探讨妊娠功能性维生素 D 缺乏的概念：25-羟维生素 D 与甲状旁腺激素相互作用对围产结局的影响。

Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes.

机构信息

Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.

The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.

出版信息

Am J Clin Nutr. 2018 Oct 1;108(4):821-829. doi: 10.1093/ajcn/nqy150.

DOI:10.1093/ajcn/nqy150

PMID:30169726

Abstract

BACKGROUND

Associations of vitamin D with perinatal outcomes are inconsistent and few studies have considered the wider calcium metabolic system.

OBJECTIVES

We aimed to explore functional vitamin D deficiency in pregnancy by investigating associations between vitamin D status, parathyroid hormone (PTH), and perinatal outcomes.

DESIGN

SCOPE (Screening for Pregnancy Endpoints) Ireland is a prospective cohort study of low-risk, nulliparous pregnant women. We measured serum 25-hydroxyvitamin D [25(OH)D] and PTH at 15 wk of gestation in 1754 participants.

RESULTS

Mean ± SD 25(OH)D was 56.6 ± 25.8 nmol/L (22.7 ± 10.3 ng/mL) and geometric mean (95% CI) PTH was 7.84 pg/mL (7.7, 8.0 pg/mL) [0.86 pmol/L (0.85, 0.88 pmol/L)]. PTH was elevated in 34.3% of women who had 25(OH)D <30 nmol/L and in 13.9% of those with 25(OH)D ≥75 nmol/L. Whereas 17% had 25(OH)D <30 nmol/L, 5.5% had functional vitamin D deficiency, defined as 25(OH)D <30 nmol/L with elevated PTH. Elevated mean arterial pressure (MAP), gestational hypertension, pre-eclampsia, and small-for-gestational-age (SGA) birth were confirmed in 9.2%, 11.9%, 3.8%, and 10.6% of participants, respectively. In fully adjusted regression models, neither low 25(OH)D nor elevated PTH alone increased the risk of any individual outcome. The prevalence of elevated MAP (19.1% compared with 9.7%) and SGA (16.0% compared with 6.7%) were highest (P < 0.05) in those with functional vitamin D deficiency compared with the reference group [25(OH)D ≥75 nmol/L and normal PTH]. The adjusted prevalence ratio (PR) and RR (95% CIs) for elevated MAP and SGA were 1.83 (1.02, 3.27) and 1.53 (0.80, 2.93), respectively. There was no effect of functional vitamin D deficiency on the risk of gestational hypertension (adjusted RR: 1.00; 95% CI: 0.60, 1.67) or pre-eclampsia (adjusted RR: 1.17; 95% CI: 0.32, 4.20).

CONCLUSION

The concept of functional vitamin D deficiency, reflecting calcium metabolic stress, should be considered in studies of vitamin D in pregnancy. The SCOPE pregnancy cohort is registered at http://www.anzctr.org.au as ACTRN12607000551493.

摘要

背景

维生素 D 与围产期结局的相关性不一致，并且很少有研究考虑更广泛的钙代谢系统。

目的

我们旨在通过研究维生素 D 状态、甲状旁腺激素 (PTH) 与围产期结局之间的关系，来探讨妊娠期间功能性维生素 D 缺乏症。

设计

SCOPE（妊娠终点筛查）爱尔兰是一项针对低危、初产妇的前瞻性队列研究。我们在 1754 名参与者妊娠 15 周时测量了血清 25-羟维生素 D [25(OH)D] 和 PTH。

结果

平均 ± 标准差 25(OH)D 为 56.6 ± 25.8 nmol/L（22.7 ± 10.3 ng/mL），几何平均值（95%CI）PTH 为 7.84 pg/mL（7.7，8.0 pg/mL）[0.86 pmol/L（0.85，0.88 pmol/L）]。25(OH)D <30 nmol/L 的女性中，34.3%的 PTH 升高，25(OH)D ≥75 nmol/L 的女性中，13.9%的 PTH 升高。17%的人 25(OH)D <30 nmol/L，5.5%的人存在功能性维生素 D 缺乏，定义为 25(OH)D <30 nmol/L 伴 PTH 升高。平均动脉压 (MAP) 升高、妊娠期高血压、子痫前期和胎儿生长受限 (SGA) 的发生率分别为 9.2%、11.9%、3.8%和 10.6%。在完全调整的回归模型中，低 25(OH)D 或单独升高的 PTH 均未增加任何单一结局的风险。与参考组 [25(OH)D ≥75 nmol/L 和正常 PTH] 相比，功能性维生素 D 缺乏症患者 MAP 升高（19.1%比 9.7%）和 SGA（16.0%比 6.7%）的患病率最高（P < 0.05）。MAP 升高和 SGA 的调整后患病率比（PR）和相对危险度（RR）（95%CI）分别为 1.83（1.02，3.27）和 1.53（0.80，2.93）。功能性维生素 D 缺乏症对妊娠期高血压（调整 RR：1.00；95%CI：0.60，1.67）或子痫前期（调整 RR：1.17；95%CI：0.32，4.20）的风险没有影响。