Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
BMC Pregnancy Childbirth. 2018 Jun 20;18(1):251. doi: 10.1186/s12884-018-1887-x.
Pregnant women are at increased susceptibility to vitamin D deficiency. Hence, there is continuing interest in determining how vitamin D influences pregnancy health. We aimed to compare vitamin D status in two distinct populations of pregnant women in Australia and New Zealand and to investigate the relationship between vitamin D status and pregnancy outcome. This included evaluating possible effect measure modifications according to fetal sex.
Serum 25-hydroxy vitamin D (25(OH)D) was measured at 15 ± 1 weeks' gestation in 2800 women from Adelaide and Auckland who participated in the multi-centre, prospective cohort SCreening fOr Pregnancy Endpoints (SCOPE) study.
Mean serum 25(OH)D in all women was 68.1 ± 27.1 nmol/L and 28% (n = 772) were considered vitamin D deficient (< 50 nmol/L). Serum 25(OH)D was lower in the women recruited in Adelaide when compared to the women recruited in Auckland and remained lower after adjusting for covariates including maternal body mass index and socioeconomic index (Adelaide: 58.4 ± 50.3 vs. Auckland: 70.2 ± 54.5 nmol/L, P < 0.001). A 53% decreased risk for gestational diabetes mellitus (GDM) was observed with high (> 81 nmol/L) "standardised" vitamin D status when compared to moderate-high (63-81 nmol/L, aRR, 0.47; 95% CI: 0.23, 0.96). Marginal sex-specific differences occurred between vitamin D status and GDM: women carrying a female fetus had a 56% decreased risk for GDM in those with low-moderate levels of standardised vitamin D (44-63 nmol/L) compared to moderate-high levels (aRR: 0.44; 95% CI: 0.20, 0.97), whilst in women carrying a male fetus, a 55% decreased risk of GDM was found with high standardised vitamin D when compared to moderately-high vitamin D, but this was not statistically significant (aRR: 0.45; 95% CI: 0.15, 1.38).
High serum 25(OH)D at 15 ± 1 weeks' gestation was shown to be protective against the development of GDM. A possible association between fetal sex, vitamin D status and GDM provides further questions and encourages continual research and discussion into the role of vitamin D in pregnancy, particularly in vitamin D replete populations.
孕妇对维生素 D 缺乏的易感性增加。因此，人们一直对维生素 D 如何影响妊娠健康感兴趣。我们旨在比较澳大利亚和新西兰两个不同孕妇群体的维生素 D 状况，并研究维生素 D 状况与妊娠结局之间的关系。这包括根据胎儿性别评估可能的效应修正。
在多中心前瞻性队列研究 SCreening fOr Pregnancy Endpoints (SCOPE)中，对来自阿德莱德和奥克兰的 2800 名孕妇在 15±1 周妊娠时测量血清 25-羟维生素 D (25(OH)D)。
所有女性的平均血清 25(OH)D 为 68.1±27.1 nmol/L，28%（n=772）被认为是维生素 D 缺乏（<50 nmol/L）。与在奥克兰招募的女性相比，在阿德莱德招募的女性血清 25(OH)D 水平较低，调整了包括母体体重指数和社会经济指数在内的协变量后仍然较低（阿德莱德：58.4±50.3 与奥克兰：70.2±54.5 nmol/L，P<0.001）。与中高水平（63-81 nmol/L，aRR，0.47；95%CI：0.23，0.96）相比，高（>81 nmol/L）“标准化”维生素 D 状态时，妊娠期糖尿病（GDM）的风险降低 53%。维生素 D 状态与 GDM 之间出现了边际性别特异性差异：在低-中水平标准化维生素 D（44-63 nmol/L）的女性中，携带女性胎儿的 GDM 风险降低 56%，与中高水平（aRR：0.44；95%CI：0.20，0.97）相比，而携带男性胎儿的女性，高标准化维生素 D 与中高水平维生素 D 相比，GDM 的风险降低 55%，但这并不具有统计学意义（aRR：0.45；95%CI：0.15，1.38）。
15±1 周妊娠时血清 25(OH)D 水平较高可预防 GDM 的发生。胎儿性别、维生素 D 状态与 GDM 之间的可能关联提出了进一步的问题，并鼓励对维生素 D 在妊娠中的作用，特别是在维生素 D 充足的人群中，进行持续的研究和讨论。
