Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China.
Tongzhou Maternal and Child Health Hospital of Beijing, 101101, China.
Nutr Metab Cardiovasc Dis. 2020 Nov 27;30(12):2398-2405. doi: 10.1016/j.numecd.2020.07.046. Epub 2020 Aug 11.
To examine the independent effect of maternal serum 25-hydroxyvitamin D [25(OH)D] deficiency and its joint effect with gestational diabetes mellitus (GDM) on infant birth size.
This retrospective cohort study was conducted in 15,724 mother-offspring dyads in Beijing, China between 2016 and 2017. Outcomes included infant birth weight Z-score (adjusted for gestational age and sex) and large for gestational age (LGA). Exposures were maternal 25(OH)D concentrations. Linear and logistic regression models were used to assess the associations of exposures with continuous and binary outcomes, respectively. Exposure-outcome associations were not observed when analyzing 25(OH)D concentrations continuously or in quartiles (P > 0.05); however, mothers with severely deficient 25(OH)D concentrations (n = 307) had a decreased risk of LGA compared with those with sufficient 25(OH)D concentrations (≥30.0 ng/mL; n = 5400) (adjusted odds ratio (OR): 0.63; 95% confidence interval (CI): 0.42, 0.93). Compared to mothers with no 25(OH)D deficiency (≥20.0 ng/mL) and no GDM (n = 7975), those with both 25(OH)D deficiency and GDM (n = 1090) had 0.15 (95% CI: 0.09, 0.21) higher infant birth weight Z-score and a higher risk of LGA (OR: 1.29; 95% CI: 1.09, 1.52). Maternal 25(OH)D deficiency and GDM had additive interaction on the risk of LGA (relative risk due to interaction: 0.18).
Mothers with severely deficient 25(OH)D might have a decreased risk of LGA. However, the joint effect of maternal 25(OH)D deficiency and GDM might increase the risk of LGA. Our findings have clinical and public health implications and provide potential directions for future studies.
本研究旨在探讨母体血清 25-羟维生素 D [25(OH)D] 缺乏的独立作用及其与妊娠期糖尿病（GDM）的联合作用对婴儿出生体重的影响。
本回顾性队列研究于 2016 年至 2017 年在北京对 15724 对母婴进行，研究结局包括婴儿出生体重 Z 评分（按胎龄和性别调整）和大于胎龄儿（LGA）。暴露因素为母体 25(OH)D 浓度。采用线性和逻辑回归模型分别评估暴露因素与连续和二分类结局的关系。当分析 25(OH)D 浓度连续或四分位数时（P>0.05），未观察到暴露因素与结局之间的关联；然而，与具有足够 25(OH)D 浓度（≥30.0ng/mL；n=5400）的母亲相比，严重缺乏 25(OH)D 的母亲（n=307）发生 LGA 的风险降低（校正比值比（OR）：0.63；95%置信区间（CI）：0.42，0.93）。与无 25(OH)D 缺乏（≥20.0ng/mL）和无 GDM（n=7975）的母亲相比，同时存在 25(OH)D 缺乏和 GDM 的母亲（n=1090）的婴儿出生体重 Z 评分高 0.15（95%CI：0.09，0.21），且 LGA 的风险更高（OR：1.29；95%CI：1.09，1.52）。母体 25(OH)D 缺乏和 GDM 对 LGA 的风险具有相加交互作用（交互归因比：0.18）。
严重缺乏 25(OH)D 的母亲可能 LGA 的风险降低。然而，母体 25(OH)D 缺乏和 GDM 的联合作用可能会增加 LGA 的风险。本研究结果具有临床和公共卫生意义，并为未来的研究提供了潜在方向。
