Galthen-Sørensen M, Andersen L B, Sperling L, Christesen H T
Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Ultrasound Obstet Gynecol. 2014 Dec;44(6):633-40. doi: 10.1002/uog.13431.
To assess systematically the role of maternal vitamin D levels in fetal bone growth.
PubMed, EMBASE and Cochrane databases were searched using the search words [Vitamin D] in combination with [fetal, fetus, intrauterine, or prenatal AND growth, development, bone, femur, or humerus]; [crown-rump length]; or [ultrasonography, prenatal]. Criteria for inclusion in this systematic review were data on maternal serum 25-hydroxyvitamin D (25(OH)D) during pregnancy and measurement of fetal growth by ultrasound.
We identified 750 publications initially, from which five observational studies were selected for inclusion in the final review. The parameters studied were humerus length (HL) and femur length (FL) and their Z-scores, femoral volume, femoral distal metaphyseal cross-sectional area (CSA), femoral proximal metaphyseal diameter (PMD), femoral mid-shaft diameter and crown-rump length. In one study, 25(OH)D was associated directly with FL; in another study 25(OH)D only correlated with FL and HL Z-scores when calcium intake was insufficient. Two studies found no association between 25(OH)D and FL, but detected a direct association with femoral PMD, and an inverse relation with femoral distal metaphyseal CSA, respectively.
Observational studies investigating the role of maternal vitamin D levels in fetal bone growth are sparse. Their evidence suggests that low maternal 25(OH)D levels may affect fetal bone growth under certain circumstances, especially in cases of simultaneous low calcium intake. Further studies are necessary.
系统评估母体维生素D水平在胎儿骨骼生长中的作用。
使用检索词[维生素D]与[胎儿、胎儿期、子宫内或产前以及生长、发育、骨骼、股骨或肱骨]；[顶臀长度]；或[超声检查、产前]组合在PubMed、EMBASE和Cochrane数据库中进行检索。纳入本系统评价的标准是孕期母体血清25-羟维生素D（25(OH)D）的数据以及通过超声测量胎儿生长情况。
我们最初识别出750篇出版物，从中选择了五项观察性研究纳入最终评价。所研究的参数包括肱骨长度（HL）和股骨长度（FL）及其Z评分、股骨体积、股骨远端干骺端横截面积（CSA）、股骨近端干骺端直径（PMD）、股骨干中轴直径和顶臀长度。在一项研究中，25(OH)D与FL直接相关；在另一项研究中，仅当钙摄入量不足时，25(OH)D才与FL和HL Z评分相关。两项研究发现25(OH)D与FL之间无关联，但分别检测到与股骨PMD直接相关以及与股骨远端干骺端CSA呈负相关。
关于母体维生素D水平在胎儿骨骼生长中作用的观察性研究较少。现有证据表明，母体25(OH)D水平较低在某些情况下可能会影响胎儿骨骼生长，尤其是在同时钙摄入量较低的情况下。有必要进行进一步研究。
