Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; CARE Fertility Leeds, Leeds Teaching Hospital Trust, Seacroft Hospital, Leeds, England; Birmingham Women's and Children's Foundation Hospital Trust, Edgbaston, Birmingham, United Kingdom.
Birmingham Women's and Children's Foundation Hospital Trust, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Fertil Steril. 2022 Jul;118(1):111-122. doi: 10.1016/j.fertnstert.2022.04.017. Epub 2022 May 28.
To investigate whether a significant association between vitamin D status and the risk of miscarriage or recurrent miscarriage (RM) exists.
Systematic review and meta-analysis.
Not applicable.
PATIENT(S): Women with miscarriage and RM.
INTERVENTION(S): We searched the Ovid MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials from database inception to May 2021. Randomized and observational studies investigating the association between maternal vitamin D status and miscarriage and/or vitamin D treatment and miscarriage were included.
MAIN OUTCOME MEASURE(S): The primary outcome was miscarriage or RM, with vitamin D status used as the predictor of risk. Whether vitamin D treatment reduces the risk of miscarriage and RM was also assessed.
RESULT(S): Of 902 studies identified, 10 (n = 7,663 women) were included: 4 randomized controlled trials (n = 666 women) and 6 observational studies (n = 6,997 women). Women diagnosed with vitamin D deficiency (<50 nmol/L) had an increased risk of miscarriage compared with women who were vitamin D replete (>75 nmol/L) (odds ratio, 1.94; 95% confidence interval, 1.25-3.02; 4 studies; n = 3,674; I = 18%). Combined analysis, including women who were vitamin D insufficient (50-75 nmol/L) and deficient (<50 nmol/L) compared with women who were replete (>75 nmol/L), found an association with miscarriage (odds ratio, 1.60; 95% confidence interval, 1.11-2.30; 6 studies; n = 6,338; I = 35%). Although 4 randomized controlled trials assessed the effect of vitamin D treatment on miscarriage, study heterogeneity, data quality, and reporting bias precluded direct comparison and meta-analysis. The overall study quality was "low" or "very low" using the Grading of Recommendations, Assessment, Development and Evaluations approach.
CONCLUSION(S): Vitamin D deficiency and insufficiency are associated with miscarriage. Whether preconception treatment of vitamin D deficiency protects against pregnancy loss in women at risk of miscarriage remains unknown.
CRD42021259899.
探讨维生素 D 状态与流产或复发性流产（RM）风险之间是否存在显著关联。
系统评价和荟萃分析。
不适用。
流产和 RM 的女性。
我们检索了 Ovid MEDLINE、Embase、护理学和联合健康文献累积索引以及 Cochrane 对照试验中心注册库，检索时间从数据库建立到 2021 年 5 月。纳入了研究母体维生素 D 状态与流产和/或维生素 D 治疗与流产之间关系的随机和观察性研究。
主要结局是流产或 RM，以维生素 D 状态作为风险预测因素。还评估了维生素 D 治疗是否降低流产和 RM 的风险。
在 902 项研究中，有 10 项（n = 7663 名女性）符合纳入标准：4 项随机对照试验（n = 666 名女性）和 6 项观察性研究（n = 6997 名女性）。与维生素 D 充足（>75 nmol/L）的女性相比，维生素 D 缺乏症（<50 nmol/L）的女性流产风险增加（比值比，1.94；95%置信区间，1.25-3.02；4 项研究；n = 3674；I² = 18%）。综合分析包括维生素 D 不足（50-75 nmol/L）和缺乏症（<50 nmol/L）的女性与充足（>75 nmol/L）的女性相比，也与流产有关（比值比，1.60；95%置信区间，1.11-2.30；6 项研究；n = 6338；I² = 35%）。尽管 4 项随机对照试验评估了维生素 D 治疗对流产的影响，但研究异质性、数据质量和报告偏倚妨碍了直接比较和荟萃分析。使用推荐评估、制定与评价分级方法，整体研究质量为“低”或“极低”。
维生素 D 缺乏和不足与流产有关。维生素 D 缺乏症的孕前治疗是否能预防有流产风险的女性妊娠丢失尚不清楚。
CRD42021259899。
