Koster M P H, van Duijn L, Krul-Poel Y H M, Laven J S, Helbing W A, Simsek S, Steegers-Theunissen R P M
Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands.
Department of Internal Medicine, Medical Centre Alkmaar, PO Box 501, 1800AM Alkmaar, The Netherlands.
Early Hum Dev. 2018 Feb;117:50-56. doi: 10.1016/j.earlhumdev.2017.12.011. Epub 2017 Dec 27.
Interactions between genetic and environmental factors, including modifiable maternal nutrition and lifestyle, play a significant role in the pathogenesis of most congenital heart defects (CHD). The aim of this study was to investigate associations between periconceptional maternal vitamin D status and the prevalence of CHD in offspring.
A case-control study was performed in 345 mothers of a child with CHD and 432 mothers of a child without CHD from four tertiary hospitals in the Netherlands between 2003 and 2005. Approximately 15months after pregnancy mothers filled out questionnaires regarding general characteristics and periconceptional lifestyle. Maternal blood was obtained to determine serum 25-hydroxyvitamin D and lipid concentrations. The 25-hydroxyvitamin D concentration was stratified into a deficient <50nmol/l, moderate 50-75nmol/l and adequate >75nmol/l status. Logistic regression was performed to study associations between vitamin D status and CHD risk, adjusted for maternal age, body mass index, ethnicity, smoking and total cholesterol concentration.
Case mothers less often had an adequate vitamin D status compared with controls (27% vs. 38%; p=0.002). The use of multivitamin supplements, ethnicity, season and body mass index were associated with vitamin D concentrations. A moderate (odds ratio 1.58, [95%CI 1.08, 2.32]) and deficient (odds ratio 2.15, [95%CI 1.44-3.19]) vitamin D status were associated with CHD in offspring.
A compromised maternal vitamin D status is associated with an approximately two-fold increased prevalence of CHD in offspring. Therefore, improvement of the periconceptional maternal vitamin D status is recommended.
遗传因素与环境因素之间的相互作用，包括可改变的母体营养和生活方式，在大多数先天性心脏病（CHD）的发病机制中起着重要作用。本研究的目的是调查受孕前母体维生素D状态与后代CHD患病率之间的关联。
2003年至2005年期间，在荷兰四家三级医院对345名患有CHD儿童的母亲和432名未患有CHD儿童的母亲进行了病例对照研究。妊娠后约15个月，母亲们填写了关于一般特征和受孕前生活方式的问卷。采集母体血液以测定血清25-羟基维生素D和脂质浓度。25-羟基维生素D浓度被分层为缺乏（<50nmol/l）、中等（50-75nmol/l）和充足（>75nmol/l）状态。进行逻辑回归分析以研究维生素D状态与CHD风险之间的关联，并对母亲年龄、体重指数、种族、吸烟和总胆固醇浓度进行了调整。
与对照组相比，病例组母亲维生素D状态充足的情况较少（27%对38%；p=0.002）。多种维生素补充剂的使用、种族、季节和体重指数与维生素D浓度相关。中等（优势比1.58，[95%置信区间1.08，2.32]）和缺乏（优势比2.15，[95%置信区间1.44-3.19]）的维生素D状态与后代CHD相关。
母体维生素D状态受损与后代CHD患病率增加约两倍相关。因此，建议改善受孕前母体维生素D状态。
