目的 结合维生素D(vitamin D, VD)补充剂量和补充时长前瞻性探讨孕早期VD补充与小于胎龄儿(small for gestational age, SGA)发生风险的关系。方法 选取2018–2022年纳入同济出生队列的研究对象。通过面对面调查收集孕妇的基本情况、生活方式及营养补充剂服用情况。SGA指新生儿出生体重低于同性别同胎龄平均体重第10百分位数者。根据孕早期VD补充剂量和时长,将孕妇分为四组：不补充组(non-users, VD=0 IU/d)、低剂量组(VD-L, VD<400 IU/d且补充任意时长)、高剂量短期组(VD-HS, VD≥400 IU/d且补充时长<2月)和高剂量长期组(VD-HL, VD≥400 IU/d且补充时长≥2月)。采用多因素Logistic回归模型评估孕早期VD补充与SGA的关联。结果 本研究共纳入2558名孕妇,平均年龄(28.89±3.49)岁。与non-users相比,VD-HL组文化程度、家庭人均月收入及防晒霜使用比例更高,且更有可能是初产妇(P<0.05)。多因素Logistic回归模型显示,与non-users相比,VD-HL组与SGA发生风险降低50%有关(OR=0.50, 95%CI: 0.33, 0.75),未显示VD-L组和VD-HS组与SGA发生风险的显著关联。结论 孕早期高剂量长期补充VD可降低SGA发生风险。
Abstract
Objective To prospectively explore the association between vitamin D (VD) supplementation in early pregnancy and the risk of small for gestational age (SGA) among pregnant women in Wuhan. Methods Participants were all from the Tongji birth cohort conducted from 2018 to 2022. Information on socio-demographic characteristics, lifestyle, and nutritional supplement consumption was collected through face-to-face surveys. SGA refers to an infant with a birth weight below the 10th percentile for the gestational age. According to the dosage and duration of VD supplementation, participants were divided into four groups: non-user group (VD=0 IU/d), low-dose group (VD-L, VD<400 IU/d for any duration), high-dose short-term group (VD-HS, VD≥400 IU/d with<2 months), and high-dose long-term group (VD-HL, VD≥400 IU/d with≥2 months). Multiple logistic regressions were used to evaluate the correlation between VD supplementation and SGA risk. Results A total of 2558 subjects were included. The average age was 28.89±3.49 years. Compared with the Non-users, pregnant women in the VD-HL group had higher education levels, per capita monthly household income, and the proportion of sunscreen use, and were more likely to be primiparous women (P<0.05). The multivariate logistic regression model showed that compared to the non-users, women in VD-HL group was associated with a 50% reduction in the risk of SGA (OR=0.50, 95% CI: 0.33, 0.75). No significant association was found between VD-L, VD-HS groups and the risk of SGA. Conclusion High-dose and long-term VD supplementation in early pregnancy reduces the risk of SGA.
关键词
维生素D /
维生素D补充 /
小于胎龄儿 /
孕早期
Key words
vitamin D /
vitamin D supplementation /
small for gestational age /
early pregnancy
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参考文献
[1] 游晶玉, 苏喆, 潘丽丽. 小于胎龄儿的研究进展[J].中国实用儿科杂志,2021,36: 602–607.
[2] Lee AC, Katz J, Blencowe H, et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010[J]. Lancet Glob Health, 2013, 1: e26–e36.
[3] Ray JG, Park AL, Fell DB.Mortality in infants affected by preterm birth and severe small-for-gestational age birth weight[J]. Pediatrics, 2017, 140: e20171881.
[4] Katz J, Lee AC, Kozuki N, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis[J]. Lancet (London, England), 2013, 382: 417–425.
[5] Christian P, Murray-Kolb LE, Tielsch JM, et al. Associations between preterm birth, small-for-gestational age, and neonatal morbidity and cognitive function among school-age children in Nepal[J]. BMC Pediatr, 2014, 14: 58.
[6] Martín-Calvo N, Goni L, Tur JA, et al. Low birth weight and small for gestational age are associated with complications of childhood and adolescence obesity: systematic review and meta-analysis[J]. Obes Rev, 2022, 23(Suppl 1): e13380.
[7] Lindell N, Bladh M, Carlsson A, et al. Size for gestational age affects the risk for type 1 diabetes in children and adolescents: a Swedish national case-control study[J]. Diabetologia, 2021, 64: 1113–1120.
[8] Ciresi A, Giordano C.Vitamin D across growth hormone (GH) disorders: From GH deficiency to GH excess[J]. Growth Horm IGF Res, 2017, 33: 35–42.
[9] Roth DE, Morris SK, Zlotkin S, et al. Vitamin D supplementation in pregnancy and lactation and infant growth[J]. N Engl J Med, 2018, 379: 535–546.
[10] Bi WG, Nuyt AM, Weiler H, et al. Association between vitamin D supplementation during pregnancy and offspring growth, morbidity, and mortality: a systematic review and meta-analysis[J]. JAMA Pediatr, 2018, 172: 635–645.
[11] Tao RX, Meng DH, Li JJ, et al. Current recommended vitamin D prenatal supplementation and fetal growth: Results from the China-Anhui birth cohort study[J]. J Clin Endocrinol Metab, 2018, 103: 244–252.
[12] Liu Y, Ding C, Xu R, et al. Effects of vitamin D supplementation during pregnancy on offspring health at birth: a meta-analysis of randomized controlled trials[J]. Clin Nutr, 2022, 41: 1532–1540.
[13] Ganguly A, Tamblyn JA, Finn-Sell S, et al. Vitamin D, the placenta and early pregnancy: effects on trophoblast function[J]. J Endocrinol, 2018, 236: R93–R103.
[14] Mumford SL, Garbose RA, Kim K, et al. Association of preconception serum 25-hydroxyvitamin D concentrations with livebirth and pregnancy loss: a prospective cohort study[J]. Lancet Diabetes Endocrinol, 2018, 6: 725–732.
[15] Von Websky K, Hasan AA, Reichetzeder C, et al. Impact of vitamin D on pregnancy-related disorders and on offspring outcome[J]. J Steroid Biochem Mol Biol, 2018, 180: 51–64.
[16] Anderson CM, Ralph JL, Johnson L, et al. First trimester vitamin D status and placental epigenomics in preeclampsia among Northern Plains primiparas[J]. Life Sci, 2015, 129: 10–15.
[17] 宗心南, 李辉. 中国不同胎龄新生儿生长参照标准的建立:调查方案设计和标准研制方法[J]. 中国循证儿科杂志, 2020, 15: 251–260.
[18] Sudfeld CR, Manji KP, Muhihi A, et al. Vitamin D3 supplementation during pregnancy and lactation for women living with HIV in Tanzania: a randomized controlled trial[J]. PLoS Med, 2022, 19: e1003973.
[19] Thorne-Lyman A, Fawzi WW.Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis[J]. Paediatr Perinat Epidemiol, 2012, 26(Suppl 1): 75–90.
[20] Pérez-López FR, Pasupuleti V, Mezones-Holguin E, ,et al. Effect of vitamin D supplementation during pregnancy on maternal. Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials [J]. Fertil Steril, 2015; 103: 1278–1288.e4.
[21] Chen YH, Yu Z, Fu L, et al. Vitamin D3 inhibits lipopolysaccharide-induced placental inflammation through reinforcing interaction between vitamin D receptor and nuclear factor kappa B p65 subunit[J]. Sci Rep, 2015, 5: 10871.
[22] Chen YH, Liu ZB, Ma L, et al. Gestational vitamin D deficiency causes placental insufficiency and fetal intrauterine growth restriction partially through inducing placental inflammation[J]. J Steroid Biochem Mol Biol, 2020, 203: 105733.
[23] Amarilyo G, Oren A, Mimouni FB, et al. Increased cord serum inflammatory markers in small-for-gestational-age neonates[J]. J Perinatol, 2011, 31: 30–32.
[24] Zhang Q, Chen H, Wang Y, et al. Severe vitamin D deficiency in the first trimester is associated with placental inflammation in high-risk singleton pregnancy[J]. Clin Nutr, 2019, 38: 1921–1926.
[25] Motamed S, Nikooyeh B, Anari R, et al. The effect of vitamin D supplementation on oxidative stress and inflammatory biomarkers in pregnant women: a systematic review and meta-analysis of clinical trials[J]. BMC Pregnancy Childbirth, 2022, 22: 816.
基金
武汉市卫健委资助项目（No.WX21B36）; 湖北省自然科学基金(No.2021CFB526)
