孕母和新生兒維生素D水平及糖代謝的相關(guān)性研究
發(fā)布時間：2018-08-13 15:46
【摘要】：研究背景： 維生素D除調(diào)節(jié)鈣磷代謝,與骨骼健康密切相關(guān)外,還具有其他更為廣泛的骨骼外生物學(xué)效應(yīng),如調(diào)節(jié)免疫、抗腫瘤、保護中樞神經(jīng)系統(tǒng)和防控代謝綜合征等作用。由于富含維生素D食物的缺乏,人體內(nèi)維生素D主要來源于皮膚光照合成。而現(xiàn)代生活方式改變及各種條件限制大大減少了皮膚暴露于利于維生素D合成的波長290～315nm的紫外線B的時間。故近年來,幾乎在全球各種族人群中均有維生素D缺乏發(fā)生率增高的研究報道。 孕婦及嬰幼兒特殊的生理特點使其成為維生素D缺乏的高危人群。妊娠期間,尤其在孕晚期25-(OH)D能通過胎盤轉(zhuǎn)運至胎兒,是新生兒維生素D儲備的來源。因此,嬰幼兒維生素D缺乏可能不僅是由于嬰幼兒期產(chǎn)生和獲得維生素D不足,更可能是由于胎兒時期從母體獲得的維生素D儲備不足導(dǎo)致。 研究表明,孕母維生素D缺乏不僅與先兆子癇、妊娠糖尿病(GDM)、細(xì)菌性陰道病、流產(chǎn)、早產(chǎn)的發(fā)生有關(guān),孕母充足的維生素D營養(yǎng)還可防止小兒呼吸道感染、哮喘、Ⅰ型糖尿病(TIDM)、炎癥性腸道疾病、雙相情感障礙、精神分裂癥等的發(fā)生。妊娠期受體內(nèi)激素的影響,易發(fā)生胰島素抵抗,孕晚期正常孕婦胰島素反應(yīng)比非妊娠婦女降低50-70%。維生素D缺乏一直被認(rèn)為是糖耐受不良的重要因素,國外研究發(fā)現(xiàn)孕母維生素D營養(yǎng)狀況與其本身GDM及其后代TIDM的發(fā)生密切相關(guān)。GDM孕婦維生素D水平較低,維生素D缺乏孕婦的胰島素抵抗水平較高、GDM發(fā)生率增高,孕期母親補充魚肝油及由飲食中攝入較多的維生素D,可降低兒童T1DM相關(guān)的自身免疫的發(fā)生。 我國維生素D強化食物除配方奶粉外,尚未普及,雖然中華醫(yī)學(xué)會兒科分會制定的維生素D缺乏性佝僂病的防治建議中已提出,孕末期母親應(yīng)補充維生素D400-1000IU/d,但尚未推廣。國內(nèi)對孕母及新生兒維生素D水平的調(diào)查及相關(guān)性研究較少,且樣本量小,更缺乏對孕母維生素D水平與糖代謝關(guān)系的研究,因此迫切需要進行大樣本孕母及新生兒維生素D水平的調(diào)查研究,以了解孕母及新生兒維生素D水平及其相關(guān)因素,明確孕母與新生兒維生素D水平的相關(guān)性,并探索孕母維生素D水平與其本身及其新生兒糖代謝的關(guān)系,為婦幼公共衛(wèi)生中維生素D缺乏防治措施的制定提供依據(jù)。 第一部分孕母和新生兒維生素D水平及其相關(guān)因素的分析研究方法： 1)酶聯(lián)免疫法檢測孕30-37周齡孕母及其新生兒臍血的血清25-(OH)D濃度。 2)參考病歷及問卷調(diào)查收集孕母生活方式,膳食習(xí)慣及新生兒出生情況資料。 3)不同季節(jié)孕母及新生兒維生素D水平的差異采用多樣本秩和檢驗。 4)根據(jù)血清25-(OH)D水平,將孕母維生素D水平劃分為50nmol/L及≥50nmol/L兩組。 5)與孕母維生素D水平相關(guān)的因素,單因素分析采用兩樣本秩和檢驗及Pearson卡方檢驗,多因素分析采用二分類logistic回歸。 6) Spearman相關(guān)及偏相關(guān)分析母親-新生兒25-(OH)D水平的相關(guān)性。 結(jié)果： 1)本研究共納入624例孕母及其分娩的499例新生兒。 2)孕母25-(OH)D濃度的中位數(shù)(5-95百分位數(shù))為33.2(15.6-59.8)nmol/L,新生兒為29.6(13.2-54.2) nmol/L,分別有88%的孕母及91%的新生兒血清25-(OH)D50nmol/L,僅1例新生兒及1%的孕母25-(OH)D水平75nmol/L. 3)孕母及新生兒維生素D水平存在明顯的季節(jié)差異(X2分別=137.6,79.4,P均=0.000)；春季最低,98%的孕母和99%的新生兒血清25-(OH)D50nmol/L;秋季最高,但仍有68%的孕母及75%的新生兒50nmol/L。 4)除季節(jié)因素外,孕期補充鈣維生素D合劑≥1次／天可減少孕母維生素D缺乏(25-(OH)D50nmol/L)的發(fā)生(OR=3.07[95%CI:1.39,6.76])。 5)孕母和新生兒臍血25-(OH)D水平呈較弱的正相關(guān)性(r=0.38,P=0.000,N=499),當(dāng)孕母25-(OH)D≤25nmol/L時,則兩者相關(guān)性無統(tǒng)計學(xué)意義。 第二部分孕母維生素D水平對其本身及其新生兒糖代謝的影響 研究方法： 1)通過病歷和問卷調(diào)查收集孕母人口學(xué)基本信息、孕周和妊娠合并癥情況、孕期身體鍛煉、乳類攝入、鈣維生素D合劑補充狀況及新生兒出生情況。 2)檢測孕母及新生兒臍血糖代謝指標(biāo)：空腹血糖(FG)、糖化血紅蛋白(HbAlc)、血清C肽(CP)、胰島素(IN)及孕母血清25-(OH)D濃度。 3)根據(jù)穩(wěn)態(tài)模型計算胰島素抵抗指數(shù)(IR),即：IN (mIU/L)×FG (mmol/L)/22.5. 4)根據(jù)孕母25-(OH)D濃度,將孕母和新生兒劃分為25-(OH)D≤25nmol/L,25-50nmol/L,≥50nmol/L三組。 5)孕母及新生兒FG. HbAlc、CP、IN、IR水平的組間差異采用多樣本秩和檢驗。 6)校正孕母年齡、孕周、季節(jié)、孕前體塊指數(shù)(BMI)、鈣維生素D合劑補充、乳類攝入及孕期身體鍛煉情況,偏相關(guān)分析發(fā)現(xiàn)孕母25-(OH)D與其本身及其新生兒糖代謝指標(biāo)的相關(guān)性。 結(jié)果： 1)本研究共納入513例孕母及其370例新生兒。 2)不同維生素D水平孕母的HbAlc、FG、IN及IR有顯著統(tǒng)計學(xué)差異(P均0.05)。孕母25-(OH)D水平與其糖代謝指標(biāo)FG(偏相關(guān)系數(shù)r=-0.18,P=0.000)、IN(偏相關(guān)系數(shù)r=-0.13,P=0.003)及IR(偏相關(guān)系數(shù)r=-0.14,P=0.001)呈負(fù)相關(guān)。 3)不同維生素D水平孕母的新生兒HbAlc有顯著統(tǒng)計學(xué)差異(P=0.03)。孕母25-(OH)D與其新生兒臍血各糖代謝指標(biāo)均無明顯統(tǒng)計學(xué)相關(guān)。 結(jié)論： 1)孕晚期母親及新生兒的維生素D水平普遍較低,并有明顯季節(jié)差異,以春季最低。提示應(yīng)重視妊娠期維生素D補充,尤其是冬春季節(jié),以保證孕母和胎兒充足的維生素D營養(yǎng)。 2)孕母-新生兒25-(OH)D水平呈較弱的正相關(guān),當(dāng)孕母25-(OH)D≤25nmol/L時,則無明顯相關(guān)性。提示25-(OH)D從孕母向胎兒的轉(zhuǎn)運不僅與母親維生素D水平有關(guān),也可能與胎盤轉(zhuǎn)運機制有關(guān)。 3)孕晚期母親維生素D水平與其自身FG、IN及IR呈較弱的負(fù)相關(guān)性,與新生兒糖代謝無明顯相關(guān)。提示充足的維生素D營養(yǎng)有利于保護孕母,減少妊娠誘導(dǎo)的胰島素抵抗風(fēng)險,孕母維生素D水平對其后代的糖代謝影響作用有待于進一步追蹤隨訪。
[Abstract]:Research background:
In addition to regulating calcium and phosphorus metabolism, vitamin D is closely related to bone health, it also has other wider extraskeletal biological effects, such as regulating immunity, anti-tumor, protecting the central nervous system and preventing metabolic syndrome. Substitution lifestyle changes and conditional restrictions have greatly reduced skin exposure to UVB at wavelengths of 290-315 nm favorable for vitamin D synthesis.
Pregnant women and infants are at high risk for vitamin D deficiency due to their special physiological characteristics. 25-(OH) D can be transported to the fetus during pregnancy, especially in the late trimester, and is a source of vitamin D reserves in the newborn. Therefore, vitamin D deficiency in infants and young children may be due not only to the production of vitamin D in infancy and insufficient vitamin D availability, but also more likely to occur. It is due to insufficient vitamin D reserves obtained from the mother during the fetus.
Studies have shown that maternal vitamin D deficiency is not only associated with preeclampsia, gestational diabetes mellitus (GDM), bacterial vaginosis, abortion, premature delivery, but also prevents respiratory tract infections, asthma, type 1 diabetes mellitus (TIDM), inflammatory bowel disease, bipolar affective disorders, schizophrenia and so on. Vitamin D deficiency has been considered to be an important factor in impaired glucose tolerance. It has been found that the nutritional status of vitamin D in pregnant women is closely related to the occurrence of GDM and TIDM in their offspring. Low levels of D, high levels of insulin resistance and high incidence of GDM in pregnant women with vitamin D deficiency, supplementation of cod liver oil and high intake of vitamin D from diet during pregnancy can reduce the incidence of T1DM-related autoimmunity in children.
Vitamin D fortified foods have not been widely used in China except formula milk powder. Although the suggestion of vitamin D deficient rickets made by the branch of Chinese Medical Association has been put forward that mothers should take vitamin D 400-1000IU/d at the end of pregnancy, it has not been popularized yet. Because of the small sample size and the lack of research on the relationship between vitamin D level and glucose metabolism in pregnant women, it is urgent to investigate and study the vitamin D level of pregnant women and newborns with large sample size in order to understand the vitamin D level of pregnant women and newborns and its related factors, clarify the correlation between the vitamin D level of pregnant women and newborns, and explore the survival of pregnant women. The relationship between the level of vitamin D and the glucose metabolism of the newborn provides the basis for the prevention and treatment of vitamin D deficiency in maternal and child public health.
Part one: analysis of vitamin D levels and related factors in pregnant women and newborns.
1) serum 25- (OH) D concentration was measured by enzyme-linked immunosorbent assay (UCI) in 30-37 week pregnant women and their newborns.
2) Data on maternal lifestyle, dietary habits and neonatal births were collected from medical records and questionnaires.
3) the difference of vitamin D levels between pregnant women and newborns in different seasons was analyzed by multiple rank sum test.
4) According to the serum 25-(OH) D level, the pregnant women were divided into 50 nmol/L and <50 nmol/L groups.
5) Factors related to vitamin D levels in pregnant women were analyzed by two-sample rank sum test and Pearson chi-square test, and binary logistic regression was used for multivariate analysis.
6) Spearman correlation and partial correlation analysis of maternal neonatal 25- (OH) D level correlation.
Result:
1) the study included 624 pregnant women and 499 newborn babies.
2) The median concentration of 25-(OH) D in pregnant women (5-95 percentile) was 33.2 (15.6-59.8) nmol/L, 29.6 (13.2-54.2) nmol/L in newborns, 88% of pregnant women and 91% of newborns serum 25-(OH) D50 nmol/L, only one newborns and 1% of pregnant women had 25-(OH) D levels of 75 nmol/L.
3) There were significant seasonal differences in vitamin D levels between pregnant women and newborns (X2 = 137.6,79.4,P = 0.000 respectively); the lowest in spring, 98% of pregnant women and 99% of newborns serum 25-(OH) D50 nmol/L; the highest in autumn, but still 68% of pregnant women and 75% of newborns were 50 nmol/L.
4) In addition to seasonal factors, supplementation of calcium and vitamin D (> once a day) during pregnancy can reduce the incidence of vitamin D deficiency (25-(OH) D50nmol/L) in pregnant women (OR = 3.07 [95% CI: 1.39, 6.76]).
5) There was a weak positive correlation between maternal and neonatal umbilical cord blood 25 - (OH) D levels (r = 0.38, P = 0.000, N = 499), but no significant correlation was found when maternal 25 - (OH) D < 25 nmol / L.
The second part is the effect of maternal vitamin D level on the glucose metabolism of the newborn and its newborns.
Research methods:
1) Basic maternal demographic information, gestational age and complications, physical exercise during pregnancy, milk intake, calcium and vitamin D supplementation and neonatal birth status were collected through medical records and questionnaires.
2) The levels of fasting blood glucose (FG), glycosylated hemoglobin (HbAlc), serum C peptide (CP), insulin (IN) and maternal serum 25-(OH) D were measured.
3) calculate the insulin resistance index (IR) according to the steady state model, that is, IN (mIU/L) x FG (mmol/L) /22.5.
4) According to maternal 25-(OH) D concentration, pregnant women and newborns were divided into three groups: 25-(OH) D < 25 nmol/L, 25-50 nmol/L, and < 50 nmol/L.
5) the difference of FG. HbAlc, CP, IN and IR levels between pregnant women and neonates was analyzed by multiple rank sum test.
6) Maternal age, gestational age, gestational age, season, BMI, calcium and vitamin D supplementation, milk intake and physical exercise during pregnancy were adjusted. Partial correlation analysis showed that 25-(OH) D of pregnant women was correlated with glucose metabolism of themselves and their newborns.
Result:
1) a total of 513 pregnant women and 370 newborns were included in this study.
2) There were significant differences in HBAlc, FG, IN and IR among pregnant women with different vitamin D levels (all P 0.05). There was a negative correlation between 25-(OH) D level and FG (partial correlation coefficient r = - 0.18, P = 0.000), IN (partial correlation coefficient r = - 0.13, P = 0.003) and IR (partial correlation coefficient r = - 0.14, P = 0.001).
3) There was significant difference in HbAlc between pregnant women with different vitamin D levels (P = 0.03). There was no significant correlation between pregnant women 25-(OH) D and their umbilical cord blood glucose metabolism.
Conclusion:
1) The vitamin D levels of mothers and newborns in late pregnancy are generally low, and there are obvious seasonal differences, with the lowest in spring.
2) The level of 25-(OH) D between mother and newborn was weakly positively correlated, but there was no significant correlation between 25-(OH) D and 25 nmol/L. It suggested that the transport of 25-(OH) D from mother to fetus was not only related to the level of vitamin D in mother, but also to the mechanism of placental transport.
3) The maternal vitamin D level in the third trimester of pregnancy was negatively correlated with FG, IN and IR, but not significantly with glucose metabolism in the newborn. Visit.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R722.1
本文編號：2181443
[Abstract]:Research background:
In addition to regulating calcium and phosphorus metabolism, vitamin D is closely related to bone health, it also has other wider extraskeletal biological effects, such as regulating immunity, anti-tumor, protecting the central nervous system and preventing metabolic syndrome. Substitution lifestyle changes and conditional restrictions have greatly reduced skin exposure to UVB at wavelengths of 290-315 nm favorable for vitamin D synthesis.
Pregnant women and infants are at high risk for vitamin D deficiency due to their special physiological characteristics. 25-(OH) D can be transported to the fetus during pregnancy, especially in the late trimester, and is a source of vitamin D reserves in the newborn. Therefore, vitamin D deficiency in infants and young children may be due not only to the production of vitamin D in infancy and insufficient vitamin D availability, but also more likely to occur. It is due to insufficient vitamin D reserves obtained from the mother during the fetus.
Studies have shown that maternal vitamin D deficiency is not only associated with preeclampsia, gestational diabetes mellitus (GDM), bacterial vaginosis, abortion, premature delivery, but also prevents respiratory tract infections, asthma, type 1 diabetes mellitus (TIDM), inflammatory bowel disease, bipolar affective disorders, schizophrenia and so on. Vitamin D deficiency has been considered to be an important factor in impaired glucose tolerance. It has been found that the nutritional status of vitamin D in pregnant women is closely related to the occurrence of GDM and TIDM in their offspring. Low levels of D, high levels of insulin resistance and high incidence of GDM in pregnant women with vitamin D deficiency, supplementation of cod liver oil and high intake of vitamin D from diet during pregnancy can reduce the incidence of T1DM-related autoimmunity in children.
Vitamin D fortified foods have not been widely used in China except formula milk powder. Although the suggestion of vitamin D deficient rickets made by the branch of Chinese Medical Association has been put forward that mothers should take vitamin D 400-1000IU/d at the end of pregnancy, it has not been popularized yet. Because of the small sample size and the lack of research on the relationship between vitamin D level and glucose metabolism in pregnant women, it is urgent to investigate and study the vitamin D level of pregnant women and newborns with large sample size in order to understand the vitamin D level of pregnant women and newborns and its related factors, clarify the correlation between the vitamin D level of pregnant women and newborns, and explore the survival of pregnant women. The relationship between the level of vitamin D and the glucose metabolism of the newborn provides the basis for the prevention and treatment of vitamin D deficiency in maternal and child public health.
Part one: analysis of vitamin D levels and related factors in pregnant women and newborns.
1) serum 25- (OH) D concentration was measured by enzyme-linked immunosorbent assay (UCI) in 30-37 week pregnant women and their newborns.
2) Data on maternal lifestyle, dietary habits and neonatal births were collected from medical records and questionnaires.
3) the difference of vitamin D levels between pregnant women and newborns in different seasons was analyzed by multiple rank sum test.
4) According to the serum 25-(OH) D level, the pregnant women were divided into 50 nmol/L and <50 nmol/L groups.
5) Factors related to vitamin D levels in pregnant women were analyzed by two-sample rank sum test and Pearson chi-square test, and binary logistic regression was used for multivariate analysis.
6) Spearman correlation and partial correlation analysis of maternal neonatal 25- (OH) D level correlation.
Result:
1) the study included 624 pregnant women and 499 newborn babies.
2) The median concentration of 25-(OH) D in pregnant women (5-95 percentile) was 33.2 (15.6-59.8) nmol/L, 29.6 (13.2-54.2) nmol/L in newborns, 88% of pregnant women and 91% of newborns serum 25-(OH) D50 nmol/L, only one newborns and 1% of pregnant women had 25-(OH) D levels of 75 nmol/L.
3) There were significant seasonal differences in vitamin D levels between pregnant women and newborns (X2 = 137.6,79.4,P = 0.000 respectively); the lowest in spring, 98% of pregnant women and 99% of newborns serum 25-(OH) D50 nmol/L; the highest in autumn, but still 68% of pregnant women and 75% of newborns were 50 nmol/L.
4) In addition to seasonal factors, supplementation of calcium and vitamin D (> once a day) during pregnancy can reduce the incidence of vitamin D deficiency (25-(OH) D50nmol/L) in pregnant women (OR = 3.07 [95% CI: 1.39, 6.76]).
5) There was a weak positive correlation between maternal and neonatal umbilical cord blood 25 - (OH) D levels (r = 0.38, P = 0.000, N = 499), but no significant correlation was found when maternal 25 - (OH) D < 25 nmol / L.
The second part is the effect of maternal vitamin D level on the glucose metabolism of the newborn and its newborns.
Research methods:
1) Basic maternal demographic information, gestational age and complications, physical exercise during pregnancy, milk intake, calcium and vitamin D supplementation and neonatal birth status were collected through medical records and questionnaires.
2) The levels of fasting blood glucose (FG), glycosylated hemoglobin (HbAlc), serum C peptide (CP), insulin (IN) and maternal serum 25-(OH) D were measured.
3) calculate the insulin resistance index (IR) according to the steady state model, that is, IN (mIU/L) x FG (mmol/L) /22.5.
4) According to maternal 25-(OH) D concentration, pregnant women and newborns were divided into three groups: 25-(OH) D < 25 nmol/L, 25-50 nmol/L, and < 50 nmol/L.
5) the difference of FG. HbAlc, CP, IN and IR levels between pregnant women and neonates was analyzed by multiple rank sum test.
6) Maternal age, gestational age, gestational age, season, BMI, calcium and vitamin D supplementation, milk intake and physical exercise during pregnancy were adjusted. Partial correlation analysis showed that 25-(OH) D of pregnant women was correlated with glucose metabolism of themselves and their newborns.
Result:
1) a total of 513 pregnant women and 370 newborns were included in this study.
2) There were significant differences in HBAlc, FG, IN and IR among pregnant women with different vitamin D levels (all P 0.05). There was a negative correlation between 25-(OH) D level and FG (partial correlation coefficient r = - 0.18, P = 0.000), IN (partial correlation coefficient r = - 0.13, P = 0.003) and IR (partial correlation coefficient r = - 0.14, P = 0.001).
3) There was significant difference in HbAlc between pregnant women with different vitamin D levels (P = 0.03). There was no significant correlation between pregnant women 25-(OH) D and their umbilical cord blood glucose metabolism.
Conclusion:
1) The vitamin D levels of mothers and newborns in late pregnancy are generally low, and there are obvious seasonal differences, with the lowest in spring.
2) The level of 25-(OH) D between mother and newborn was weakly positively correlated, but there was no significant correlation between 25-(OH) D and 25 nmol/L. It suggested that the transport of 25-(OH) D from mother to fetus was not only related to the level of vitamin D in mother, but also to the mechanism of placental transport.
3) The maternal vitamin D level in the third trimester of pregnancy was negatively correlated with FG, IN and IR, but not significantly with glucose metabolism in the newborn. Visit.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R722.1
【參考文獻】
相關(guān)期刊論文 前1條
1 黃淑珍,崔文霞,季冬,趙立梅;0歲～3歲嬰幼兒維生素D缺乏性佝僂病患病情況調(diào)查[J];實用醫(yī)技雜志;2004年05期
，本文編號：2181443
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