From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital - all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh.
N Engl J Med. 2018 Aug 9;379(6):535-546. doi: 10.1056/NEJMoa1800927.
It is unclear whether maternal vitamin D supplementation during pregnancy and lactation improves fetal and infant growth in regions where vitamin D deficiency is common.
We conducted a randomized, double-blind, placebo-controlled trial in Bangladesh to assess the effects of weekly prenatal vitamin D supplementation (from 17 to 24 weeks of gestation until birth) and postpartum vitamin D supplementation on the primary outcome of infants' length-for-age z scores at 1 year according to World Health Organization (WHO) child growth standards. One group received neither prenatal nor postpartum vitamin D (placebo group). Three groups received prenatal supplementation only, in doses of 4200 IU (prenatal 4200 group), 16,800 IU (prenatal 16,800 group), and 28,000 IU (prenatal 28,000 group). The fifth group received prenatal supplementation as well as 26 weeks of postpartum supplementation in the amount of 28,000 IU (prenatal and postpartum 28,000 group).
Among 1164 infants assessed at 1 year of age (89.5% of 1300 pregnancies), there were no significant differences across groups in the mean (±SD) length-for-age z scores. Scores were as follows: placebo, -0.93±1.05; prenatal 4200, -1.11±1.12; prenatal 16,800, -0.97±0.97; prenatal 28,000, -1.06±1.07; and prenatal and postpartum 28,000, -0.94±1.00 (P=0.23 for a global test of differences across groups). Other anthropometric measures, birth outcomes, and morbidity did not differ significantly across groups. Vitamin D supplementation had expected effects on maternal and infant serum 25-hydroxyvitamin D and calcium concentrations, maternal urinary calcium excretion, and maternal parathyroid hormone concentrations. There were no significant differences in the frequencies of adverse events across groups, with the exception of a higher rate of possible hypercalciuria among the women receiving the highest dose.
In a population with widespread prenatal vitamin D deficiency and fetal and infant growth restriction, maternal vitamin D supplementation from midpregnancy until birth or until 6 months post partum did not improve fetal or infant growth. (Funded by the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT01924013 .).
在维生素 D 缺乏普遍的地区，孕妇和哺乳期补充维生素 D 是否能改善胎儿和婴儿的生长情况尚不清楚。
我们在孟加拉国开展了一项随机、双盲、安慰剂对照试验，评估了孕妇每周补充维生素 D（从妊娠 17 至 24 周持续至分娩）以及产后补充维生素 D 对主要结局的影响，主要结局是根据世界卫生组织（WHO）儿童生长标准评估婴儿 1 岁时的身长别年龄 Z 评分。一组既不接受产前也不接受产后维生素 D（安慰剂组）。三组仅接受产前补充，剂量分别为 4200IU（产前 4200 组）、16800IU（产前 16800 组）和 28000IU（产前 28000 组）。第五组在接受 28000IU 产前补充的同时还接受 26 周产后补充（产前和产后 28000 组）。
在 1164 名 1 岁婴儿中（1300 例妊娠的 89.5%），各组的平均（±SD）身长别年龄 Z 评分无显著差异。评分结果如下：安慰剂组-0.93±1.05；产前 4200 组-1.11±1.12；产前 16800 组-0.97±0.97；产前 28000 组-1.06±1.07；产前和产后 28000 组-0.94±1.00（组间差异的总体检验 P=0.23）。各组间其他人体测量指标、分娩结局和发病率无显著差异。维生素 D 补充对产妇和婴儿血清 25-羟维生素 D 和钙浓度、产妇尿钙排泄以及产妇甲状旁腺激素浓度有预期作用。各组间不良事件的发生频率无显著差异，但接受最高剂量的妇女发生高钙尿症的频率较高。
在孕妇普遍存在维生素 D 缺乏以及胎儿和婴儿生长受限的人群中，从中孕期至分娩或产后 6 个月补充维生素 D 并不能改善胎儿或婴儿的生长情况。（由比尔及梅琳达·盖茨基金会资助；临床试验.gov 注册号，NCT01924013）。
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