母亲患有妊娠糖尿病的婴儿的维生素 D 状况：出生时的状况和婴儿期维生素 D 补充的随机对照试验。

Vitamin D Status of Infants of Mothers with Gestational Diabetes: Status at Birth and a Randomized Controlled Trial of Vitamin D Supplementation across Infancy.

机构信息

Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada; School of Human Nutrition, McGill University, Ste Anne de Bellevue, Quebec, Canada.

School of Human Nutrition, McGill University, Ste Anne de Bellevue, Quebec, Canada; Clinical Nutrition Department, King Abdulaziz University, Jeddah, Saudi Arabia.

出版信息

J Nutr. 2022 Nov;152(11):2441-2450. doi: 10.1093/jn/nxac194. Epub 2022 Sep 23.

DOI:10.1093/jn/nxac194

PMID:36774110

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9644174/

Abstract

BACKGROUND

Vitamin D status and requirements of infants of women with gestational diabetes mellitus (GDM) are unclear.

OBJECTIVES

The objectives were to assess vitamin D status in infants of mothers with GDM and compare vitamin D status in response to 400 vs. 1000 IU/d vitamin D supplementation in infants born with serum 25-hydroxyvitamin D [25(OH)D] <50 nmol/L.

METHODS

Women with GDM delivering full-term infants (n = 98; March 2017-2019, Montreal, Canada) were surveyed for demographic and lifestyle factors. Pregnancy history was obtained from medical records. Newborn serum 25(OH)D was measured (immunoassay) and categorized as <30 (deficient) or ≥40 nmol/L (adequate). Breastfed neonates (n = 16) with serum 25(OH)D <50 nmol/L at birth were randomly assigned to 400 or 1000 IU/d of supplemental cholecalciferol (vitamin D), and serum 25(OH)D was measured at baseline (≤1 mo) and 3, 6, and 12 mo of age. Groups were compared using a linear mixed-effects model and Tukey-Kramer post hoc tests.

RESULTS

Mean newborn serum 25(OH)D was 46.4 (95% CI: 43.9, 49.9) nmol/L, with 15.3% (95% CI: 8.2%, 22.4%) <30 nmol/L and 61.2% (95% CI: 51.6%, 70.9%) ≥40 nmol/L. During the trial, most infants were breastfed to 3 mo (400 IU/d: 87.5%; 1000 IU/d: 75.0%). Mean (± SEM) infant serum 25(OH)D was higher in the 1000-IU/d group at 3 mo (79.9 ± 5.9 vs. 111.5 ± 15.2 nmol/L; P = 0.0263), and although not different at 6-12 mo, was maintained at >50 nmol/L.

CONCLUSIONS

Most infants of women with GDM had adequate vitamin D status in this study. In those born with serum 25(OH)D <50 nmol/L, vitamin D status was corrected by 3 mo of age in response to 400 or 1000 IU/d of supplemental vitamin D. Dietary guidance should continue to recommend that all women who could become pregnant take a multivitamin supplement and that breastfed infants receive 400 IU/d of supplemental vitamin D. This study and ancillary trial were registered at clinicaltrials.gov (https://www.

CLINICALTRIALS

gov/ct2/show/NCT02563015) as NCT02563015.

摘要

背景

孕妇患有妊娠糖尿病（GDM）时，婴儿的维生素 D 状态和需求情况尚不清楚。

目的

本研究旨在评估 GDM 孕妇所产婴儿的维生素 D 状态，并比较维生素 D 状态，以评估血清 25-羟维生素 D [25（OH）D] <50 nmol/L 的新生儿接受 400 或 1000 IU/d 维生素 D 补充剂的反应。

方法

本研究对 2017 年 3 月至 2019 年在加拿大蒙特利尔分娩足月婴儿的 98 名 GDM 妇女进行了问卷调查，调查内容包括人口统计学和生活方式因素。妊娠史从病历中获取。新生儿血清 25（OH）D 采用（免疫测定）进行测量，并分为 <30（缺乏）或 ≥40 nmol/L（充足）。对于出生时血清 25（OH）D <50 nmol/L 的母乳喂养新生儿（n=16），随机分配接受 400 或 1000 IU/d 的胆钙化醇（维生素 D）补充剂，基线（≤1 个月）和 3、6 和 12 个月时测量血清 25（OH）D。使用线性混合效应模型和 Tukey-Kramer 事后检验比较组间差异。

结果

新生儿血清 25（OH）D 的平均水平为 46.4（95%CI：43.9，49.9）nmol/L，其中 15.3%（95%CI：8.2%，22.4%）<30 nmol/L，61.2%（95%CI：51.6%，70.9%）≥40 nmol/L。在试验期间，大多数婴儿在 3 个月时母乳喂养（400 IU/d：87.5%；1000 IU/d：75.0%）。在 3 个月时，1000 IU/d 组婴儿血清 25（OH）D 平均水平（± SEM）更高（79.9 ± 5.9 比 111.5 ± 15.2 nmol/L；P=0.0263），虽然 6-12 个月时无差异，但仍保持在>50 nmol/L。

结论

在本研究中，大多数 GDM 孕妇的婴儿维生素 D 状态充足。在血清 25（OH）D <50 nmol/L 的新生儿中，400 或 1000 IU/d 的维生素 D 补充剂可在 3 个月内纠正维生素 D 状态。膳食指南应继续建议所有可能怀孕的妇女服用多种维生素补充剂，并建议母乳喂养的婴儿每天补充 400 IU/d 的维生素 D。本研究和辅助试验均在 clinicaltrials.gov（https://www.clinicaltrials.gov/ct2/show/NCT02563015）注册，注册号为 NCT02563015。