Pehlivan Ismail, Hatun Sükrü, Aydoğan Metin, Babaoğlu Kadir, Gökalp Ayşe Sevim
Department of Pediatrics, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
Turk J Pediatr. 2003 Oct-Dec;45(4):315-20.
The objective of this study was to evaluate the common effects of maternal vitamin D deficiency, various doses of vitamin D given to newborns and the effects of these on vitamin D status in early childhood. Seventy-eight pregnant women and 65 infants who were followed up in various health centers were included in the sudy. 25-hydroxyvitamin-D (25-OHvitD), calcium (Ca), phosphorus (P) and alkaline phosphatase levels were measured in blood samples drawn from pregnant women in the last trimester. Infants born to these mothers were given 400 or 800 IU of vitamin D subsequently at the start of the second week. 25-OHvitD, Ca, P and alkaline phosphatase levels of the 65 infants who were brought in for controls (May-September 2000) were measured and hand-wrist X-rays were evaluated. We analyzed the relationship between vitamin D status of the mothers and infants and socio-economic status; mothers' dressing habits (covered vs uncovered), educational level, and number of pregnancies; and sunlight exposure of the house. Covered as a dressing habit meant covering the hair and sometimes part of the face and wearing dresses that completely cover the arms and legs. In 40 infants who were breast-fed and received the recommended doses of vitamin D on a regular basis, the relationship between serum vitamin D levels and supplementation doses given was analyzed. Serum 25-OHvitD level of the mothers was 17.50 +/- 10.30 and 94.8% of the mothers had a 25-OHvitD level below 40 nmol/L (below 25 nmol/L in 79.5%). The risk factors associated with low maternal 25-OHvitD were low educational level (p = 0.042), insufficient intake of vitamin D within diet (p = 0.020) and "covered" dressing habits (p = 0.012). 25-OHvitD level of the infants was 83.70 +/- 53.70 nmol/L, and 24.6% of the infants had 25-OHvitD levels lower than 40 nmol/L. Risk factors for low 25-OHvitD levels in infants were a) not receiving recommended doses of vitamin D regularly (p = 0.002) and b) insufficient sunlight exposure of the house (p = 0.033). There was a pour but significant correlation between maternal vitamin D levels and infants' 25-OHvitD levels at four months (r = 0.365, p < 0.05). No significant correlation was found between 25-OHvitD levels and supplementation doses of vitamin D (19 infants were supplemented with 400 IU/day and 21 with 800 IU/day of vitamin D) (p = 0.873). Severe maternal vitamin D deficiency remains a commonly seen problem in Turkey. However, vitamin D deficiency can be prevented by supplementation of vitamin D to newborns (at least 400 IU). Supplementation of 800 IU vitamin D in the areas of maternal vitamin D deficiency has no greater benefits for the infants.
本研究的目的是评估母亲维生素D缺乏的常见影响、给予新生儿不同剂量维生素D的影响以及这些对幼儿期维生素D状态的影响。纳入了在各健康中心接受随访的78名孕妇和65名婴儿。在妊娠晚期从孕妇采集的血样中测量25-羟维生素D（25-OHvitD）、钙（Ca）、磷（P）和碱性磷酸酶水平。这些母亲所生的婴儿随后在第二周开始时给予400或800国际单位的维生素D。对前来进行对照检查（2000年5月至9月）的65名婴儿测量其25-OHvitD、Ca、P和碱性磷酸酶水平，并对其手腕部X线进行评估。我们分析了母亲和婴儿的维生素D状态与社会经济状况之间的关系；母亲的着装习惯（遮盖与未遮盖）、教育水平、妊娠次数；以及房屋的阳光照射情况。遮盖作为一种着装习惯意味着遮盖头发，有时还遮盖部分面部，穿着完全遮盖手臂和腿部的连衣裙。在40名母乳喂养且定期接受推荐剂量维生素D的婴儿中，分析了血清维生素D水平与所给予补充剂量之间的关系。母亲的血清25-OHvitD水平为17.50±10.30，94.8%的母亲25-OHvitD水平低于40nmol/L（79.5%低于25nmol/L）。与母亲低25-OHvitD相关的危险因素为低教育水平（p = 0.042）、饮食中维生素D摄入不足（p = 0.020）和“遮盖”着装习惯（p = 0.012）。婴儿的25-OHvitD水平为83.70±53.70nmol/L，24.6%的婴儿25-OHvitD水平低于40nmol/L。婴儿低25-OHvitD水平的危险因素为：a）未定期接受推荐剂量的维生素D（p = 0.002）和b）房屋阳光照射不足（p = 0.033）。四个月时母亲的维生素D水平与婴儿的25-OHvitD水平之间存在较弱但显著的相关性（r = 0.365，p < 0.05）。未发现25-OHvitD水平与维生素D补充剂量之间存在显著相关性（19名婴儿每天补充400国际单位维生素D，21名婴儿每天补充800国际单位维生素D）（p = 0.873）。母亲严重维生素D缺乏在土耳其仍然是一个常见问题。然而，通过给新生儿补充维生素D（至少400国际单位）可以预防维生素D缺乏。在母亲维生素D缺乏地区补充800国际单位维生素D对婴儿没有更大益处。
