Department of Applied Chemistry and Microbiology, Division of Nutrition, P.O. Box 66, University of Helsinki, FI-00014 Helsinki, Finland.
J Clin Endocrinol Metab. 2010 Apr;95(4):1749-57. doi: 10.1210/jc.2009-1391. Epub 2010 Feb 5.
Vitamin D regulates 3% of the human genome, including effects on bone health throughout life. Maternal vitamin D status may program neonatal skeletal development. The objective here was to determine the association of mothers' vitamin D status with bone variables of their newborns.
In a birth hospital, pregnant women (n = 125) participated in a cross-sectional study with a longitudinal follow-up of the pregnancy. The mean (sd) values for age, body mass index before pregnancy, pregnancy weight gain, and total vitamin D intake in mothers were 31 (4) yr, 23.5 (3.7) kg/m(2), 13.1 (4.3) kg, and 14.3 (5.8) microg, respectively. All newborns were full-term, 99% were appropriate for gestational age, and 53% were boys. Blood samples were collected from mothers during the first trimester and 2 d postpartum and from umbilical cords at birth for analysis of serum 25-hydroxyvitamin D (S-25-OHD), PTH, and bone remodeling markers. Bone variables were measured by pQCT at the 20% site of the newborn tibia on an average of 10 (11) d postpartum. Bone contour was analyzed with a single threshold of 180 mg/mm(3) for the detection of total bone mineral density (BMD), bone mineral content (BMC), and cross-sectional area (CSA).
Mean S-25-OHD was 41.0 (13.6), 45.1 (11.9), and 50.7 (14.9) nmol/liter during the first trimester, postpartum, and in the umbilical cord, respectively. The median value of the individual means for first trimester and the 2-d postpartum S-25-OHD was 42.6 nmol/liter, which was used as cutoff to define two equal-sized groups. Groups are called below median and above median in the text. Newborns below median were heavier (P = 0.05), and 60% were boys. Tibia bone mineral content was 0.047 (95% confidence interval, 0.011-0.082) g/cm higher (P = 0.01), and cross-sectional area was 12.3 (95% confidence interval, 2.0-22.6) mm(2) larger (P = 0.02), but no difference in bone mineral density was observed, above median compared with below median group. These results were adjusted for newborn Z-score birth weight, maternal height, and newborn age at the measurement. A positive, significant correlation was observed between remodeling markers in mothers at different time points and above median group in the cord.
Although the mean total intake of vitamin D among mothers met current Nordic recommendations, 71% of women and 15% of newborns were vitamin D deficient during the pregnancy. Our results suggest that maternal vitamin D status affects bone mineral accrual during the intrauterine period and influences bone size. More efforts should be made to revise current nutrition recommendations for pregnant women that may have permanent effects on the well-being of children.
维生素 D 调控着人类基因组的 3%，包括对终生骨骼健康的影响。母体维生素 D 状况可能会影响新生儿骨骼的发育。本研究旨在确定母亲的维生素 D 状况与新生儿骨骼变量之间的关系。
在一家产科医院，125 名孕妇参与了一项横断面研究，并对妊娠进行了纵向随访。母亲的平均（标准差）年龄、妊娠前体重指数、妊娠体重增加和总维生素 D 摄入量分别为 31（4）岁、23.5（3.7）kg/m2、13.1（4.3）kg 和 14.3（5.8）μg。所有新生儿均为足月，99%为适于胎龄儿，53%为男孩。在妊娠早期和产后 2 天采集母亲的血液样本，在分娩时采集脐带血以分析血清 25-羟维生素 D（S-25-OHD）、甲状旁腺激素和骨重塑标志物。产后平均 10（11）天，在新生儿胫骨 20%处使用 pQCT 测量骨骼变量。使用 180mg/mm3 的单一阈值分析骨轮廓，以检测总骨密度（BMD）、骨矿物质含量（BMC）和横截面积（CSA）。
妊娠早期、产后和脐带血中 S-25-OHD 的平均值分别为 41.0（13.6）、45.1（11.9）和 50.7（14.9）nmol/L。第一孕期和产后 2 天的个体平均值中位数为 42.6 nmol/L，以此作为定义两个相等大小组别的截止值。组在文本中分别称为中位数以下和中位数以上。中位数以下组的新生儿体重较重（P=0.05），且 60%为男孩。胫骨骨矿物质含量高 0.047（95%置信区间，0.011-0.082）g/cm（P=0.01），横截面积大 12.3（95%置信区间，2.0-22.6）mm2（P=0.02），但两组间骨密度无差异。这些结果在调整新生儿出生体重 Z 分数、母亲身高和测量时新生儿年龄后得到校正。在不同时间点的母亲和脐带中的重塑标志物与中位数以上组呈正相关。
尽管母亲的维生素 D 总摄入量符合当前北欧的推荐量，但妊娠期间仍有 71%的女性和 15%的新生儿维生素 D 缺乏。我们的研究结果表明，母体维生素 D 状况会影响子宫内的骨矿物质积累，并影响骨骼大小。应加大力度修订孕妇的现行营养建议，这可能会对儿童的健康产生永久性影响。
