Reverzani Cristina, Zaake Daniel, Nansubuga Faridah, Ssempewo Herman, Manirakiza Leonard, Kayiira Anthony, Tumwine Gilbert
Department of Obstetrics and Gynaecology, Uganda Martyrs University, Mother Kevin Postgraduate Medical School, Nsambya Campus, Kampala, Uganda
Department of Obstetrics and Gynaecology, Uganda Martyrs University, Mother Kevin Postgraduate Medical School, Nsambya Campus, Kampala, Uganda.
BMJ Open. 2025 Jan 22;15(1):e089504. doi: 10.1136/bmjopen-2024-089504.
There is a dearth of published data on the vitamin D status of the Ugandan population; the objective of the study was to determine the prevalence of vitamin D deficiency among pregnant women in Uganda and its associations with maternal characteristics and adverse foetal-maternal outcomes.
We conducted a cross-sectional study on pregnant women admitted to a tertiary referral hospital in Kampala, Uganda for delivery during the study period from July to December 2023.
The study was conducted on 351 pregnant women aged ≥18 years who consented to participate in the study, who had a single intrauterine pregnancy and a gestational age greater than 26 weeks, and who delivered at St. Francis Hospital, Nsambya. We excluded pregnant women admitted to the hospital longer than 1 week before delivery; pregnant women with self-reported pre-existing kidney diseases, liver diseases, or gut or malabsorption disorders and pregnant women with severe pregnancy-unrelated comorbidities requiring intensive care unit admission before delivery.
Maternal venous blood was collected at admission, and serum 25-hydroxy-vitamin D (25(OH)D) was measured by an electrochemiluminescence binding assay.
Maternal sociodemographic characteristics and obstetric-medical factors, and adverse maternal and foetal outcomes were captured by using a data collection form. The data were analysed by logistic regression analysis at the univariate, bivariate and multivariate levels.
The prevalence of vitamin D deficiency, defined as a serum 25(OH)D concentration less than 20 ng/mL, was 40.2%. This was seen more among the Muslims (OR 2.4, 95% CI 1.33 to 4.43, p value 0.004), members of the Banyankore tribe (OR 2.1, 95% CI 1.02 to 4.36, p value 0.043) and primigravidae (OR 0.6 for women with parity of 1-4 compared with primigravidity, 95% CI 0.36 to 0.94, p value 0.028). Among adverse maternal outcomes, vitamin D deficiency was associated with hypertensive disorders in pregnancy (OR 2.4, 95% CI 1.16 to 4.10, p value <0.001), in particular gestational hypertension (OR 2.2, 95% CI 1.21 to 4.94, p value 0.014), and pre-eclampsia/eclampsia/haemolysis, elevated liver enzymes and low platelets syndrome (OR 2.9, 95% CI 1.45 to 6.08, p value 0.003), with increased preterm birth (OR of 4.0, 95% CI 1.78 to 10.84, p value<0.001) and with delivery of babies with low birth weight (OR 4.2, 95% CI 2.63 to 13.62, p value 0.001).
The study found a high prevalence (40.2%) of vitamin D deficiency among pregnant women delivering at St. Francis Hospital, Nsambya. Additionally, vitamin D deficiency was linked with adverse maternal and foetal outcomes such as hypertensive disorders in pregnancy, preterm birth and low birth weight.
关于乌干达人群维生素D状况的已发表数据匮乏；本研究的目的是确定乌干达孕妇维生素D缺乏的患病率及其与母亲特征和不良母婴结局的关联。
我们对2023年7月至12月研究期间在乌干达坎帕拉一家三级转诊医院住院分娩的孕妇进行了一项横断面研究。
本研究对351名年龄≥18岁、同意参与研究、单胎宫内妊娠且孕周大于26周、并在圣弗朗西斯医院恩桑比亚分娩的孕妇进行。我们排除了分娩前住院超过1周的孕妇；自我报告有既往肾病、肝病、肠道或吸收不良疾病的孕妇，以及分娩前因严重妊娠无关合并症需要入住重症监护病房的孕妇。
入院时采集孕妇静脉血，采用电化学发光结合法测定血清25-羟基维生素D（25(OH)D）。
使用数据收集表记录母亲的社会人口学特征和产科-医学因素，以及不良母婴结局。数据在单变量、双变量和多变量水平上通过逻辑回归分析进行分析。
血清25(OH)D浓度低于20 ng/mL定义的维生素D缺乏患病率为40.2%。在穆斯林中更为常见（比值比2.4，95%置信区间1.33至4.43，p值0.004）、巴尼扬科雷部落成员中（比值比2.1，95%置信区间1.02至4.36，p值0.043）以及初产妇中（与初产妇相比，产次为1-4次的女性比值比为0.6，95%置信区间0.36至0.94，p值0.028）。在不良母亲结局中，维生素D缺乏与妊娠期高血压疾病相关（比值比2.4，95%置信区间1.16至4.10，p值<0.001），尤其是妊娠期高血压（比值比2.2，95%置信区间1.21至4.94，p值0.014），以及子痫前期/子痫/溶血、肝酶升高和血小板减少综合征（比值比2.9，95%置信区间1.45至6.08，p值0.003），与早产增加（比值比4.0，95%置信区间1.78至10.84，p值<0.001）以及低出生体重儿分娩相关（比值比4.2，95%置信区间 2.63至13.62，p值0.001）。
该研究发现，在圣弗朗西斯医院恩桑比亚分娩的孕妇中，维生素D缺乏患病率很高（40.2%）。此外，维生素D缺乏与不良母婴结局有关，如妊娠期高血压疾病、早产和低出生体重。
