Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland.
Department of Food Sciences and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah, Saudi Arabia.
Am J Clin Nutr. 2021 Sep 1;114(3):1208-1218. doi: 10.1093/ajcn/nqab112.
The achievement of target 25-hydroxyvitamin D [25(OH)D] concentrations in pregnancy may be altered by maternal obesity.
The authors examined the effects of maternal supplementation of 10 μg compared with 20 μg vitamin D3/d on maternal and umbilical cord 25(OH)D. The secondary aim was to investigate the influence of maternal BMI (in kg/m2) on the response of the primary outcomes.
The authors performed a 2-arm parallel double-blind randomized trial with 240 pregnant women recruited throughout the year in Northern Ireland. Women were stratified by BMI to receive 10 or 20 µg vitamin D3/d from 12 gestational wk (GW) until delivery. Maternal blood samples collected at 12, 28, and 36 GW and from the umbilical cord were analyzed for total serum 25(OH)D. A total of 166 women completed the study.
Mean ± SD 25(OH)D at 36 GW was 80.8 ± 28.2 compared with 94.4 ± 33.2 nmol/L (P < 0.001) (10 compared with 20 µg vitamin D3/d, respectively). In those classified with 25(OH)D <50 nmol/L at baseline and assigned 10 µg vitamin D3/d, mean 25(OH)D concentrations remained <50 nmol/L at 36 GW, whereas those <50 nmol/L at baseline and assigned 20 µg vitamin D3/d, had mean 25(OH)D concentrations ≥50 nmol/L at 28 and 36 GW. In women with obesity and 25(OH)D <50 nmol/L at baseline, the related mean umbilical cord 25(OH)D was deficient (<25 nmol/L) in both treatment groups, whereas those with obesity and 25(OH)D ≥50 nmol/L at baseline had an average umbilical cord 25(OH)D between 25 and 50 nmol/L in both treatment groups.
Supplementation of 20 µg vitamin D3/d is needed to attain maternal and umbilical cord 25(OH)D concentrations ≥50 nmol/L on average, in those who start pregnancy with low 25(OH)D concentrations (<50 nmol/L). Under current recommendations, women with obesity and low 25(OH)D in early pregnancy are particularly vulnerable to maintaining a low 25(OH)D concentration throughout pregnancy and having an infant born with deficient 25(OH)D concentrations. This trial was registered at ClinicalTrials.gov as NCT02713009.
母体肥胖可能会影响妊娠时达到 25-羟维生素 D [25(OH)D] 目标浓度。
作者研究了与母体补充 10μg 与 20μg 维生素 D3/d 相比对母体和脐带 25(OH)D 的影响。次要目的是研究母体 BMI（kg/m2）对主要结局反应的影响。
作者进行了一项 2 臂平行双盲随机试验，在北爱尔兰全年招募了 240 名孕妇。根据 BMI 将女性分层，从妊娠 12 周（GW）开始至分娩时分别接受 10μg 或 20μg 维生素 D3/d。在 12、28 和 36 GW 时采集母体血样，并分析总血清 25(OH)D。共有 166 名女性完成了研究。
36 GW 时的平均±SD 25(OH)D 为 80.8±28.2 与 94.4±33.2 nmol/L（P<0.001）（10μg 与 20μg 维生素 D3/d 相比）。在基线时 25(OH)D <50 nmol/L 且接受 10μg 维生素 D3/d 治疗的患者中，25(OH)D 浓度在 36 GW 时仍保持<50 nmol/L，而在基线时 25(OH)D <50 nmol/L 且接受 20μg 维生素 D3/d 治疗的患者中，25(OH)D 浓度在 28 和 36 GW 时均≥50 nmol/L。在基线时肥胖且 25(OH)D <50 nmol/L 的女性中，两组治疗中脐带 25(OH)D 均不足（<25 nmol/L），而在基线时肥胖且 25(OH)D≥50 nmol/L 的女性中，两组治疗中脐带 25(OH)D 平均在 25 至 50 nmol/L 之间。
在那些起始妊娠时 25(OH)D 浓度较低（<50 nmol/L）的女性中，需要补充 20μg 维生素 D3/d 才能达到平均≥50 nmol/L 的母体和脐带 25(OH)D 浓度。根据当前的建议，在妊娠早期肥胖且 25(OH)D 较低的女性在整个妊娠期间维持较低的 25(OH)D 浓度并使婴儿出生时 25(OH)D 浓度不足的风险特别高。该试验在 ClinicalTrials.gov 上注册为 NCT02713009。
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