孕妇维生素D缺乏与妊娠期糖尿病的相关性分析

目的:调查孕妇妊娠早期维生素D水平及其影响因素,探讨维生素D缺乏与妊娠期糖尿病的相关性。方法:选取2012年7月至2013年4月在上海交通大学医学院附属新华医院产科正规产检并分娩的非孕前糖尿病孕妇,在其建卡初检时采用电化学发光免疫技术测定血清25(OH)D3水平;妊娠24-28周行糖筛查及糖耐量试验,诊断是否为妊娠期糖尿病GDM。收集并整理孕妇年龄,孕前体重指数BMI、维生素D测定孕周与测定季节、孕期维生素D补充情况等信息。结果:1000例孕妇中,GDM发病率为11.5%,维生素D缺乏比例占67.4%;其中,约有54%孕妇常规补充复合维生素,约含维生素400 IU/天,10%孕妇常规补充维生素D。GDM孕妇25(OH)D3水平显著低于正常对照组(P=0.007)。维生素D缺乏孕妇发生GDM的风险是维生素D水平较高组的1.944倍,且在秋冬季更易发生GDM。可以考虑在孕14-16周进行维生素D水平的早期测定。结论:孕妇维生素D缺乏十分普遍。妊娠早期孕妇低维生素D水平可能增加孕妇胰岛素抵抗及孕期发生GDM的发生风险。

Analysis of Correlation of Vitamin D Deficiency with the Risk of Gestational Diabetes Mellitus in Pregnant Women

Objective:To investigate the vitamin D level in early pregnancy of pregnant women and its influencing factors. The association between vitamin D deficiency and risk of gestational diabetes mellitus (GDM) was also studied.Methods:A study examined the association between 25-hydroxyvitamin D and risk of gestational diabetes with a cohort of pregnant women fromJuly 2012 to April 2013 attending the gynecology clinic of Xin Hua hospital Affiliated to Shanghai Jiao Tong University School of Medicine , who had undergone antenatal screening in first trimester and subsequent glucose tolerance testing. Cases were women diagnosed with gestational diabetes and controls were women without gestational diabetes matched on age and gestational weeks of blood collection. The pre-BMI, date of blood collection of cases and controls were also collected. Serum 25-hydroxyvitamin D, fasting plasma glucose and Insulin concentration were all measured and compared between cases and controls.Results:Of the 1000 paticipants, 115(11.5%) women were diagnosed with GDM, 674 (67.4%) women had vitamin D deficiency. Among the 1000 cases, about 54%had regular multivitamin supplementation which containing vitamin 400 IU/d while less than 10%had regular vitamin D supplementation in pregnant women. The pregnant women with vitamin D deficiency were more likely to get GDM in autumn and winter than in spring and summer. After adjusting for gestational age, pre-BMI, gestational weeks of blood collection and season, serum 25-hydroxyvitamin D below the first quartile (<12.32 ng/ml, P25) was associated with a twofold likelihood of gestation diabetes (adjusted odds ratio1.944, 95% Confidence interval 1.069-3.537, P=0.029). Moreover, it was suggested that 14-16 week was considered as the time to measure vitaminD during early gestation period was suggested.Conclusion:Vitamin D deficiency was very common in the pregnant women. Low vitaminD status may increase the risk of GDM.