血清 25-羟维生素 D 水平与妊娠糖尿病孕妇血脂及临床结局的关系：一项观察性队列研究。
Serum 25-hydroxyvitamin D levels in relation to lipids and clinical outcomes in pregnant women with gestational diabetes mellitus: an observational cohort study.
机构信息
Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Nanjing, China.
Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing, China.
出版信息
BMJ Open. 2020 Nov 27;10(11):e039905. doi: 10.1136/bmjopen-2020-039905.
OBJECTIVE
The aim of the present study was to investigate whether 25-hydroxyvitamin D (25(OH)D) status at 24-28 weeks is associated with blood lipids and pregnancy outcomes in patients with gestational diabetes mellitus (GDM).
DESIGN
We performed an observational cohort study.
SETTING
The study was conducted in China.
PARTICIPANTS
A total of 261 pregnant women diagnosed with GDM at 24-28 weeks of gestation in our hospital were included between June 2015 and December 2017. According to the levels of 25(OH)D, the women were divided into the G1 (<20 ng/mL) and G2 (≥20 ng/mL) groups. The levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), TG/HDL-c and TC/HDL-c ratios were obtained from medical records. Pregnancy outcomes included gestational weeks of birth and delivery mode. Newborn information included birth weight and body length. Differences between groups were tested with adjusted multiple linear regression.
RESULTS
The serum levels of 25(OH)D (14.1±3.4 ng/mL vs 28.5±6.5 ng/mL, p<0.001), TC (5.3±0.9 vs 5.6±0.8, p=0.006), HDL-c (1.8±0.4 vs 1.9±0.4, p=0.046) and LDL-c (2.5±0.6 vs 2.7±0.7, p=0.015) in the G2 group were significantly higher than those in G1 group, while TG/HDL-c ratios (1.43±0.7 vs 1.26±0.7, p=0.035) were significantly higher in the G1 group. Moreover, we failed to find a significant difference in pregnancy outcomes of mothers and newborns among the two groups (p>0.05). In models adjusting for maternal age, parity, height, blood pressure, socioeconomic status, educational attainment, pre-pregnancy body mass index, season and gestational age, maternal 25(OH)D was associated with TG/HDL-c ratios (B=-0.016; 95% CI= -0.025 to -0.006).
CONCLUSION
We found that there was no relationship between vitamin D and pregnancy/neonatal outcomes in our study. Maternal 25(OH)D at 24-28 weeks was inversely associated with TG/HDL-c ratios.
目的
本研究旨在探讨妊娠 24-28 周时 25-羟维生素 D（25（OH）D）水平与妊娠糖尿病（GDM）患者血脂和妊娠结局的关系。
设计
我们进行了一项观察性队列研究。
地点
研究在中国进行。
参与者
2015 年 6 月至 2017 年 12 月期间，我院共纳入 261 例妊娠 24-28 周时诊断为 GDM 的孕妇。根据 25（OH）D 水平，将孕妇分为 G1（<20ng/mL）和 G2（≥20ng/mL）组。从病历中获得总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、TG/HDL-c 和 TC/HDL-c 比值。妊娠结局包括分娩时的孕周和分娩方式。新生儿信息包括出生体重和身长。采用调整后的多元线性回归检验组间差异。
结果
G2 组血清 25（OH）D（14.1±3.4ng/mL 比 28.5±6.5ng/mL，p<0.001）、TC（5.3±0.9 比 5.6±0.8，p=0.006）、HDL-c（1.8±0.4 比 1.9±0.4，p=0.046）和 LDL-c（2.5±0.6 比 2.7±0.7，p=0.015）水平明显高于 G1 组，而 G1 组 TG/HDL-c 比值（1.43±0.7 比 1.26±0.7，p=0.035）明显更高。此外，两组产妇和新生儿的妊娠结局无显著差异（p>0.05）。在调整了母亲年龄、产次、身高、血压、社会经济状况、教育程度、孕前体重指数、季节和孕周等因素的模型中，母亲 25（OH）D 与 TG/HDL-c 比值呈负相关（B=-0.016；95%CI=-0.025 至-0.006）。
结论
本研究未发现维生素 D 与妊娠/新生儿结局之间存在关系。妊娠 24-28 周时母体 25（OH）D 与 TG/HDL-c 比值呈负相关。
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