孕母和新生儿维生素D水平及糖代谢的相关性研究
发布时间：2018-08-13 15:46
【摘要】：研究背景： 维生素D除调节钙磷代谢,与骨骼健康密切相关外,还具有其他更为广泛的骨骼外生物学效应,如调节免疫、抗肿瘤、保护中枢神经系统和防控代谢综合征等作用。由于富含维生素D食物的缺乏,人体内维生素D主要来源于皮肤光照合成。而现代生活方式改变及各种条件限制大大减少了皮肤暴露于利于维生素D合成的波长290～315nm的紫外线B的时间。故近年来,几乎在全球各种族人群中均有维生素D缺乏发生率增高的研究报道。 孕妇及婴幼儿特殊的生理特点使其成为维生素D缺乏的高危人群。妊娠期间,尤其在孕晚期25-(OH)D能通过胎盘转运至胎儿,是新生儿维生素D储备的来源。因此,婴幼儿维生素D缺乏可能不仅是由于婴幼儿期产生和获得维生素D不足,更可能是由于胎儿时期从母体获得的维生素D储备不足导致。 研究表明,孕母维生素D缺乏不仅与先兆子痫、妊娠糖尿病(GDM)、细菌性阴道病、流产、早产的发生有关,孕母充足的维生素D营养还可防止小儿呼吸道感染、哮喘、Ⅰ型糖尿病(TIDM)、炎症性肠道疾病、双相情感障碍、精神分裂症等的发生。妊娠期受体内激素的影响,易发生胰岛素抵抗,孕晚期正常孕妇胰岛素反应比非妊娠妇女降低50-70%。维生素D缺乏一直被认为是糖耐受不良的重要因素,国外研究发现孕母维生素D营养状况与其本身GDM及其后代TIDM的发生密切相关。GDM孕妇维生素D水平较低,维生素D缺乏孕妇的胰岛素抵抗水平较高、GDM发生率增高,孕期母亲补充鱼肝油及由饮食中摄入较多的维生素D,可降低儿童T1DM相关的自身免疫的发生。 我国维生素D强化食物除配方奶粉外,尚未普及,虽然中华医学会儿科分会制定的维生素D缺乏性佝偻病的防治建议中已提出,孕末期母亲应补充维生素D400-1000IU/d,但尚未推广。国内对孕母及新生儿维生素D水平的调查及相关性研究较少,且样本量小,更缺乏对孕母维生素D水平与糖代谢关系的研究,因此迫切需要进行大样本孕母及新生儿维生素D水平的调查研究,以了解孕母及新生儿维生素D水平及其相关因素,明确孕母与新生儿维生素D水平的相关性,并探索孕母维生素D水平与其本身及其新生儿糖代谢的关系,为妇幼公共卫生中维生素D缺乏防治措施的制定提供依据。 第一部分孕母和新生儿维生素D水平及其相关因素的分析研究方法： 1)酶联免疫法检测孕30-37周龄孕母及其新生儿脐血的血清25-(OH)D浓度。 2)参考病历及问卷调查收集孕母生活方式,膳食习惯及新生儿出生情况资料。 3)不同季节孕母及新生儿维生素D水平的差异采用多样本秩和检验。 4)根据血清25-(OH)D水平,将孕母维生素D水平划分为50nmol/L及≥50nmol/L两组。 5)与孕母维生素D水平相关的因素,单因素分析采用两样本秩和检验及Pearson卡方检验,多因素分析采用二分类logistic回归。 6) Spearman相关及偏相关分析母亲-新生儿25-(OH)D水平的相关性。 结果： 1)本研究共纳入624例孕母及其分娩的499例新生儿。 2)孕母25-(OH)D浓度的中位数(5-95百分位数)为33.2(15.6-59.8)nmol/L,新生儿为29.6(13.2-54.2) nmol/L,分别有88%的孕母及91%的新生儿血清25-(OH)D50nmol/L,仅1例新生儿及1%的孕母25-(OH)D水平75nmol/L. 3)孕母及新生儿维生素D水平存在明显的季节差异(X2分别=137.6,79.4,P均=0.000)；春季最低,98%的孕母和99%的新生儿血清25-(OH)D50nmol/L;秋季最高,但仍有68%的孕母及75%的新生儿50nmol/L。 4)除季节因素外,孕期补充钙维生素D合剂≥1次／天可减少孕母维生素D缺乏(25-(OH)D50nmol/L)的发生(OR=3.07[95%CI:1.39,6.76])。 5)孕母和新生儿脐血25-(OH)D水平呈较弱的正相关性(r=0.38,P=0.000,N=499),当孕母25-(OH)D≤25nmol/L时,则两者相关性无统计学意义。 第二部分孕母维生素D水平对其本身及其新生儿糖代谢的影响 研究方法： 1)通过病历和问卷调查收集孕母人口学基本信息、孕周和妊娠合并症情况、孕期身体锻炼、乳类摄入、钙维生素D合剂补充状况及新生儿出生情况。 2)检测孕母及新生儿脐血糖代谢指标：空腹血糖(FG)、糖化血红蛋白(HbAlc)、血清C肽(CP)、胰岛素(IN)及孕母血清25-(OH)D浓度。 3)根据稳态模型计算胰岛素抵抗指数(IR),即：IN (mIU/L)×FG (mmol/L)/22.5. 4)根据孕母25-(OH)D浓度,将孕母和新生儿划分为25-(OH)D≤25nmol/L,25-50nmol/L,≥50nmol/L三组。 5)孕母及新生儿FG. HbAlc、CP、IN、IR水平的组间差异采用多样本秩和检验。 6)校正孕母年龄、孕周、季节、孕前体块指数(BMI)、钙维生素D合剂补充、乳类摄入及孕期身体锻炼情况,偏相关分析发现孕母25-(OH)D与其本身及其新生儿糖代谢指标的相关性。 结果： 1)本研究共纳入513例孕母及其370例新生儿。 2)不同维生素D水平孕母的HbAlc、FG、IN及IR有显著统计学差异(P均0.05)。孕母25-(OH)D水平与其糖代谢指标FG(偏相关系数r=-0.18,P=0.000)、IN(偏相关系数r=-0.13,P=0.003)及IR(偏相关系数r=-0.14,P=0.001)呈负相关。 3)不同维生素D水平孕母的新生儿HbAlc有显著统计学差异(P=0.03)。孕母25-(OH)D与其新生儿脐血各糖代谢指标均无明显统计学相关。 结论： 1)孕晚期母亲及新生儿的维生素D水平普遍较低,并有明显季节差异,以春季最低。提示应重视妊娠期维生素D补充,尤其是冬春季节,以保证孕母和胎儿充足的维生素D营养。 2)孕母-新生儿25-(OH)D水平呈较弱的正相关,当孕母25-(OH)D≤25nmol/L时,则无明显相关性。提示25-(OH)D从孕母向胎儿的转运不仅与母亲维生素D水平有关,也可能与胎盘转运机制有关。 3)孕晚期母亲维生素D水平与其自身FG、IN及IR呈较弱的负相关性,与新生儿糖代谢无明显相关。提示充足的维生素D营养有利于保护孕母,减少妊娠诱导的胰岛素抵抗风险,孕母维生素D水平对其后代的糖代谢影响作用有待于进一步追踪随访。
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.1
本文编号：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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.1
【参考文献】
相关期刊论文 前1条
1 黄淑珍,崔文霞,季冬,赵立梅;0岁～3岁婴幼儿维生素D缺乏性佝偻病患病情况调查[J];实用医技杂志;2004年05期
，本文编号：2181443
本文链接：https://www.wllwen.com/yixuelunwen/eklw/2181443.html
最近更新
教材专著
