孕妇血维生素D水平与妊娠期糖尿病相关性研究

叶瑛瑛; 王金辉; 王丽君; 龚爱敏

doi:10.16766/j.cnki.issn.1674-4152.001735

孕妇血维生素D水平与妊娠期糖尿病相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.001735

玉环市人民医院妇科，浙江玉环 317600

基金项目:

浙江省医药卫生科技计划项目 2018KY922

详细信息

通讯作者:
叶瑛瑛, E-mail：lavenda0916@163.com

中图分类号: R715.3 R977.24
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出版历程
- 收稿日期: 2019-10-21
- 网络出版日期: 2022-02-19

Study on the relationship between serum vitamin D level and gestational diabetes mellitus in pregnant women

Gynaecology, Yuhuan People's Hospital of Zhejiang Province, Yuhuan, Zhejiang 317600, China

摘要

摘要: 目的探讨孕妇血清25-羟维生素D[25-(OH)D]水平与妊娠期糖尿病(gestational diabetes mellitus，GDM)的关系，分析孕妇血清25-(OH)D水平的影响因素。方法采用随机数字表法选取2017年9月—2018年12月在玉环市人民医院产检的300例孕妇，在孕早期、中期、晚期分别检测25-(OH)D水平，根据血清25-(OH)D水平分为缺乏组和不缺乏组，比较2组孕妇妊娠期糖尿病发生率的差别；根据孕晚期血清25-(OH)D水平，分析孕妇血清25-(OH)D水平的影响因素。结果孕早期缺乏组、不缺乏组孕妇妊娠期糖尿病发生率分别为26.32%、12.50%，比较差异无统计学意义(P＞0.05)；孕中期缺乏组、不缺乏组孕妇妊娠期糖尿病发生率分别为28.65%、9.80%，比较差异有统计学意义(P < 0.05)；孕晚期缺乏组、不缺乏组孕妇妊娠期糖尿病发生率分别为27.47%、10.00%，比较差异有统计学意义(P < 0.05)；在单因素分析的基础上经多因素logistic回归分析显示每日户外活动时间少、孕晚期在冬春季、未正规补充维生素D、未及时补充维生素D为孕妇血清25-(OH)D缺乏的独立危险因素(均P < 0.05)。结论孕妇血清25-(OH)D水平下降可能增加妊娠期糖尿病发生的风险，孕早期合理补充维生素D可有效预防孕妇维生素D缺乏，有助于降低妊娠期糖尿病的发生风险。
- 孕妇 /
- 25-羟维生素D /
- 妊娠期糖尿病 /
- 维生素
Abstract: Objective To investigate the relationship between serum 25-hydroxyvitamin D [25-(OH)D] level and gestational diabetes mellitus (GDM) in pregnant women, and to analyze the influencing factors of serum 25-hydroxyvitamin D level in pregnant women. Methods A random number table was used to select 300 pregnant women who were examined in Yuhuan People's Hospital from September 2017 to December 2018. The levels of 25-(OH)D were detected in the early, middle and late stages of pregnancy. According to the serum levels of 25-(OH)D, the pregnant women were divided into two groups: lack group and no lack group, and the incidence of gestational diabetes was compared between the two groups. According to the serum 25-(OH)D level in the third trimester, the influencing factors of serum 25-(OH)D level in pregnant women were analyzed. Results The incidence of gestational diabetes was 26.32% in the lack group and 12.50% in the no lack group, with no statistically significant difference (P>0.05). The incidence of gestational diabetes in the second trimester deficiency group and the no deficiency group were 28.65% and 9.80%, respectively, with statistically significant differences (P < 0.05). The incidence of gestational diabetes was 27.47% and 10.00% in the lack group and no lack group, respectively, with statistically significant differences (P < 0.05). On the basis of univariate analysis, multivariate logistic regression analysis showed that the independent risk factors of serum 25-(OH)D deficiency in pregnant women were less time spent in outdoor activities, winter and spring, no regular vitamin D supplementation, and no timely vitamin D supplementation (all P < 0.05). Conclusion Decreased serum 25-(OH)D level in pregnant women may increase the risk of gestational diabetes. Reasonable vitamin D supplementation in early pregnancy can effectively prevent vitamin D deficiency in pregnant women and help reduce the risk of gestational diabetes.
- Pregnant women /
- 25-hydroxyvitamin D /
- Gestational diabetes mellitus /
- Vitamin

HTML全文

表 1 2组孕妇不同孕期GDM情况比较[例(%)]

孕期	组别	例数	妊娠期糖尿病	χ²值	P值
孕早期	缺乏组	190	50(26.32)	2.840	0.092
	不缺乏组	32	4(12.50)
孕中期	缺乏组	171	49(28.65)	7.584	0.006
	不缺乏组	51	5(9.80)
孕晚期	缺乏组	182	50(27.47)	5.439	0.020
	不缺乏组	40	4(10.00)

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表 2 影响孕妇血清25-(OH)D水平的单因素分析[例(%)]

因素	变量取值	例数	25-(OH)D不缺乏	χ²值	P值
每日户外活动时间(有无>1 h)	有	66	18(27.27)	5.446	0.020
	无	156	22(14.10)
孕晚期季节	夏秋季	82	21(25.61)	5.073	0.024
	冬春季	140	19(13.57)
正规补充维生素D	有	67	20(29.85)	9.096	0.003
	无	155	20(12.90)
及时补充维生素D(孕早期开始补充)	有	82	21(25.61)	5.073	0.024
	无	140	19(13.57)
年龄(是否在30岁以上)	是	118	19(16.10)	0.626	0.429
	否	104	21(20.19)
孕前体质指数(是否>24)	是	42	8(19.05)	0.037	0.847
	否	180	32(17.78)

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表 3 影响孕妇血清25-(OH)D水平的多因素分析

变量	B	SE	Wald ^χ2	P值	OR值	95% CI
每日户外活动时间少	1.480	0.453	10.670	0.001	4.392	1.807~10.673
冬春季	0.806	0.399	4.071	0.044	2.239	1.023~4.898
未正规补充维生素D	1.499	0.446	11.299	0.001	4.476	1.868~10.725
未及时补充维生素D	0.871	0.386	5.079	0.024	2.389	1.120~5.093

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参考文献(20)

[1]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018: 105-109.
[2]	ZHU Y Y, ZHANG C L. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective[J]. Curr Diab Rep, 2016, 16(1): 7-18. doi: 10.1007/s11892-015-0699-x
[3]	ZHANG C L, RAWAL S, CHONG Y S. Risk factors for gestational diabetes: is prevention possible?[J]. Diabetologia, 2016, 59(7): 1385-1390. doi: 10.1007/s00125-016-3979-3
[4]	LI Y X, ZHOU L. Vitamin D deficiency, obesity and diabetes[J]. Cell Mol Biol(Noisy-le-grand), 2015, 61(3): 35-38. http://www.researchgate.net/profile/Lei_Zhou62/publication/280033254_Vitamin_D_Deficiency_Obesity_and_Diabetes/links/5959e1ae0f7e9ba95e126c9c/Vitamin-D-Deficiency-Obesity-and-Diabetes.pdf
[5]	ANGELLOTTI E, PITTAS A G. The Role of Vitamin D in the prevention of Type 2 diabetes: to D or Not to D?[J]. Endocrinology, 2017, 158(7): 2013-2021. doi: 10.1210/en.2017-00265
[6]	刘冰, 洪旭. 血清25羟基维生素D与初诊2型糖尿病患者血糖控制及酮症酸中毒的关系[J]. 中华实用诊断与治疗杂志, 2018, 32(5): 480-482. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD201805019.htm
[7]	HOU W, YAN X T, BAI C M, et al. Decreased serum vitamin D levels in early spontaneous pregnancy loss[J]. Eur J Clin Nutr, 2016, 70(9): 1004-1008. doi: 10.1038/ejcn.2016.83
[8]	KIELY M, HEMMINGWAY A, O'CALLAGHAN KM. Vitamin D in pregnancy: current perspectives and future directions[J]. Ther Adv Musculoskelet Dis, 2017, 9(6): 145-154. doi: 10.1177/1759720X17706453
[9]	周建烈, 王山米. 孕产妇补充维生素D的研究进展[J]. 中国妇产科临床杂志, 2018, 19(3): 277-279. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC201803036.htm
[10]	冯钰婷, 盛少琴. 妊娠期糖尿病的发病现状及影响因素[J]. 浙江临床医学, 2017, 19(3): 520-521. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCW201905015.htm
[11]	高建瓴, 刘洪. 妊娠中期维生素D水平降低与妊娠期糖尿病相关性研究进展[J]. 陕西医学杂志, 2019, 48(7): 954-957. doi: 10.3969/j.issn.1000-7377.2019.07.041
[12]	裴晶晶, 廖祥鹏, 肖建平, 等. 妊娠期妇女维生素D状况与血糖水平关系的分析[J]. 中国妇幼保健, 2016, 31(4): 716-718. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201604019.htm
[13]	韦叙, 莫竞华. 某院妊娠早中期妇女418例维生素D及微量元素状况分析[J]. 现代医药卫生, 2017, 33(3): 424-425. doi: 10.3969/j.issn.1009-5519.2017.03.038
[14]	ZHANG M X, PAN G T, GUO J F, et al. Vitamin D deficiency increases the risk of gestational diabetes mellitus: a meta-analysis of observational studies[J]. Nutrients, 2015, 7(10): 8366-8375. doi: 10.3390/nu7105398
[15]	BOUCHER B J. Early pregnancy maternal vitamin D concentrations and risk of gestational diabetes mellitus[J]. Paediatr Perinat Epidemiol, 2015, 29(3): 196-199. doi: 10.1111/ppe.12187
[16]	BOYLE V T, THORSTENSEN B E, MOURATH D, et al. The relationship between 25-hydroxyvitamin D concentration in early pregnancy and pregnancy outcomes in a large, prospective cohort[J]. Br J Nutr, 2016, 116(8): 1409-1415. doi: 10.1017/S0007114516003202
[17]	XIA J, SONG Y, RAWAL S, et al. Vitamin D status during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study in a multiracial cohort[J]. Diabetes Obes Metab, 2019, 21(8): 1895-1905. doi: 10.1111/dom.13748
[18]	尹万军, 金丹, 姚梦楠, 等. 维生素D补充对妊娠期糖尿病预防和治疗作用的Meta分析[J]. 卫生研究, 2019, 48(5): 811-816, 821. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ201905024.htm
[19]	应一樱, 陈洁, 包蓓艳. 维生素D联合西格列汀对2型糖尿病肾病患者尿蛋白水平、骨密度和骨代谢的影响[J]. 中华全科医学, 2019, 17(5): 797-800, 840. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201905026.htm
[20]	潘晨萍, 管金丽, 祁玲娥. 妊娠早期25-羟维生素D不足对妊娠期糖尿病的预测价值[J]. 中国计划生育学杂志, 2017, 25(4): 260-262, 266. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY201704012.htm