维生素 D 补充剂、脐带 25-羟维生素 D 和出生体重：奥登塞儿童队列研究的结果。

Vitamin D supplementation, cord 25-hydroxyvitamin D and birth weight: Findings from the Odense Child Cohort.

机构信息

Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.

Institute of Molecular Medicine, Department of Cancer and Inflammation, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.

出版信息

Clin Nutr. 2017 Dec;36(6):1621-1627. doi: 10.1016/j.clnu.2016.10.008. Epub 2016 Oct 27.

DOI:10.1016/j.clnu.2016.10.008

PMID:27817876

Abstract

BACKGROUND & AIMS: Hypovitaminosis D, defined as serum 25-hydroxyvitamin D (s-25(OH)D) <50 nmol/L, is frequent in pregnant women and neonates worldwide and has been associated with both low birth weight (BW) and placental weight (PW) as well as reduced placental development. We aimed to assess the prevalence and the risk factors of cord vitamin D deficiency (s-25(OH)D <25 nmol/L) and insufficiency (s-25(OH)D 25-50 nmol/L) and to evaluate the association between cord s-25(OH)D levels and neonatal outcomes (BW, PW and PW/BW ratio).

METHODS

Women enrolled in Odense Child Cohort, a Danish observational prospective population-based cohort, who gave birth to singletons and donated a blood sample for s-25(OH)D measurements were included (n = 2082).

RESULTS

The prevalence of cord vitamin D deficiency was 16.7% and 41.0% for insufficiency. White skin, winter season at birth, maternal supplementation dose of <15 μg/day, non-western ethnicity and high body mass index (BMI) were identified as independent risk factors of both vitamin D deficiency and insufficiency. Adherence to the recommended vitamin D supplementation dose (10 μg/day) was reported by 87% (primipara 91% vs. multipara 81%, p < 0.0001). An U-shaped relationship between cord s-25(OH)D and BW was visualized by spline regression (p = 0.003). After adjustment, cord s-25(OH)D was positively associated with BW (β = 1.522, p = 0.026), PW (β = 0.927, p < 0.001) and PW/BW ratio (β = 0.018, p < 0.001), largely driven by positive associations for cord s-25(OH)D >60 nmol/L.

CONCLUSION

Cord hypovitaminosis D was present in 57.7%. Multipara was identified as a novel risk factor of non-adherence to vitamin D supplementation recommendations; and a maternal supplementation dose <15 μg/day as a novel, independent risk factor of cord hypovitaminosis D. Higher BW, PW, and PW/BW ratio were associated to higher cord s-25(OH)D levels with a suggested cut-off at 60 nmol/L. More studies are encouraged to elucidate the impact of cord s-25(OH)D levels on offspring health and to establish optimal cut-offs for these outcomes.

摘要

背景与目的

血清 25-羟维生素 D（s-25（OH）D）<50nmol/L 定义为维生素 D 缺乏症，在全世界范围内孕妇和新生儿中较为常见，与低出生体重（BW）和胎盘重量（PW）以及胎盘发育不良有关。我们旨在评估脐带维生素 D 缺乏症（s-25（OH）D<25nmol/L）和不足症（s-25（OH）D 25-50nmol/L）的患病率和危险因素，并评估脐带 s-25（OH）D 水平与新生儿结局（BW、PW 和 PW/BW 比值）之间的关系。

方法

纳入在丹麦观察性前瞻性基于人群的奥登塞儿童队列中分娩并捐献血液样本进行 s-25（OH）D 测量的单胎孕妇（n=2082）。

结果

脐带维生素 D 缺乏症的患病率为 16.7%，不足症的患病率为 41.0%。白皮、冬季出生、母亲补充剂量<15μg/天、非西方种族和高体重指数（BMI）被确定为维生素 D 缺乏症和不足症的独立危险因素。87%（初产妇 91%比经产妇 81%，p<0.0001）报告了推荐剂量（10μg/天）的维生素 D 补充剂。Spline 回归显示脐带 s-25（OH）D 与 BW 呈 U 型关系（p=0.003）。调整后，脐带 s-25（OH）D 与 BW（β=1.522，p=0.026）、PW（β=0.927，p<0.001）和 PW/BW 比值（β=0.018，p<0.001）呈正相关，这主要归因于脐带 s-25（OH）D>60nmol/L 与 BW、PW 和 PW/BW 比值的正相关。

结论

57.7%的新生儿存在脐带维生素 D 缺乏症。多产妇被确定为不遵守维生素 D 补充建议的新危险因素；而母亲的补充剂量<15μg/天则是脐带维生素 D 缺乏症的一个新的、独立的危险因素。较高的 BW、PW 和 PW/BW 比值与较高的脐带 s-25（OH）D 水平相关，建议以 60nmol/L 为截断值。鼓励开展更多的研究阐明脐带 s-25（OH）D 水平对后代健康的影响，并确定这些结果的最佳截断值。