母体维生素 D 状况与妊娠期糖尿病发病风险：前瞻性队列研究的系统评价和荟萃分析。

Maternal vitamin D status and risk of gestational diabetes mellitus: A systematic review and meta-analysis of prospective cohort studies.

机构信息

Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Department of Health, Science and Research Branch, AJA University of Medical Sciences, Tehran, Iran.

Department of Sports Injuries, Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran.

出版信息

Clin Nutr. 2021 May;40(5):2576-2586. doi: 10.1016/j.clnu.2021.03.037. Epub 2021 Apr 2.

DOI:10.1016/j.clnu.2021.03.037

PMID:33933723

Abstract

BACKGROUND

No earlier systematic review and meta-analysis have been done on the association between maternal serum vitamin D status and risk of GDM among prospective studies. The current study was done to systematically review prospective cohort studies (with several years of follow-up) on the association between maternal serum vitamin D deficiency or insufficiency and risk of GDM.

METHODS

Relevant papers published up to January 2020 were searched through PubMed, MEDLINE, SCOPUS, EMBASE, and Google Scholar using suitable keywords. All prospective cohort studies reporting Hazard Ratios (HRs) or Relative Risks (RRs) and 95% Confidence Intervals (CI) for GDM across categories of maternal serum vitamin D status were included.

RESULTS

A total of 29 prospective and nested case-control studies were included in the current systematic review, of which 27 studies had sufficient data for the meta-analysis. Individuals with vitamin D deficiency had a 26% greater risk of developing GDM than those with normal serum vitamin D concentrations (OR: 1.26; 95% CI: 1.13, 1.41). In addition, a significant positive association was seen between combined vitamin D insufficiency and deficiency and risk of developing GDM (OR: 1.23; 95% CI: 1.11, 1.35). Dose-response analysis showed a significant U-shaped non-linear association between serum vitamin D concentrations and risk of developing GDM (P < 0.001), such that those with serum vitamin D concentrations between 40 and 90 nmol/L had significantly reduced risk of GDM.

CONCLUSIONS

We found a significant association between vitamin D deficiency and an increased risk of GDM. The lowest risk of GDM was found among those with a serum vitamin D levels of 40-90 nmol/L. Further studies, including randomized clinical trials, are needed to confirm our findings.

REGISTRATION

PROSPERO (ID: 180722), https://www.crd.york.ac.uk/prospero/.

摘要

背景

以前没有对前瞻性研究中母体血清维生素 D 状态与 GDM 风险之间的关系进行过系统评价和荟萃分析。本研究旨在系统评价前瞻性队列研究（随访时间数年）中母体血清维生素 D 缺乏或不足与 GDM 风险之间的关系。

方法

通过合适的关键词，在 PubMed、MEDLINE、SCOPUS、EMBASE 和 Google Scholar 中检索了截至 2020 年 1 月发表的相关文献。纳入了报告了母体血清维生素 D 状态分类下 GDM 的危险比（HR）或相对风险（RR）和 95%置信区间（CI）的所有前瞻性队列研究。

结果

本系统评价共纳入了 29 项前瞻性和巢式病例对照研究，其中 27 项研究有足够的数据进行荟萃分析。与血清维生素 D 浓度正常的个体相比，维生素 D 缺乏的个体发生 GDM 的风险增加 26%（OR：1.26；95%CI：1.13，1.41）。此外，维生素 D 不足和缺乏与 GDM 发病风险之间存在显著正相关（OR：1.23；95%CI：1.11，1.35）。剂量反应分析显示，血清维生素 D 浓度与 GDM 发病风险之间存在显著的 U 形非线性关系（P<0.001），血清维生素 D 浓度在 40-90 nmol/L 之间的个体 GDM 发病风险显著降低。