Hans Christian Andersen Children's Hospital, Odense University Hospital, J. B. Windsløws Vej 4, 5000, Odense C, Denmark.
Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 3, 5000, Odense C, Denmark.
J Bone Miner Metab. 2018 Nov;36(6):700-709. doi: 10.1007/s00774-017-0881-0. Epub 2017 Nov 11.
Skull changes are poorly described in vitamin D insufficiency [serum 25-hydroxyvitamin D (s-25(OH)D) 25-50 nmol/L]. We aimed to investigate factors associated with cranial anthropometrics in infants, especially s-25(OH)D. In infants 2.5-6 months old from the Odense Child Cohort, associations between cord and pregnancy s-25(OH)D and anterior fontanel area (n = 765), head circumference (HC, n = 1776) and head shape (n = 1527) were investigated along with other factors. Age was corrected for preterm birth. The mean (SD) s-25(OH)D in early pregnancy was 65.97 (21.33) nmol/L; late pregnancy 78.61 (27.18) nmol/L; and cord 47.1 (21.7) nmol/L. At median (IQR) age 3.7 (2.5-5.9) months, the fontanel area was 225 (0-1690) mm, and mean (SD) HC was 41.5 (1.5) cm. Asymmetric/flat head shape was present in 846 infants (55.3%). No associations were found between cord, early or late pregnancy s-25(OH)D and any cranial measure by univariate or adjusted analysis. Among significant, independent associations in multivariate analysis, fontanel area was associated inversely with gestational age (GA); HC was associated directly with GA, maternal pre-pregnancy overweight and caesarean section and inversely with smoking; and asymmetrical head shape showed a novel association with male sex: adjusted OR = 1.54 (95% CI 1.25; 1.89), p < 0.001. Other associations with asymmetrical head shape included parity 3+, gestational age and maternal age 30+ years (all protective). In conclusion, neither pregnancy nor cord s-25(OH)D was associated with fontanel size, HC or asymmetrical head shape despite a high prevalence of cord s-25(OH)D < 50 nmol/L. Lower GA was associated with larger fontanel size, lower HC and asymmetrical head shape, and boys more frequently had asymmetrical head shape, probably due to heavier heads.
颅骨变化在维生素 D 不足[血清 25-羟维生素 D（s-25（OH）D）25-50 nmol/L]中描述不佳。我们旨在研究与婴儿颅面形态相关的因素，特别是 s-25（OH）D。在奥登塞儿童队列中 2.5-6 个月大的婴儿中，我们调查了脐带和妊娠 s-25（OH）D 与前囟面积（n=765）、头围（HC，n=1776）和头型（n=1527）之间的关系，同时还调查了其他因素。对于早产，年龄进行了校正。妊娠早期 s-25（OH）D 的平均值（SD）为 65.97（21.33）nmol/L；妊娠晚期为 78.61（27.18）nmol/L；脐带血为 47.1（21.7）nmol/L。中位（IQR）年龄为 3.7（2.5-5.9）个月，前囟面积为 225（0-1690）mm，平均（SD）头围为 41.5（1.5）cm。846 名婴儿（55.3%）存在不对称/扁平头型。单变量或调整后的分析均未发现脐带、妊娠早期或晚期 s-25（OH）D 与任何颅面测量值之间存在相关性。在多元分析中，有显著的独立相关性，前囟面积与胎龄（GA）呈负相关；HC 与 GA、产妇孕前超重、剖宫产和吸烟呈负相关，与男性呈正相关；不对称头型与男性呈新的关联：调整后的比值比（OR）为 1.54（95%可信区间 1.25；1.89），p<0.001。与不对称头型相关的其他因素包括产次 3 次以上、GA 和产妇年龄 30 岁以上（均为保护因素）。总之，尽管脐带血 s-25（OH）D<50 nmol/L 的发生率很高，但妊娠或脐带血 s-25（OH）D 与前囟大小、HC 或不对称头型均无相关性。GA 较低与较大的前囟面积、较低的 HC 和不对称头型相关，男孩头型不对称的发生率较高，可能是由于头部较重。
