Sharma Nalini, Nath Chandan, Mohammad Jamil
Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
J Family Med Prim Care. 2019 Feb;8(2):356-360. doi: 10.4103/jfmpc.jfmpc_404_18.
Studies of vitamin D (VD) physiology suggest that effects of vitamin D deficiency (VDD) could be much broader than rickets including cardiovascular disease, cancers, diabetes, infection, and allergy and pregnancy complications. Data regarding the prevalence of hypovitaminosis in pregnancy are scanty especially in north eastern part of India. Therefore, this study has undertaken with the intention to find out prevalence and outcome of hypovitaminosis of VD in pregnancy.
In total, 177 pregnant women with singleton pregnancy, <16 weeks of gestational age, visited to antenatal clinic of our institute were consecutively enrolled for the study. The serum VD was estimated by Beckman coulter unicel DXI immunoassay system using the principle of Chemiluminescence. Incidence of vitamin deficiency and insufficiency calculated. VDD was defined as 25(OH)D levels in blood <20 ng/mL, and insufficiency of VD was defined as 25(OH)D levels <32 ng/mL. Antenatal complications, such as intrauterine growth restriction (IUGR), oligohydramnios, pre-eclampsia, preterm labor, gestational diabetes, if any, were noted. Labor and delivery information including induction of labor, mode of delivery, and newborn birth weight were noted.
In total, 177 women recruited for the study. Mean age and parity of the subjects were 26.71 ± 9.96 and 2.10 ± 1.8, respectively. For detailed statistical analysis, women were divided into three groups depending upon their VD levels: deficiency group [25(OH)D level <20 ng/mL], insufficiency group [25(OH)D level <32 ng/mL], and sufficient group [25(OH)D level >32 ng/mL]. VDD was present in 84.18% subjects. VD insufficiency was present in 12.44% of cases. There is association of preeclampsia, cesarean section, and low birth weight babies with lower level of VD.
This study showed that the prevalence of VDD in pregnancy is astonishingly high till now there is no guideline to screen antenatal women for VDD. As the test is costly even, offering it to all at-risk women may not be cost effective compared with offering universal supplementation, particularly as treatment is regarded as being very safe.
维生素D（VD）生理学研究表明，维生素D缺乏（VDD）的影响可能比佝偻病更为广泛，包括心血管疾病、癌症、糖尿病、感染、过敏和妊娠并发症。关于孕期维生素缺乏症患病率的数据很少，尤其是在印度东北部。因此，本研究旨在了解孕期VD缺乏症的患病率和结局。
共有177例单胎妊娠、孕周<16周且到我院产前门诊就诊的孕妇连续纳入本研究。采用贝克曼库尔特Unicel DXI免疫分析系统，利用化学发光原理测定血清VD。计算维生素缺乏和不足的发生率。VDD定义为血液中25（OH）D水平<20 ng/mL，VD不足定义为25（OH）D水平<32 ng/mL。记录产前并发症，如宫内生长受限（IUGR）、羊水过少、先兆子痫、早产、妊娠期糖尿病（如有）。记录分娩和接生信息，包括引产、分娩方式和新生儿出生体重。
本研究共招募177例女性。研究对象的平均年龄和胎次分别为26.71±9.96和2.10±1.8。为进行详细的统计分析，根据VD水平将女性分为三组：缺乏组[25（OH）D水平<20 ng/mL]、不足组[25（OH）D水平<32 ng/mL]和充足组[25（OH）D水平>32 ng/mL]。84.18%的研究对象存在VDD。12.44%的病例存在VD不足。先兆子痫、剖宫产和低体重儿与较低的VD水平有关。
本研究表明，孕期VDD的患病率惊人地高，目前尚无针对产前女性进行VDD筛查的指南。由于该检测成本高昂，与提供普遍补充剂相比，对所有高危女性进行检测可能不具有成本效益，特别是因为治疗被认为非常安全。
