子痫前期孕妇血清维生素D水平对新生儿结局的影响

肖佳荔; 罗晶; 江余明; 曹芳; 张寅英; 杨戎威

doi:10.16766/j.cnki.issn.1674-4152.003922

子痫前期孕妇血清维生素D水平对新生儿结局的影响

doi: 10.16766/j.cnki.issn.1674-4152.003922

嘉兴市妇幼保健院新生儿科，浙江嘉兴 314000

基金项目:

浙江省医药卫生科技计划项目 2023KY1218

详细信息

通讯作者:
杨戎威，E-mail：yrw615@sina.com

中图分类号: R714.246
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出版历程
- 收稿日期: 2024-05-17
- 网络出版日期: 2025-05-14

Effects of serum vitamin D levels on neonatal outcomes in pregnant women with preeclampsia

Neonatal Department, Jiaxing Maternal and Child Health Hospital, Jiaxing, Zhejiang 314000, China

摘要

摘要: 目的子痫前期(PE)孕妇不良妊娠结局风险升高，本研究旨在分析血清维生素D(VD)缺乏的严重程度与胎龄、新生儿出生体重及新生儿不良结局的关系，为降低PE孕妇不良妊娠结局提供新思路。方法选择2023年1月—2023年12月嘉兴市妇幼保健院诊治的PE患者280例作为PE组、正常孕妇280例作为对照组，比较PE患者与对照组血清25(OH)D水平的差异。在PE患者中，按照血清25(OH)D水平分为VD严重缺乏组、VD轻度缺乏组、VD正常组。应用二分类logistic回归方程分析患者血清VD缺乏与不良妊娠结局间的相关性。结果 PE组孕妇血清25(OH)D水平[(48.29±12.88)nmol/L]显著低于对照组[(57.75±11.92)nmol/L]，差异有统计学意义(P＜0.05)。VD严重缺乏组重度PE发生率显著高于VD正常组及VD轻度缺乏组(P＜0.05)，而VD正常组与VD轻度缺乏组比较差异无统计学意义(P＞0.05)；VD严重缺乏组胎龄、新生儿出生体重、Apgar评分均低于VD正常组及VD轻度缺乏组，新生儿窒息发生率高于VD正常组及VD轻度缺乏组，差异有统计学意义(P＜0.05)，而VD正常组及VD轻度缺乏组比较差异无统计学意义(P＞0.05)；3组围产儿死亡率比较差异无统计学意义(P＞0.05)；多因素logistic回归分析显示，患者年龄＞35岁、BMI＞25、重度PE、VD严重缺乏是新生儿不良结局的独立危险因素。结论在PE患者中，血清VD严重缺乏会增加新生儿不良结局的风险。
- 子痫前期 /
- 维生素D /
- 新生儿 /
- 妊娠
Abstract: Objective Pregnant women with preeclampsia (PE) have an increased risk of adverse pregnancy outcomes. This study analyzed the relationship between the severity of serum vitamin D (VD) deficiency and gestational age, newborn birth weight, and neonatal adverse outcomes, and provided new ideas for reducing adverse pregnancy outcomes in women with PE. Methods A total of 280 PE patients treated in Jiaxing Maternal and Child Health Hospital from January 2023 to December 2023 were selected as the PE group and 280 normal pregnant women as the control group, and the difference of serum 25 (OH) D level between PE patients and control group was compared. PE patients were divided into severe VD deficiency group, mild VD deficiency group, and normal VD group according to serum 25(OH) D level. The binary logistic regression equation was used to investigate the relationship between serum VD deficiency and adverse pregnancy outcomes. Results The serum 25(OH)D level in the PE group [(48.29±12.88)nmol/L] was significantly lower than that in the control group [(57.75±11.92)nmol/L], and the difference was statistically significant (P < 0.05). The incidence of severe PE in the severe VD deficiency group was significantly higher than that in the normal VD group and the mild VD deficiency group (P < 0.05), but there was no statistical significance between the normal VD group and the mild VD deficiency group (P>0.05). Gestational age, neonatal birth weight, and Apgar score in severe VD deficiency group were lower than those in normal VD group and mild VD deficiency group, and the incidence of neonatal asphyxia was higher than that in normal VD group and mild VD deficiency group, with statistical significance (P < 0.05), while there was no statistical significance between normal VD group and mild VD deficiency group (P>0.05). There was no significant difference in perinatal mortality among the three groups (P>0.05). Multivariate logistic regression results showed that age >35 years old, BMI>25, severe PE, and VD deficiency were independent risk factors for neonatal adverse outcomes. Conclusion Serious deficiency of serum VD increases the risk of adverse neonatal outcomes in PE patients.
- Preeclampsia /
- Vitamin D /
- Newborn /
- Pregnancy

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表 1 PE组与对照组孕妇一般资料及血清25(OH)D水平比较

Table 1. Comparison of general data and serum 25(OH)D levels between the control group and PE group

组别	例数	年龄(x±s，岁)	BMI(x±s)	经产妇[例(%)]	25(OH)D检测孕周(x±s)	入组季节[例(%)]		血清25(OH)D(x±s，nmol/L)
组别	例数	年龄(x±s，岁)	BMI(x±s)	经产妇[例(%)]	25(OH)D检测孕周(x±s)	夏秋季	冬春季	血清25(OH)D(x±s，nmol/L)
对照组	280	30.35±6.32	22.97±6.76	124(44.29)	30.4±5.1	157(56.07)	123(43.93)	57.75±11.92
PE组	280	30.81±6.71	22.15±7.58	119(42.50)	30.2±4.9	164(58.57)	116(41.43)	48.29±12.88
统计量		0.837^a	1.351^a	0.182^b	0.473^a	0.358^b		9.020^a
P值		0.403	0.177	0.670	0.636	0.550		＜0.001
注：^a为t值，^b为χ²值。

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表 2 PE患者中不同VD水平之间临床特征比较

Table 2. Comparison of clinical features among patients with different VD levels in PE patients

组别	例数	年龄(x±s, 岁)	重度PE[例(%)]	血压(x±s, mmHg)
组别	例数	年龄(x±s, 岁)	重度PE[例(%)]	收缩压	舒张压
VD正常组	88	30.02±6.86	11(12.50)	149.11±16.11	94.08±8.92
VD轻度缺乏组	102	31.39±6.57	18(17.65)	151.49±12.36	94.36±6.27
VD严重缺乏组	90	30.93±6.70	56(62.22)^bc	150.02±11.38	93.14±7.92
统计量		1.006^a	24.292^d	0.769^a	0.638^a
P值		0.367	＜0.001	0.464	0.529
注：^a为F值，^d为χ²值。与VD正常组比较，^bP＜0.05；与VD轻度缺乏组比较，^cP＜0.05。

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表 3 PE患者中不同VD水平之间新生儿结局比较

Table 3. Comparison of neonatal outcomes among different VD levels in PE patients

组别	例数	胎龄(x±s，周)	新生儿出生体重(x±s，g)	Apgar评分(x±s)	新生儿窒息[例(%)]	围产儿死亡[例(%)]
VD正常组	88	37.03±1.63	2 803.18±275.13	9.75±0.46	5(5.68)	1(1.14)
VD轻度缺乏组	102	36.60±2.02	2 702.65±302.57	9.46±0.73	7(6.86)	2(1.96)
VD严重缺乏组	90	34.50±1.77^ab	2 505.33±294.35^ab	8.39±0.83^ab	13(14.44)^ab	3(3.33)
统计量		50.058^c	24.177^c	96.421^c	5.044^d	1.051^d
P值		＜0.001	＜0.001	＜0.001	0.041	0.312
注：与VD正常组比较，^aP＜0.05；与VD轻度缺乏组比较，^bP＜0.05。^c为F值，^d为χ²值。

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表 4 新生儿不良结局影响因素logistic回归分析

Table 4. Logistic regression analysis of influencing factors of adverse neonatal outcomes

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄(＞35岁)	1.116	0.377	9.769	0.002	3.053	1.488~6.264
BMI(＞25)	1.292	0.389	15.056	＜0.001	3.639	1.814~7.302
重度PE(是)	0.674	0.375	6.004	0.040	1.963	1.031~3.737
VD水平
轻度缺乏	0.295	0.348	1.208	0.357	1.343	0.718~2.513
严重缺乏	1.228	0.436	17.271	＜0.001	3.413	1.808~6.442

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