Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
The Central Hospital of Wuhan, Wuhan, Hubei, China.
Food Funct. 2022 Jan 4;13(1):14-37. doi: 10.1039/d1fo03033g.
Epidemiological studies have investigated the associations between vitamin D and the risk of adverse pregnancy outcomes; however, the results are conflicting and dose-response relationships remain to be confirmed. This study aimed to summarize previous studies on the associations of vitamin D levels with the risk of gestational diabetes mellitus (GDM), pre-eclampsia (PE), gestational hypertension (GH), and caesarean section (C-section), and to clarify the dose-response trends. PubMed, Embase, Scopus, and Web of Science were searched to identify eligible articles. A total of 69 prospective observational studies including cohort studies, case-cohort studies, or nested case-control studies were included in the current systematic review, of which 68 studies were available for meta-analysis. Compared with the lowest level, the highest level of 25(OH)D was significantly associated with a lower risk of GDM (RR: 0.76; 95% CI: 0.66-0.87), PE (RR: 0.74; 95% CI: 0.60-0.90;), and GH (RR: 0.87; 95% CI: 0.79-0.97); however, no significant relationship was found for C-section (RR: 1.00; 95% CI: 0.90-1.12). There was significant between-study heterogeneity for GDM ( = 69.2%; < 0.001), PE ( = 52.0%; = 0.001), and C-section ( = 59.1%; < 0.001), while no heterogeneity was found for GH ( = 0.0%; = 0.676). For each 25 nmol L increase in 25(OH)D, the pooled RR was 0.92 (95% CI: 0.86-0.97) for GDM and 0.89 (95% CI: 0.84-0.94) for PE, respectively. Notably, the dose-response analysis showed a non-linear relationship between maternal 25(OH)D levels and the risk of PE ( = 0.009). Our meta-analysis provides further scientific evidence of the inverse association between 25(OH)D levels and the risk of GDM, PE, and GH, which may be useful for the prevention of pregnancy complications. However, more evidence from prospective studies is needed regarding the dietary intake of vitamin D during pregnancy.
流行病学研究调查了维生素 D 与不良妊娠结局风险之间的关联；然而，结果存在冲突，剂量反应关系仍有待证实。本研究旨在总结先前关于维生素 D 水平与妊娠糖尿病（GDM）、子痫前期（PE）、妊娠高血压（GH）和剖宫产（C -section）风险之间关联的研究，并阐明剂量反应趋势。使用 PubMed、Embase、Scopus 和 Web of Science 搜索了合格的文章。本系统评价共纳入了 69 项前瞻性观察性研究，包括队列研究、病例-对照研究或巢式病例对照研究，其中 68 项研究可进行荟萃分析。与最低水平相比，25(OH)D 的最高水平与 GDM（RR：0.76；95%CI：0.66-0.87）、PE（RR：0.74；95%CI：0.60-0.90；）和 GH（RR：0.87；95%CI：0.79-0.97）的风险降低显著相关；然而，C 剖（RR：1.00；95%CI：0.90-1.12）之间无显著关系。GDM（ = 69.2%；<0.001）、PE（ = 52.0%； = 0.001）和 C 剖（ = 59.1%；<0.001）存在显著的研究间异质性，而 GH 无异质性（ = 0.0%； = 0.676）。对于 25(OH)D 每增加 25 nmol/L，GDM 的汇总 RR 为 0.92（95%CI：0.86-0.97），PE 为 0.89（95%CI：0.84-0.94）。值得注意的是，剂量反应分析显示母体 25(OH)D 水平与 PE 风险之间存在非线性关系（ = 0.009）。本荟萃分析进一步提供了维生素 D 水平与 GDM、PE 和 GH 风险之间负相关的科学证据，这可能有助于预防妊娠并发症。然而，还需要更多关于怀孕期间维生素 D 饮食摄入的前瞻性研究证据。
