Madanchi Nima, Fava Andrea, Goldman Daniel W, Magder Laurence S, Petri Michelle
Johns Hopkins University, Baltimore, Maryland.
University of Maryland, Baltimore.
Arthritis Care Res (Hoboken). 2025 Apr;77(4):432-439. doi: 10.1002/acr.25440. Epub 2024 Oct 16.
We evaluated the association of 25-hydroxyvitamin D (25(OH)D) levels with adverse pregnancy outcomes in systemic lupus erythematosus (SLE).
The Hopkins Lupus Cohort includes visits of pregnant patients, including assessment of 25(OH)D levels at each visit. We examined the relationship between 25(OH)D levels and adverse pregnancy outcomes (miscarriage, preterm delivery, and small for gestational age). We also used a time-to-event analysis to assess whether time-varying of 25(OH)D levels were associated with time to miscarriage or preterm delivery.
In subgroups of patients defined by the average of 25(OH)D levels, we observed significantly different risks of miscarriage (P = 0.0045), preterm delivery (P = 0.0007), and the composite measure of all three adverse pregnancy outcomes (P = 0.011). The highest risks were observed among those with the lowest or highest levels of vitamin D. Nine of 10 pregnant patients with low vitamin D levels during the second trimester resulted in having a premature delivery. The time-to-event model confirmed the same U-shaped association after adjustment for SLE disease activity; however, the increased risk among those with highest levels of vitamin D was not statistically significant. Body mass index did not appear to be a confounding factor.
Our study is not able to prove causation, but the results strongly suggest an association of 25(OH)D at both lower and higher levels with adverse pregnancy outcomes. We recommend the monitoring of maternal serum 25(OH)D levels during SLE pregnancies, aiming for the ideal range of 40 to 59 ng/mL.
我们评估了25-羟基维生素D（25(OH)D）水平与系统性红斑狼疮（SLE）患者不良妊娠结局之间的关联。
霍普金斯狼疮队列研究纳入了妊娠患者的访视情况，包括每次访视时对25(OH)D水平的评估。我们研究了25(OH)D水平与不良妊娠结局（流产、早产和小于胎龄儿）之间的关系。我们还采用了事件发生时间分析来评估25(OH)D水平的随时间变化是否与流产或早产时间相关。
在根据25(OH)D水平平均值定义的患者亚组中，我们观察到流产风险（P = 0.0045）、早产风险（P = 0.0007）以及所有三种不良妊娠结局的综合指标风险（P = 0.011）存在显著差异。维生素D水平最低或最高的患者风险最高。孕中期维生素D水平低的10名妊娠患者中有9名早产。事件发生时间模型在调整SLE疾病活动度后证实了相同的U型关联；然而，维生素D水平最高者的风险增加在统计学上并不显著。体重指数似乎不是一个混杂因素。
我们的研究无法证明因果关系，但结果强烈提示较低和较高水平的25(OH)D均与不良妊娠结局相关。我们建议在SLE妊娠期间监测孕妇血清25(OH)D水平，目标范围为40至59 ng/mL。
