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维生素D缺乏与产前及产后抑郁之间的关联:一项纵向研究的系统评价与荟萃分析

Association between vitamin D deficiency and antepartum and postpartum depression: a systematic review and meta-analysis of longitudinal studies.

作者信息

Wang Jie, Liu Na, Sun Weijia, Chen Dandan, Zhao Jingxia, Zhang Wei

机构信息

School of Nursing, Jilin University, Changchun, China.

出版信息

Arch Gynecol Obstet. 2018 Dec;298(6):1045-1059. doi: 10.1007/s00404-018-4902-6. Epub 2018 Sep 27.

Abstract

PURPOSE

The two previous reviews performed on the association of vitamin D deficiency in pregnancy with antepartum and postpartum depression were limited in reporting forms as they were both systematic reviews and the conclusions were also deemed to be inconclusive. Considering the high prevalence of vitamin D deficiency and depression during and after pregnancy as well as their numerous hazards to pregnancy outcomes, it is of great need to synthesize existing evidence in a more accurate statistical method, so that reliable guidance related to vitamin D supplementation during pregnancy could be provided for clinical decision making.

METHODS

We performed a systematic review and meta-analysis to investigate the association of vitamin D deficiency with antepartum and postpartum depression.

RESULTS

Nine longitudinal studies with 8470 participants were included in the meta-analysis. We found serum 25(OH)D levels < 50 nmol/l was associated with 2.67 times (OR 3.67; 95% CI 1.72-7.85) increased risk of postpartum depression than those 25(OH)D levels ≥ 50 nmol/l, but we did not find a significant association between low vitamin D levels and depressive symptoms during pregnancy with a serum 25(OH)D cut-off level of 30 nmol/l (OR 1.47; 95% CI 0.92-2.36).

CONCLUSIONS

The low status of maternal vitamin D could be an adverse factor for postpartum depression, but the available evidence suggested no association between vitamin D deficiency and depressive symptoms during pregnancy. However, this result should be interpreted with caution owning to the small number of studies. Well-designed intervention studies are also needed to further evaluate the benefits of vitamin D supplementation during pregnancy.

摘要

目的

之前两项关于孕期维生素D缺乏与产前及产后抑郁关联的综述在报告形式上存在局限性,因为它们均为系统评价,且结论也被认为不明确。鉴于孕期及产后维生素D缺乏和抑郁的高患病率以及它们对妊娠结局的诸多危害,非常需要用更精确的统计方法综合现有证据,以便为临床决策提供关于孕期补充维生素D的可靠指导。

方法

我们进行了一项系统评价和荟萃分析,以研究维生素D缺乏与产前及产后抑郁的关联。

结果

荟萃分析纳入了9项纵向研究,共8470名参与者。我们发现,血清25(OH)D水平<50 nmol/l的产妇发生产后抑郁的风险比血清25(OH)D水平≥50 nmol/l的产妇高2.67倍(比值比3.67;95%置信区间1.72 - 7.85),但当血清25(OH)D临界值设定为30 nmol/l时,我们未发现孕期低维生素D水平与抑郁症状之间存在显著关联(比值比1.47;95%置信区间0.92 - 2.36)。

结论

母亲维生素D水平低可能是产后抑郁的一个不利因素,但现有证据表明维生素D缺乏与孕期抑郁症状之间无关联。然而,由于研究数量较少,对这一结果的解读应谨慎。还需要设计良好的干预研究来进一步评估孕期补充维生素D的益处。

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