Nagendra Namrata, Chhina Amitoj Singh, Shenoi Praveena, Shenoi Arvind, Bhattacharya Modhulika, Kumar R Kishore
Department of Obstetrics and Gynaecology, Cloudnine Hospital, Old Airport Road, Bangalore, 560017 India.
Department of Neonatology, Cloudnine Hospital, Old Airport Road, Bangalore, 560017 India.
J Obstet Gynaecol India. 2019 Oct;69(Suppl 2):89-94. doi: 10.1007/s13224-018-1095-7. Epub 2018 Mar 9.
To determine 25-hydroxyvitamin D (25OHD) levels in pregnant women at 28 weeks and supplement based on these levels and check maternal and neonatal levels after delivery at term.
This is a prospective observational study wherein pregnant women aged 18-35 years received cholecalciferol from 28 weeks till delivery at term. Women with 25OHD levels ≥ 75 nmol/L received 12.5 μg/day, those with levels 50-74.9 nmol/L received 100 μg/day and those with levels ≤ 49.9 nmol/L received 1500 μg/week.
Of 555, 532 women (95.8%) completed the study. Of 532, 77 (14.5%) women had 25OHD ≥ 75 nmol/L at 28 weeks; 34/77 (44.15%) became deficient at term, and the mean 25OHD reduced from 99 ± 29.9 to 77 ± 30.4 nmol/L ( < 0.0001). One hundred and seventy-one women had 25OHD 50-74.9 nmol/L at 28 weeks; in 99 (57.89%), levels normalised at term, and mean 25OHD increased from 60.5 ± 7.5 to 78.2 ± 21.9 nmol/L ( < 0.0001). Two hundred and nineteen women had 25OHD 25-49.9 nmol/L at 28 weeks; in 135 (61.64%), levels normalised at term, and mean 25OHD increased from 36.6 ± 7.5 to 83.3 ± 32.7 nmol/L ( < 0.0001). Sixty-five women had 25OHD < 25 nmol/L at 28 weeks; In 39 (60.94%), levels normalised at term, and the mean 25OHD increased from 17.9 ± 5 to 80.6 ± 34.1 nmol/L ( < 0.0001). Seven neonates (1.3%) had cord blood ionised calcium values < 1 mmol/L, and all these had 25OHD < 50 nmol/L (mean 22.2 ± 2.5 nmol/L).
Standard 12.5 μg/day supplementation in women with normal 25OHD levels at 28 weeks leads to deficiency in 44% women by term. Cholecalciferol in doses of 100 μg/day and 1500 μg/week leads to a significant increase in 25OHD levels in vitamin D-deficient pregnant women though nearly 40% may still have deficient levels at term along with their newborns. Only 1.3% of newborns had hypocalcaemia.
测定孕妇孕28周时的25-羟维生素D（25OHD）水平，并根据这些水平进行补充，然后在足月分娩后检查母体和新生儿的水平。
这是一项前瞻性观察性研究，18至35岁的孕妇从孕28周开始直至足月分娩期间接受胆钙化醇。25OHD水平≥75 nmol/L的女性每天接受12.5μg，水平在50 - 74.9 nmol/L的女性每天接受100μg，水平≤49.9 nmol/L的女性每周接受1500μg。
555名女性中，532名（95.8%）完成了研究。在532名女性中，77名（14.5%）在孕28周时25OHD≥75 nmol/L；其中34/77（44.15%）在足月时出现缺乏，25OHD的平均值从99±29.9降至77±30.4 nmol/L（P<0.0001）。171名女性在孕28周时25OHD为50 - 74.9 nmol/L；其中99名（57.89%）在足月时水平恢复正常，25OHD的平均值从60.5±7.5升至78.2±21.9 nmol/L（P<0.0001）。219名女性在孕28周时25OHD为25 - 49.9 nmol/L；其中135名（61.64%）在足月时水平恢复正常，25OHD的平均值从36.6±7.5升至83.3±32.7 nmol/L（P<0.0001）。65名女性在孕28周时25OHD<25 nmol/L；其中39名（60.94%）在足月时水平恢复正常，25OHD的平均值从17.9±5升至80.6±34.1 nmol/L（P<0.0001）。7名新生儿（1.3%）脐带血离子钙值<1 mmol/L，且所有这些新生儿的25OHD<50 nmol/L（平均值22.2±2.5 nmol/L）。
28周时25OHD水平正常的女性每天补充标准剂量12.5μg，到足月时有44%的女性出现缺乏。每天100μg和每周1500μg剂量的胆钙化醇可使维生素D缺乏的孕妇25OHD水平显著升高，不过近40%的孕妇及其新生儿在足月时可能仍处于缺乏水平。只有1.3%的新生儿有低钙血症。
