Dodds Linda, Woolcott Christy G, Weiler Hope, Spencer Anne, Forest Jean-Claude, Armson B Anthony, Giguère Yves
Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University and IWK Health Centre, Halifax, NS, Canada.
School of Dietetics and Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada.
Paediatr Perinat Epidemiol. 2016 May;30(3):229-37. doi: 10.1111/ppe.12278. Epub 2016 Feb 5.
Vitamin D status, as measured by serum 25-hydroxyvitamin D (25(OH)D), has been shown in some studies to be inversely associated with gestational diabetes risk. Recently, it has been suggested that maternal smoking status may modify this relationship. We explored the association between 25(OH)D concentration and gestational diabetes and determined if there was an interaction between smoking and 25(OH)D.
A nested case-control study was conducted in Halifax, Nova Scotia and Quebec City, Quebec. Women were recruited before 20 weeks gestation and 25(OH)D was measured. Cases were women who developed gestational diabetes and controls were frequency matched to cases on study site, gestational age at blood draw, and season and year of blood draw. Logistic regression models estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI). Models were tested for multiplicative and additive interaction, which was estimated by relative excess risk due to interaction (RERI).
The study included 395 gestational diabetes cases and 1925 controls. Women who smoked during pregnancy and had 25(OH)D concentrations <30 nmol/L had an aOR = 3.73 [95% CI 1.95, 7.14] compared to non-smokers with 25(OH)D concentrations ≥50 nmol/L. Additive interaction was detected between smoking status and 25(OH)D [RERI = 2.44, 95% CI 0.03, 4.85].
Our study supports the inverse association of vitamin D status with gestational diabetes risk, particularly among women who smoke during pregnancy. More research is needed to confirm this finding and, if confirmed, to determine the mechanism by which the combined effect of smoking and low vitamin D status increases the risk of developing gestational diabetes.
一些研究表明，血清25-羟基维生素D（25(OH)D）所测定的维生素D状态与妊娠期糖尿病风险呈负相关。最近，有人提出母亲的吸烟状态可能会改变这种关系。我们探讨了25(OH)D浓度与妊娠期糖尿病之间的关联，并确定吸烟与25(OH)D之间是否存在相互作用。
在新斯科舍省哈利法克斯市和魁北克省魁北克市进行了一项巢式病例对照研究。在妊娠20周前招募妇女并测量25(OH)D。病例为患妊娠期糖尿病的妇女，对照按研究地点、采血时的孕周以及采血季节和年份与病例进行频率匹配。逻辑回归模型估计调整后的比值比（aOR）和95%置信区间（CI）。对模型进行乘法和加法相互作用检验，通过相互作用引起的相对超额风险（RERI）进行估计。
该研究包括395例妊娠期糖尿病病例和1925例对照。孕期吸烟且25(OH)D浓度<30 nmol/L的妇女与25(OH)D浓度≥50 nmol/L的非吸烟者相比，aOR = 3.73 [95% CI 1.95, 7.14]。在吸烟状态和25(OH)D之间检测到加法相互作用[RERI = 2.44, 95% CI 0.03, 4.85]。
我们的研究支持维生素D状态与妊娠期糖尿病风险呈负相关，特别是在孕期吸烟的妇女中。需要更多研究来证实这一发现，如果得到证实，则需确定吸烟和低维生素D状态的联合作用增加妊娠期糖尿病发生风险的机制。
