早孕期使用多种维生素可降低孕妇维生素 D 状态不足的风险：来自母婴环境化学研究 (MIREC) 队列研究的结果。

Early prenatal use of a multivitamin diminishes the risk for inadequate vitamin D status in pregnant women: results from the Maternal-Infant Research on Environmental Chemicals (MIREC) cohort study.

机构信息

Nutrition Research Division, Bureau of Nutritional Sciences, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada.

Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada.

出版信息

Am J Clin Nutr. 2021 Sep 1;114(3):1238-1250. doi: 10.1093/ajcn/nqab172.

DOI:10.1093/ajcn/nqab172

PMID:34081131

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8408885/

Abstract

BACKGROUND

Reports on the adequacy of vitamin D status of pregnant women are not available in Canada.

OBJECTIVES

The objectives of this study were to examine vitamin D status across pregnancy and identify the correlates of vitamin D status of pregnant women in Canada.

METHODS

Pregnant women (≥18 years) from 6 provinces (2008-2011) participating in a longitudinal cohort were studied. Sociodemographic data, obstetrical histories, and dietary and supplemental vitamin D intakes were surveyed. Plasma 25-hydroxyvitamin D (25OHD) was measured using an immunoassay standardized to LC-MS/MS from samples collected during the first (n = 1905) and third trimesters (n = 1649) and at delivery (n = 1543). The proportion of women with ≥40 nmol/L of plasma 25OHD (adequate status) was estimated at each time point, and factors related to achieving this cut point were identified using repeated-measures logistic regression. Differences in 25OHD concentrations across trimesters and at delivery were tested a using repeated-measures ANOVA with a post hoc Tukey's test.

RESULTS

In the first trimester, 93.4% (95% CI: 92.3%-94.5%) of participants had 25OHD ≥40 nmol/L. The mean plasma 25OHD concentration increased from the first to the third trimester and then declined by delivery (69.8 ± 0.5 nmol/L, 78.6 ± 0.7 nmol/L, and 75.7 ± 0.7 nmol/L, respectively; P < 0.0001). A lack of multivitamin use early in pregnancy reduced the odds of achieving 25OHD ≥40 nmol/L (ORadj = 0.33; 95% CI: 0.25-0.42) across all time points. Factors associated with not using a prenatal multivitamin included multiparity (ORadj = 2.08; 95% CI: 1.42-3.02) and a below-median income (ORadj = 1.39; 95% CI: 1.02-1.89).

CONCLUSIONS

The results from this cohort demonstrate the importance of early multivitamin supplement use to achieve an adequate vitamin D status in pregnant women.

摘要

背景

加拿大目前尚无关于孕妇维生素 D 状态充足性的报告。

目的

本研究旨在检测孕妇整个孕期的维生素 D 状态，并确定加拿大孕妇维生素 D 状态的相关因素。

方法

本研究纳入了来自 6 个省份（2008-2011 年）的孕妇（≥18 岁），并对其进行了一项纵向队列研究。调查了社会人口统计学数据、产科史以及膳食和补充维生素 D 摄入量。在第一次（n=1905）、第三次（n=1649）和分娩时（n=1543）采集了血样，使用免疫分析法（经 LC-MS/MS 标准化）测定血浆 25-羟维生素 D（25OHD）。分别在每个时间点估计血浆 25OHD≥40 nmol/L 的女性比例，并采用重复测量逻辑回归确定达到该切点的相关因素。使用重复测量方差分析和事后 Tukey 检验比较了不同孕期和分娩时的 25OHD 浓度差异。

结果

在孕早期，93.4%（95%CI：92.3%-94.5%）的参与者 25OHD≥40 nmol/L。血浆 25OHD 浓度从孕早期到孕晚期逐渐升高，然后在分娩时下降（分别为 69.8±0.5 nmol/L、78.6±0.7 nmol/L 和 75.7±0.7 nmol/L；P<0.0001）。孕早期未服用多种维生素会降低在所有时间点达到 25OHD≥40 nmol/L 的可能性（ORadj=0.33；95%CI：0.25-0.42）。不服用产前多种维生素的相关因素包括多胎妊娠（ORadj=2.08；95%CI：1.42-3.02）和低于中位数收入（ORadj=1.39；95%CI：1.02-1.89）。