Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH; Cincinnati Children's Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Cincinnati, OH; University of Cincinnati College of Medicine, Cincinnati, OH.
Ann Epidemiol. 2020 Mar;43:11-17. doi: 10.1016/j.annepidem.2019.12.010. Epub 2020 Jan 3.
Our objective was to systematically review and meta-analyze studies that assessed the association between gestational vitamin D levels and risk of multiple sclerosis (MS) in offspring.
Embase and Pubmed databases were searched from inception to May 2018. Original, observational studies that investigated both clinically defined MS (in offspring) and vitamin D levels in utero or shortly after birth were included. Two reviewers independently abstracted data and assessed the quality of studies using the Newcastle-Ottawa Quality Assessment Scale. Summary effect estimates and 95% confidence intervals were calculated with random effects models using inverse variance weighting. Determinants of heterogeneity were evaluated.
Four case-control studies of moderate to low risk of bias were included. Summary effect estimates of the effect of higher levels of gestational vitamin D on risk of offspring MS demonstrated a significant protective effect in random effects (OR: 0.63, 95% CI: 0.47, 0.84) models and in a stratified analysis based on study quality. Factors identified as determinants of heterogeneity were the definitions of vitamin D deficiency, the characteristics of study participants, and the quality of the study.
Sufficient levels of vitamin D during pregnancy may be protective against offspring's development of multiple sclerosis later in life.
本研究旨在系统地回顾和荟萃分析评估妊娠期维生素 D 水平与后代多发性硬化症（MS）风险之间关系的研究。
从建库到 2018 年 5 月，我们检索了 Embase 和 Pubmed 数据库。纳入了同时调查了临床定义的 MS（在后代中）和胎儿期或出生后不久维生素 D 水平的原始观察性研究。两位审阅者独立提取数据，并使用纽卡斯尔-渥太华质量评估量表评估研究质量。使用随机效应模型和Inverse Variance Weighting 计算汇总效应估计值和 95％置信区间。评估了异质性的决定因素。
纳入了四项偏倚风险为中低的病例对照研究。汇总效应估计表明，妊娠期较高水平的维生素 D 对后代 MS 风险具有显著的保护作用（OR：0.63，95％CI：0.47，0.84），且在基于研究质量的分层分析中也是如此。确定为异质性决定因素的因素包括维生素 D 缺乏的定义、研究参与者的特征和研究质量。
妊娠期间维生素 D 水平充足可能对后代日后发生多发性硬化症具有保护作用。
