素敏感度(ISIcomp)等几项指标均显著升高(P<0.01),治疗后组间比较FPG与2hPG两项指标差异无统计学意义(P>0.05),其余指标组间比较差异均有统计学意义(均P<0.01);观察组孕产妇与围生儿的并发症总发生率为14.29%,低于对照组的32.65%,差异有统计学意义(P<0.05)。结论门冬胰岛素联合维生素D治疗GDM疗效肯定,较单纯应用门冬胰岛素更具临床推广价值。     

孕产妇维生素D缺乏与早产的关系

维生素D是人体必需的一种营养素,具有广泛的生物学效应。妊娠会使孕妇体内激素水平和代谢状况发生改变,所需营养素明显增加,也是维生素D缺乏的一个高发阶段。维生素D缺乏可能是造成早产的危险因素之一。该文就孕产妇维生素D缺乏与早产的关系进行综述。     

Vitamin D: implications for health and pregnancy

Vitamin D gained importance since the discovery of its steroid structure. Vitamin D participates in mineral homeostasis, regulation of gene expression, and cell differentiation. Recent advances in the study of the enzyme involved in the conversion of 25-hydroxyvitamin D3 into 1,25-dihydroxyvitamin D3 (calcitriol), as well as the discovery of it's hormone mechanism of action, have led to a better knowledge and understanding of vitamin D endocrine system, as well as it's implication in health and pregnancy.     

Vitamin D status and hypertensive disorders in pregnancy

PurposeSeveral studies have reported increased risk of preeclampsia when 25-hyrdoxyvitamin D (25[OH]D) levels are low. The extent to which 25(OH)D may lower risk for hypertensive disorder during pregnancy remains unclear.MethodsAmong women enrolled in the Project Viva prenatal cohort in Massachusetts, we examined associations of 25(OH)D levels obtained at 16.4–36.9 weeks of gestation (mean 27.9 weeks) with hypertensive disorders of pregnancy, including preeclampsia (56/1591, 3.5%) and gestational hypertension (109/1591, 6.9%).ResultsWe did not detect an association between plasma 25(OH)D concentration (mean 58, standard deviation 22 nmol/L) and preeclampsia. For each 25 nmol/L increase in 25(OH)D, the adjusted odds ratio for preeclampsia was 1.14 (95% confidence interval, 0.77–1.67). By contrast and contrary to hypothesis, higher 25(OH)D concentrations were associated with higher odds of gestational hypertension: adjusted odds ratio for gestational hypertension was 1.32 (95% confidence interval, 1.01–1.72) per each 25 nmol/L increment in 25(OH)D. Vitamin D intake patterns suggest that this association was not because of reverse causation. Although the elevated hypertension risk may be due to chance, randomized trials of vitamin D supplementation during pregnancy should monitor for gestational hypertension.ConclusionsThese data do not support the hypothesis that higher 25(OH)D levels lower the overall risk of hypertensive disorders of pregnancy.     

Vitamin D status during pregnancy and aspects of offspring health

Low maternal vitamin D levels during pregnancy have been linked to various health outcomes in the offspring, ranging from periconceptional effects to diseases of adult onset. Maternal and infant cord 25(OH)D levels are highly correlated. Here, we review the available evidence for these adverse health effects. Most of the evidence has arisen from observational epidemiological studies, but randomized controlled trials are now underway. The evidence to date supports that women should be monitored and treated for vitamin D deficiency during pregnancy but optimal and upper limit serum 25(OH)D levels during pregnancy are not known.     

Vitamin D and adverse pregnancy outcomes: beyond bone health and growth

Concerns exist about adequacy of vitamin D in pregnant women relative to both maternal and fetal adverse health outcomes. Further contributing to these concerns is the prevalence of inadequate and deficient vitamin D status in pregnant women, which ranges from 5 to 84% globally. Although maternal vitamin D metabolism changes during pregnancy, the mechanisms underlying these changes and the role of vitamin D during development are not well understood. Observational evidence links low maternal vitamin D status with an increased risk of non-bone health outcome in the mother (pre-eclampsia, gestational diabetes, obstructed labour and infectious disease), the fetus (gestational duration) and the older offspring (developmental programming of type 1 diabetes, inflammatory and atopic disorders and schizophrenia); but the totality of the evidence is contradictory (except for maternal infectious disease and offspring inflammatory and atopic disorders), lacking causality and, thus, inconclusive. In addition, recent evidence links not only low but also high maternal vitamin D status with increased risk of small-for-gestational age and schizophrenia in the offspring. Rigorous and well-designed randomised clinical trials need to determine whether vitamin D has a causal role in non-bone health outcomes in pregnancy.     

Vitamin D Binding Protein and Vitamin D Levels in Multi-Ethnic Population

Introduction

Low levels of 25-hydroxyvitamin D (25(OH)D) has been associated with many negative health outcomes including falls and fractures. 25(OH)D is largely bound to vitamin D binding protein (VDBP). There is increasing evidence that free or bioavailable 25(OH)D may be a better measure of vitamin D deficiency.

Objective

To determine the prevalence of 25(OH)D deficiency and VDBP levels in multi-ethnic population, and its impact on muscle strength.

Design and methods

Cross-sectional study of older adults in Western region of Singapore. 295 participants from three ethnic groups were selected from the Healthy Older People Everyday (HOPE) cohort for measurements of total 25(OH)D and VDBP levels. Total 25(OH)D, VDBP, frailty status, Timed-Up-and-Go (TUG) and grip strength (GS) were assessed. Albumin, free and bioavailable 25(OH)D were only available for 256 participants.

Results

53% of Malay and 55% of Indians were deficient in 25(OH)D compared with 18.2% of ethnic Chinese participants. Chinese also had higher total 25(OH)D concentrations with a mean of 29.1 ug/l, (p = <0.001). Chinese had the lowest level of VDBP (169.6ug/ml) followed by Malay (188.8 ug/ml) and Indian having the highest (220.1 ug/ml). Calculated bioavailable and free 25(OH)D levels were significantly higher in Chinese, followed by Malays and Indians, which also correlated with better grip strength measures amongst the Chinese.

Conclusion

The Malays and Indians had overall lower free, bioavailable and total 25(OH)D compared with ethnic Chinese. Chinese ethnic group also had the lowest VDBP and better overall grip strength.