Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK.
Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TG, UK.
Hum Reprod. 2018 Jan 1;33(1):65-80. doi: 10.1093/humrep/dex326.
Is serum vitamin D associated with live birth rates in women undergoing ART?
Women undergoing ART who are replete in vitamin D have a higher live birth rate than women who are vitamin D deficient or insufficient.
Vitamin D deficiency has been associated with an increased risk of abnormal pregnancy implantation as well as obstetric complications such as pre-eclampsia and fetal growth restriction. However, the effect of vitamin D on conception and early pregnancy outcomes in couples undergoing ART is poorly understood.
STUDY DESIGN, SIZE, DURATION: A systematic review and meta-analysis of 11 published cohort studies (including 2700 women) investigating the association between vitamin D and ART outcomes.
PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Literature searches were conducted to retrieve studies which reported on the association between vitamin D and ART outcomes. Databases searched included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL. Eleven studies matched the inclusion criteria.
Live birth was reported in seven of the included studies (including 2026 patients). Live birth was found to be more likely in women replete in vitamin D when compared to women with deficient or insufficient vitamin D status (OR 1.33 [1.08-1.65]). Five studies (including 1700 patients) found that women replete in vitamin D were more likely to achieve a positive pregnancy test than women deficient or insufficient in vitamin D (OR 1.34 ([1.04-1.73]). All 11 of the included studies (including 2700 patients) reported clinical pregnancy as an outcome. Clinical pregnancy was found to be more likely in women replete in vitamin D (OR 1.46 [1.05-2.02]). Six studies (including 1635 patients) reported miscarriage by vitamin D concentrations. There was no association found between miscarriage and vitamin D concentrations (OR 1.12 [0.81-1.54]. The included studies scored well on the Newcastle-Ottawa quality assessment scale.
Although strict inclusion criteria were used in the conduct of the systematic review, the included studies are heterogeneous in population characteristics and fertility treatment protocols.
The findings of this systematic review show that there is an association between vitamin D status and reproductive treatment outcomes achieved in women undergoing ART. Our results show that vitamin D deficiency and insufficiency could be important conditions to treat in women considering ARTs. A randomized controlled trial to investigate the benefits of vitamin D deficiency treatment should be considered to test this hypothesis.
STUDY FUNDING/COMPETING INTERESTS: No external funding was either sought or obtained for this study. The authors have no competing interests to declare.
N/A.
血清维生素 D 与接受辅助生殖技术（ART）的女性活产率有关吗？
维生素 D 充足的接受 ART 的女性比维生素 D 缺乏或不足的女性活产率更高。
维生素 D 缺乏与妊娠着床异常以及子痫前期和胎儿生长受限等产科并发症的风险增加有关。然而，维生素 D 对接受 ART 的夫妇的受孕和早期妊娠结局的影响尚不清楚。
研究设计、大小和持续时间：对 11 项已发表的队列研究（包括 2700 名女性）进行系统评价和荟萃分析，以调查维生素 D 与 ART 结果之间的关系。
参与者/材料、设置、方法：进行文献检索以检索报告维生素 D 与 ART 结果之间关系的研究。检索的数据库包括 MEDLINE、EMBASE、Cochrane 对照试验中心注册库和 CINAHL。11 项研究符合纳入标准。
纳入的研究中有 7 项报告了活产（包括 2026 名患者）。与维生素 D 缺乏或不足的女性相比，维生素 D 充足的女性更有可能活产（OR 1.33 [1.08-1.65]）。5 项研究（包括 1700 名患者）发现，维生素 D 充足的女性比维生素 D 缺乏或不足的女性更有可能出现妊娠阳性试验（OR 1.34 [1.04-1.73]）。纳入的 11 项研究（包括 2700 名患者）均报告了临床妊娠作为结局。与维生素 D 缺乏或不足的女性相比，维生素 D 充足的女性更有可能出现临床妊娠（OR 1.46 [1.05-2.02]）。纳入的 6 项研究（包括 1635 名患者）报告了按维生素 D 浓度发生的流产。流产与维生素 D 浓度之间无关联（OR 1.12 [0.81-1.54]）。纳入的研究在纽卡斯尔-渥太华质量评估量表上得分较高。
局限性/谨慎的原因：尽管在进行系统评价时使用了严格的纳入标准，但纳入的研究在人群特征和生育治疗方案方面存在异质性。
这项系统评价的结果表明，维生素 D 状态与接受辅助生殖技术的女性的生殖治疗结局之间存在关联。我们的研究结果表明，维生素 D 缺乏和不足可能是接受 ARTs 的女性需要治疗的重要条件。应考虑进行随机对照试验来研究维生素 D 缺乏治疗的益处，以检验这一假设。
研究资助/利益冲突：本研究未寻求或获得外部资金。作者没有利益冲突需要申报。
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