Department of Obstetrics and Gynecology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, Clamart, France; Fondation PremUp, Paris, France.
URC/CIC Paris Descartes Necker Cochin, Necker-Enfants Malades Hospital, AP-HP, Paris, France.
Clin Nutr. 2020 Feb;39(2):440-446. doi: 10.1016/j.clnu.2019.02.015. Epub 2019 Feb 15.
BACKGROUND & AIMS: Vitamin D is thought to be involved in the pathogenesis of preeclampsia. To evaluate the relationship between vitamin D insufficiency in the first trimester of pregnancy and preeclampsia.
Nested case-control study (FEPED study) in type 3 obstetrical units. Pregnant women from 10 to 15 WA. For each patient with preeclampsia, 4 controls were selected from the cohort and matched by parity, skin color, maternal age, season and BMI. The main outcome measure was serum 25(OH)D status in the first trimester.
83 cases of preeclampsia were matched with 319 controls. Mean 25(OH)D levels in the first trimester were 20.1 ± 9.3 ng/mL in cases and 22.3 ± 11.1 ng/mL in controls (p = 0.09). The risk for preeclampsia with 25(OH)D level ≥30 ng/mL in the first trimester was decreased, but did not achieve statistical significance (OR, 0.57; 95% CI, 0.30-1.01; p = 0.09). High 25(OH)D during the 3rd trimester was associated with a significantly decreased risk of preeclampsia (OR, 0.43; 95%CI, 0.23-0.80; p = 0.008). When women with 25(OH)D levels <30 ng/mL both in the first and 3rd trimesters ("low-low") were taken as references, OR for preeclampsia was 0.59 (95% CI, 0.31-1.14; p = 0.12) for "low-high" or "high-low" women and 0.34 (95% CI, 0.13-0.86; p = 0.02) for "high-high" women.
No significant association between preeclampsia and vitamin D insufficiency in the first trimester was evidenced. However, women with vitamin D sufficiency during the 3rd trimester and both in the first and 3rd trimesters had a significantly lower risk of preeclampsia.
维生素 D 被认为与子痫前期的发病机制有关。评估妊娠早期维生素 D 不足与子痫前期的关系。
在 3 类产科单位进行巢式病例对照研究（FEPED 研究）。孕妇在 10 至 15 周 WA。对于每例子痫前期患者，从队列中选择 4 例对照，并按产次、肤色、母亲年龄、季节和 BMI 进行匹配。主要结局测量是妊娠早期血清 25（OH）D 状况。
83 例子痫前期病例与 319 例对照匹配。病例组和对照组妊娠早期 25（OH）D 平均水平分别为 20.1±9.3ng/ml 和 22.3±11.1ng/ml（p=0.09）。妊娠早期 25（OH）D 水平≥30ng/ml 时子痫前期的发病风险降低，但无统计学意义（OR，0.57；95%CI，0.30-1.01；p=0.09）。孕晚期 25（OH）D 水平较高与子痫前期的发病风险显著降低相关（OR，0.43；95%CI，0.23-0.80；p=0.008）。当将第一和第三孕期 25（OH）D 水平均<30ng/ml 的妇女（“低-低”）作为参考时，子痫前期的 OR 为“低-高”或“高-低”妇女为 0.59（95%CI，0.31-1.14；p=0.12），“高-高”妇女为 0.34（95%CI，0.13-0.86；p=0.02）。
妊娠早期子痫前期与维生素 D 不足之间无显著关联。然而，孕晚期维生素 D 充足且第一和第三孕期均充足的妇女子痫前期发病风险显著降低。
