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.
Am J Clin Nutr. 2018 Oct 1;108(4):821-829. doi: 10.1093/ajcn/nqy150.
Associations of vitamin D with perinatal outcomes are inconsistent and few studies have considered the wider calcium metabolic system.
We aimed to explore functional vitamin D deficiency in pregnancy by investigating associations between vitamin D status, parathyroid hormone (PTH), and perinatal outcomes.
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.
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).
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.
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。
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。
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。
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。
在妊娠维生素 D 研究中，应考虑反映钙代谢应激的功能性维生素 D 缺乏概念。SCOPE 妊娠队列在 http://www.anzctr.org.au 注册，注册号为 ACTRN12607000551493。
