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Vitamin D insufficiency among Danish pregnant women-Prevalence and association with adverse obstetric outcomes and placental vitamin D metabolism.

丹麦孕妇维生素d不足-患病率及其与不良产科结局和胎盘维生素d代谢的关系。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14019
  • 作者列表:"Vestergaard AL","Justesen S","Volqvartz T","Aagaard SK","Andreasen MF","Lesnikova I","Uldbjerg N","Larsen A","Bor P
  • 发表时间:2021-03-01
Abstract

INTRODUCTION:In pregnancy, vitamin D deficiency is associated with increased risk of fetal growth restriction and preeclampsia. The underlying mechanisms are not known, but placental dysfunction is believed to play a role. In a Danish population, where health authorities recommend a 10 µg/day vitamin D supplement during pregnancy, we explored current use of vitamin D supplements and vitamin D status. In term placentas, alterations in vitamin D metabolism and placental growth, evaluated by the key placental growth factor pregnancy-associated plasma protein-A (PAPP-A), and their relation to vitamin D insufficiency were investigated. MATERIAL AND METHODS:We included 225 randomly selected pregnant women attending a nuchal translucency scan at gestational weeks 11-14. Information on use of vitamin D supplements and body mass index (BMI) at inclusion was obtained using self-reported questionnaires. Plasma 25-hydroxyvitamin D was measured at inclusion and correlated with pregnancy outcomes and placental biology, as judged by expression of PAPP-A and enzymes involved in vitamin D metabolism (CYP24A1, CYP27B1) in term placentas. RESULTS:Vitamin D supplements were used by 92% of the women, but 42% were vitamin D insufficient (plasma 25-hydroxyvitamin D <75 nmol/L). Eleven women with singleton pregnancies developed fetal growth restriction or preeclampsia. In this small subset, first-trimester mean plasma 25-hydroxyvitamin D was lower in women who developed fetal growth restriction (43 ± 33nmol/L; n = 3; P = .006) and there was a tendency towards lower plasma 25-hydroxyvitamin D among women who developed preeclampsia (65 ± 19 nmol/L; n = 8; P = .08) in third trimester compared with uncomplicated pregnancies (79 ± 22 nmol/L; n = 187). In term placentas, PAPP-A expression was lower among participants with first-trimester vitamin D insufficiency (P = .009; n = 30) but no correlation was found between plasma 25-hydroxyvitamin D and mRNA expression of CYP24A1 (P = .67) and CYP27B1 (P = .34). BMI was negatively correlated with plasma 25-hydroxyvitamin D (P = .03) and positively correlated with placental mRNA expression of CYP24A1 (P = .003; n = 30). CONCLUSIONS:Despite high compliance with official guidelines regarding vitamin D supplements, vitamin D insufficiency was frequent and the findings indicate that vitamin D insufficiency may affect placental growth. High BMI was associated with vitamin D insufficiency and increased placental vitamin D turnover, but further investigations are needed.

摘要

介绍: 在怀孕期间,维生素d缺乏与胎儿生长受限和先兆子痫的风险增加有关。潜在的机制尚不清楚,但胎盘功能障碍被认为发挥了作用。在丹麦人群中,卫生当局建议在怀孕期间补充10 µ g/天的维生素d,我们探讨了目前维生素d补充剂的使用情况和维生素d状况。在术语胎盘中,研究了关键胎盘生长因子妊娠相关血浆蛋白-A (papp-a) 评估的维生素d代谢和胎盘生长的改变,以及它们与维生素d不足的关系。 材料和方法: 我们纳入了225名随机选择的孕妇,在妊娠11-14周进行颈项透明层扫描。在纳入时使用维生素d补充剂和体重指数 (BMI) 的信息通过自我报告的问卷获得。在纳入时测量血浆25-羟基维生素d,并与妊娠结局和胎盘生物学相关,如通过papp-a和参与维生素d代谢的酶 (CYP24A1,CYP27B1) 在足月胎盘中的表达来判断。 结果: 92% 的女性使用了维生素d补充剂,但42% 的女性维生素d不足 (血浆25-羟基维生素d <75 nmol/L)。11例单胎妊娠妇女出现胎儿生长受限或先兆子痫。在这个小的亚组中,发生胎儿生长受限的女性孕早期平均血浆25-羟基维生素d较低 (43 ± 33nmol/L; n = 3; P = .006) 在发生先兆子痫的妇女中,血浆25-羟维生素d水平有降低的趋势 (65 ± 19 nmol/L; n = 8;P = .08),与无并发症妊娠相比 (79 ± 22 nmol/L; n = 187)。在足月胎盘中,孕早期维生素d不足的参与者中papp-a表达较低 (P = .009; n = 30),但血浆25-羟基维生素d与CYP24A1 (P = .67) 和CYP27B1 (P = .34) 的mRNA表达之间没有相关性。BMI与血浆25-羟维生素d呈负相关 (P = .03),与胎盘CYP24A1 mRNA表达呈正相关 (P = .003; n = 30)。 结论: 尽管对有关维生素d补充剂的官方指南有很高的依从性,但维生素d不足是常见的,研究结果表明维生素d不足可能会影响胎盘生长。高BMI与维生素d不足和胎盘维生素d转换增加相关,但需要进一步调查。

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