维生素 D 与辅助生殖治疗结局：一项前瞻性队列研究。
Vitamin D and assisted reproductive treatment outcome: a prospective cohort study.
机构信息
Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, B15 2TT, UK.
Birmingham Women's and Children's National Foundation Trust, Mindelsohn Way, Birmingham, B15 2TG, UK.
出版信息
Reprod Health. 2019 Jul 15;16(1):106. doi: 10.1186/s12978-019-0769-7.
BACKGROUND
Vitamin D deficiency has been associated with an increased risk of abnormal pregnancy implantation leading to obstetric complications such as pre-eclampsia and fetal growth restriction. However, the effect of vitamin D on reproductive treatment outcomes in couples undergoing assisted reproductive treatment is poorly understood. This study investigates the association between vitamin D and reproductive treatment outcomes in women undergoing assisted reproductive treatments?
METHODS
A prospective cohort study conducted at a large tertiary teaching hospital, United Kingdom. Five hundred women undergoing assisted reproductive treatment were recruited between September 2013 and September 2015. All participants had their serum vitamin D measured and their reproductive treatment outcomes collated. Women were categorised in to three groups: vitamin D replete (> 75 nmol/L), insufficient (50-75 nmol/L) and deficient (< 50 nmol/L) according to Endocrine Society guidance. The primary outcome was live birth. Secondary outcomes included biochemical pregnancy, clinical pregnancy and pregnancy loss rates.
RESULTS
Vitamin D deficiency was found in 53.2% (266/500) of participants and vitamin D insufficiency was found in 30.8% (154/500) of participants. Only 16% (80/500) of women were vitamin D replete. The live birth rates for vitamin D deficient, insufficient and replete women were 23.2% (57/246), 27.0% (38/141) and 37.7% (29/77) respectively (p = 0.04). The respective live birth rates for vitamin D deficient, insufficient and replete women were 24.3, 27.1, 34.4% after adjustment for key prognostic factors (p = 0.25).
CONCLUSIONS
Vitamin D deficiency and insufficiency are common in women undergoing assisted reproductive treatments. The crude live birth rate achieved in women undergoing assisted reproductive treatments are associated with serum vitamin D, although statistical significance is lost when adjusting for important prognostic variables. Vitamin D deficiency could be an important condition to treat in women considering fertility treatment. A research trial to investigate the benefits of vitamin D deficiency treatment would test this hypothesis.
TRIAL REGISTRATION
Clinicaltrials.gov - NCT02187146 .
背景
维生素 D 缺乏与异常妊娠着床风险增加有关，导致子痫前期和胎儿生长受限等产科并发症。然而，维生素 D 对接受辅助生殖治疗的夫妇的生殖治疗结局的影响知之甚少。本研究旨在探讨维生素 D 与接受辅助生殖治疗的女性生殖治疗结局之间的关系。
方法
在英国一家大型三级教学医院进行的前瞻性队列研究。2013 年 9 月至 2015 年 9 月期间招募了 500 名接受辅助生殖治疗的女性。所有参与者均测量了血清维生素 D 水平，并对其生殖治疗结局进行了整理。根据内分泌学会的指导，女性被分为三组：维生素 D 充足 (>75nmol/L)、不足 (50-75nmol/L) 和缺乏 (<50nmol/L)。主要结局为活产。次要结局包括生化妊娠、临床妊娠和妊娠丢失率。
结果
研究发现 53.2%（266/500）的参与者存在维生素 D 缺乏，30.8%（154/500）的参与者存在维生素 D 不足。仅有 16%（80/500）的女性维生素 D 充足。维生素 D 缺乏、不足和充足的女性活产率分别为 23.2%（57/246）、27.0%（38/141）和 37.7%（29/77）（p=0.04）。调整关键预后因素后，维生素 D 缺乏、不足和充足的女性活产率分别为 24.3%、27.1%和 34.4%（p=0.25）。
结论
维生素 D 缺乏和不足在接受辅助生殖治疗的女性中很常见。接受辅助生殖治疗的女性的活产率与血清维生素 D 有关，但在调整重要预后变量后，其统计学意义丧失。维生素 D 缺乏可能是考虑生育治疗的女性的一个重要治疗条件。一项关于维生素 D 缺乏治疗益处的研究试验将检验这一假设。
试验注册
Clinicaltrials.gov - NCT02187146 。
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