JCME：研究发现孕期缺维D新生儿体重低
2013-01-08 MedSci MedSci原创
美国内分泌学协会会刊《临床内分泌学与新陈代谢杂志》刊登一项新研究发现，孕期缺少维生素D的妇女，其孩子出生体重更轻。 美国匹茨堡大学科学家完成的这项新研究对2146名孕妇进行了研究。研究人员在孕妇妊娠26周及之前测量了其维生素D水平和新生儿出生体重。并在婴儿出生2
美国匹茨堡大学科学家完成的这项新研究对2146名孕妇进行了研究。研究人员在孕妇妊娠26周及之前测量了其维生素D水平和新生儿出生体重。并在婴儿出生24小时内测量了其头围及体重情况等。结果发现，妊娠26周之前，孕妇的维生素D水平与新生儿出生体重和头围之间存在正关联关系。在怀孕头三个月，孕妇维生素D水平与胎儿过小危险之间成反比例关系。新研究发现，将孕妇其它因素纳入考虑范畴之后，孕妇维生素D缺乏会导致新生儿体重降低46克。怀孕头三个月维生素D不足，胎儿发育不足的危险会增加两倍。
素D缺乏的主要原因就是晒太阳不够。孕妇维生素D缺乏会导致钙、磷和骨质代谢等异常。多项研究还表明，缺少维生素D还会导致其他多种健康问题。
研究成员之一埃里森·杰南德博士表示，多项早期研究结果表明，母亲维生素D与胎儿大小之间存在易变和矛盾的关联。但是新研究发现，在怀孕早期(头三个月)和中期(4—6个月)，孕妇维生素D水平与如期出生的新生儿正常体重之间存在密切关联。
新研究主持人丽萨·博德纳博士表示，这项新研究提供的流行病学证据表明，母亲维生素D状况(特别是怀孕早期)直接影响到胎儿的病理学和生理学发育情况。研究的下一步将对孕妇进行维生素D的随机测试，以进一步证实新研究结果。
Context: Inconsistent associations between maternal vitamin D status and fetal size have been published in small studies.
Objective: Our objective was to examine the association between maternal 25-hydroxyvitamin D [25(OH)D] levels and measures of newborn and placental weight.
Design and Setting: We measured maternal 25(OH)D in mothers from the Collaborative Perinatal Project, an observational cohort conducted in 12 U.S. medical centers from 1959 to 1965.
Participants: Women delivering singleton, term, live births with 25(OH)D measured at a gestation of 26 wk or less (n = 2146).
Main Outcome Measures: Birth weight, ponderal index, placental weight, the placental to fetal weight ratio, and small for gestational age were measured. Hypotheses were formulated after data collection.
Results: After confounder adjustment, mothers with 25(OH)D of 37.5 nmol/liter or greater gave birth to newborns with 46 g [95% confidence interval (CI), 9–82 g] higher birth weights and 0.13 cm (0.01–0.25 cm) larger head circumferences compared with mothers with less than 37.5 nmol/liter. Birth weight and head circumference rose with increasing 25(OH)D up to 37.5 nmol/liter and then leveled off (P < 0.05). No association was observed between 25(OH)D and ponderal index, placental weight, or the placental to fetal weight ratio. Maternal 25(OH)D of 37.5 nmol/liter or greater vs. less than 37.5 nmol/liter in the first trimester was associated with half the risk of small for gestational age (adjusted odds ratio 0.5; 95% CI 0.3–0.9), but no second-trimester association was observed.
Conclusions: Maternal vitamin D status is independently associated with markers of physiological and pathological growth in term infants. Adequately powered randomized controlled trials are needed to test whether maternal vitamin D supplementation may improve fetal growth.
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