孕妇补充维生素D的产科和新生儿结局：巴基斯坦女性产前补充维生素D的开放标签随机对照试验结果
Obstetric and neonatal outcomes of maternal vitamin D supplementation: results of an open-label, randomized controlled trial of antenatal vitamin D supplementation in Pakistani women.
作者信息
Hossain Nazli, Kanani Fatima H, Ramzan Shabana, Kausar Robina, Ayaz Shabana, Khanani Rafiq, Pal Lubna
机构信息
Department of Obstetrics and Gynecology Unit II (N.H., S.R., R.K., S.A.), and Department of Pathology and Microbiology (R.K., F.H.K.), Dow Diagnostics and Reference Laboratory, Dow International Medical College, Dow University of Health Sciences, Dow University of Health Sciences, Karachi 74200, Pakistan; Program for Polycystic Ovarian Syndrome (L.P), Program for Reproductive Aging and Bone Health (L.P.), and Yale Reproductive Endocrinology, Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P.), Yale University School of Medicine, New Haven, Connecticut 06520.
出版信息
J Clin Endocrinol Metab. 2014 Jul;99(7):2448-55. doi: 10.1210/jc.2013-3491. Epub 2014 Mar 19.
OBJECTIVE
The objective of the study was to determine whether vitamin D (vitD) supplementation during pregnancy affects obstetric and neonatal outcomes.
SETTING
The study was conducted at a university hospital in Karachi, Pakistan.
METHODS
The study was a single-center, open-label, randomized, controlled trial of routine care (group A, 200 mg ferrous sulfate and 600 mg calcium daily) vs vitD supplementation (group B, 4000 IU vitamin D3 daily), started at 20 weeks and continued till delivery. Maternal serum samples of 25-hydroxyvitamin D (25OHD) were collected at baseline and delivery. Neonatal vitD status was assessed in cord blood or in neonatal serum samples within 48 hours of birth. Obstetric outcomes included gestational hypertension, gestational diabetes, and preterm labor, and neonatal well-being included small for gestational age, birth weight, length, head circumference, and 1- and 5-minute Apgar scores.
RESULTS
Of 207 gravidae enrolled, 193 completed the trial. Maternal age, vitD status, and gestational age at enrollment were comparable between the two groups. At delivery, maternal 25OHD was increased in group B (18.3 ± 11 ng/dL vs 8.82 ± 11.84 ng/dL (P = .001) compared with group A (6.9 ± 7.0 ng/dL vs 6.32 ± 3.97 ng/dL, P = .06). The obstetric outcomes were comparable between the two groups (P > .05). Neonatal 25OHD levels were significantly higher in group B compared with group A (19.22 ± 12.19 ng/dL vs 6.27 ± 5.2 ng/dL). There was positive correlation between maternal and neonatal 25OHD levels (r = 0.83, P = .001). One- and 5-minute Apgar scores were significantly higher in group B (7.10 ± 0.66 vs 6.90 ± 0.50, P = .026, and 8.53 ± 0.68 vs 8.33 ± 0.81, P = .051, respectively). Neonatal anthropometric parameters were comparable between the two groups (P > .05).
CONCLUSION
Maternal vitD supplementation improved maternal and neonatal vitD status.
目的
本研究的目的是确定孕期补充维生素D（vitD）是否会影响产科和新生儿结局。
背景
本研究在巴基斯坦卡拉奇的一家大学医院进行。
方法
本研究是一项单中心、开放标签、随机对照试验，比较常规护理（A组，每日200毫克硫酸亚铁和600毫克钙）与补充vitD（B组，每日4000国际单位维生素D3），从孕20周开始持续至分娩。在基线和分娩时采集孕妇25-羟维生素D（25OHD）的血清样本。在出生后48小时内采集脐带血或新生儿血清样本评估新生儿vitD状态。产科结局包括妊娠期高血压、妊娠期糖尿病和早产，新生儿健康状况包括小于胎龄儿、出生体重、身长、头围以及1分钟和5分钟阿氏评分。
结果
207名孕妇入组，193名完成试验。两组孕妇的年龄、vitD状态和入组时的孕周具有可比性。分娩时，B组孕妇的25OHD水平升高（18.3±11纳克/分升，而A组为8.82±11.84纳克/分升（P = 0.001））（6.9±7.0纳克/分升对6.32±3.97纳克/分升，P = 0.06）。两组的产科结局具有可比性（P>0.05）。B组新生儿的25OHD水平显著高于A组（19.22±12.19纳克/分升对6.27±5.2纳克/分升）。孕妇和新生儿的25OHD水平呈正相关（r = 0.83，P = 0.001）。B组1分钟和5分钟阿氏评分显著更高（分别为7.10±0.66对6.90±0.50，P = 0.026；8.53±0.68对8.33±0.81，P = 0.051）。两组新生儿人体测量参数具有可比性（P>0.05）。
结论
孕妇补充vitD可改善孕妇和新生儿的vitD状态。
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