Jung Catherine, Lu Zheng, Litonjua Augusto A, Loscalzo Joseph, Weiss Scott T, Mirzakhani Hooman
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Am J Clin Nutr. 2025 Jul;122(1):324-334. doi: 10.1016/j.ajcnut.2025.04.034. Epub 2025 May 5.
Adverse pregnancy outcomes (APOs) affect ∼20% of pregnancies and pose significant health risks for mothers and fetuses. Identifying risk factors is crucial for developing prevention strategies.
This study examined the association between vitamin D status, measured by 25-hydroxyvitamin D (25(OH)D) concentrations, and APO risk, and whether this association varies by pregnancy timing and body mass index (BMI) (kg/m).
In this ancillary analysis of the Vitamin D Antenatal Asthma Reduction Trial, we used multivariable logistic regression models to examine the association between 25(OH)D concentrations in early (10-18 wk) and late (32-38 wk) pregnancy, and development of a composite APO outcome, including pre-eclampsia, gestational hypertension, gestational diabetes, intrauterine growth restriction, and preterm birth.
Among 816 participants in the intention-to-treat analysis, 283 composite APO events occurred. Vitamin D supplementation did not significantly reduce APO risk. Participants who developed APOs had lower baseline 25(OH)D concentrations than those who did not (mean ± SD: 21.72 ± 10.04 vs. 23.47 ± 10.29 ng/mL; mean difference ± SE: 1.75 ± 0.78; P = 0.026). A significant interaction was observed between baseline 25(OH)D and BMI (interaction term, odds ratio [OR]: 1.04; 95% confidence interval [95% CI]: 1.00, 1.08; P = 0.041). Among participants with BMI < 25 (reference group), each unit increase in baseline 25(OH)D (ng/mL) was associated with 4% lower odds of developing an APO (OR: 0.96; 95% CI: 0.93, 0.99; P = 0.013), whereas no association was observed among participants with BMI ≥ 25 kg/m (OR: 1.00; 95% CI: 0.98, 1.02; P = 0.83). Third-trimester 25(OH)D concentrations did not differ between participants with and without APOs.
Although vitamin D supplementation did not reduce APO risk, higher early pregnancy 25(OH)D concentrations were associated with lower odds of APOs in participants with BMI < 25. These findings highlight the potential importance of higher early pregnancy 25(OH)D concentrations, particularly among those with normal BMI, in reducing APO risk.
This study is an ancillary analysis from VDAART, which is registered with ClinicalTrials.gov (NCT00920621: https://clinicaltrials.gov/study/NCT00920621?term=vdaart&rank=1).
不良妊娠结局（APO）影响约20%的妊娠，并对母亲和胎儿构成重大健康风险。识别风险因素对于制定预防策略至关重要。
本研究探讨了通过25-羟基维生素D（25(OH)D）浓度衡量的维生素D状态与APO风险之间的关联，以及这种关联是否因妊娠时间和体重指数（BMI，kg/m²）而异。
在维生素D预防产前哮喘试验的这项辅助分析中，我们使用多变量逻辑回归模型来研究妊娠早期（10 - 18周）和晚期（32 - 38周）的25(OH)D浓度与复合APO结局的发生之间的关联，复合APO结局包括子痫前期、妊娠期高血压、妊娠期糖尿病、胎儿生长受限和早产。
在意向性分析的816名参与者中，发生了283例复合APO事件。维生素D补充剂并未显著降低APO风险。发生APO的参与者的基线25(OH)D浓度低于未发生者（均值±标准差：21.72±10.04 vs. 23.47±10.29 ng/mL；平均差值±标准误：1.75±0.78；P = 0.026）。观察到基线25(OH)D与BMI之间存在显著交互作用（交互项，比值比[OR]：1.04；95%置信区间[95%CI]：1.00，1.08；P = 0.041）。在BMI < 25（参照组）的参与者中，基线25(OH)D（ng/mL）每增加一个单位，发生APO的几率降低4%（OR：0.96；95%CI：0.93，0.99；P = 0.013），而在BMI≥25 kg/m²的参与者中未观察到关联（OR：1.00；95%CI：0.98，1.02；P = 0.83）。有和没有APO的参与者在孕晚期的25(OH)D浓度没有差异。
尽管维生素D补充剂未降低APO风险，但妊娠早期较高的25(OH)D浓度与BMI < 25的参与者发生APO的几率较低相关。这些发现凸显了妊娠早期较高的25(OH)D浓度，特别是在BMI正常的人群中，对于降低APO风险的潜在重要性。
本研究是维生素D预防产前哮喘试验的一项辅助分析，该试验已在ClinicalTrials.gov注册（NCT00920621：https://clinicaltrials.gov/study/NCT00920621?term=vdaart&rank=1）。
