PDF(1052 KB)
PDF(1052 KB)
PDF(1052 KB)
早产儿出生时维生素D水平及影响因素分析
Vitamin D level at birth and influencing factors in preterm infants
目的 分析早产儿出生时维生素D水平及其可能影响因素。方法 采集600例早产儿出生24 h内静脉血，检测血清25-羟基维生素D[25（OH） D]水平，并分析早产儿性别、出生体重、出生季节、胎龄，以及母亲的年龄、职业、早孕期体重指数（BMI）、分娩方式及妊娠期并发症等对血清25（OH） D水平的影响。结果 早产儿维生素D缺乏、不足、充足的比例分别为42.0%、38.7%和19.3%。夏、秋季出生的早产儿血清25（OH） D水平显著高于冬季（P < 0.05），维生素D缺乏的发生率显著低于春、冬季（P < 0.003）。与母亲年龄≥ 30岁者比较，年龄 < 30岁母亲所生早产儿血清25（OH） D水平显著降低（P < 0.05），维生素D缺乏的发生率显著增高（P < 0.017）。与母亲肥胖者比较，超重或体重正常母亲所生早产儿血清25（OH） D水平显著增高（P < 0.05），维生素D缺乏的发生率显著降低（P < 0.006）。母亲妊娠合并子癎前期者，其早产儿血清25（OH） D水平显著低于无子癎前期者（P < 0.05），维生素D缺乏的发生率显著高于无子癎前期者（P < 0.017）。多因素分析结果显示，冬春季出生、母亲年龄 < 30岁及早孕期BMI ≥ 28 kg/m2为早产儿维生素D缺乏的危险因素（P < 0.05）。结论 早产儿维生素D缺乏发生率较高，有维生素D缺乏高危因素的早产儿生后需尽早补充维生素D。
Objective To investigate vitamin D level at birth and possible influencing factors in preterm infants. Methods A total of 600 preterm infants were enrolled, and venous blood samples were collected within 24 hours after birth to measure the serum level of 25-hydroxyvitamin D[25(OH)D]. The effect of sex, birth weight, birth season, gestational age, mother's age, body mass index (BMI) in early pregnancy, delivery mode, and complications during pregnancy on serum 25(OH)D level was analyzed. Results The rates of vitamin D defciency, insuffciency, and suffciency were 42.0%, 38.7%, and 19.3% respectively. The preterm infants born in summer and autumn had a signifcantly higher serum 25(OH)D level than those born in winter (P < 0.05) and a signifcantly lower incidence rate of vitamin D defciency than those born in spring and winter (P < 0.003). Compared with those whose mothers were aged < 30 years, the infants whose mothers were aged ≥ 30 years had a signifcantly higher serum 25(OH)D level (P < 0.05) and a signifcantly lower incidence rate of vitamin D defciency (P < 0.017). Compared with those whose mothers were overweight or had normal body weight, the infants whose mothers were obese had a signifcantly lower serum 25(OH)D level (P < 0.05) and a signifcantly higher incidence rate of vitamin D defciency (P < 0.006). Compared with those whose mothers had no preeclampsia, the infants whose mothers had preeclampsia during pregnancy had a signifcantly lower serum 25(OH)D level (P < 0.05) and a signifcantly higher incidence rate of vitamin D defciency (P < 0.017). The multivariate analysis showed that birth in winter and spring, mother's age < 30 years, and early-pregnancy BMI ≥ 28 kg/m2 were risk factors for vitamin D defciency (P < 0.05). Conclusions There is a high prevalence of vitamin D defciency in preterm infants. Vitamin D supplementation should be given to the preterm infants with high-risk factors for vitamin D defciency.
[1] Theodoratou E, Tzoulaki I, Zgaga L, et al. Vitamin D and multiple health outcomes:umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials[J]. BMJ, 2014, 348:g2035.
[2] Çetinkaya M, Çekmez F, Erener-Ercan T, et al. Maternal/neonatalvitamin Ddeficiency:a risk factor for bronchopulmonary dysplasia in preterms?[J]. J Perinatol, 2015, 35(10):813-817.
[3] Dinlen N, Zenciroglu A, Beken S, et al. Association of vitamin D deficiency with acute lower respiratory tract infections in newborns[J]. J Matern Fetal Neonatal Med, 2016, 29(6):928-932.
[4] Bunyavanich S, Rifas-Shiman SL, Platts-Mills TA, et al. Prenatal, perinatal, and childhood vitamin D exposure and their association with childhood allergic rhinitis and allergic sensitization[J]. J Allergy Clin Immunol, 2016, 137(4):1063-1070.
[5] Chawes BL, Bønnelykke K, Jensen PF, et al. Cord blood 25(OH)-vitamin D defciency and childhood asthma, allergy and eczema:the COPSAC2000 birth cohort study[J]. PLoS One, 2014, 9(6):e99856.
[6] Crozier SR, Harvey NC, Inskip HM, et al. Maternal vitamin D status in pregnancy is associated with adiposity in the offspring:fndings from the Southampton Women's Survey[J]. Am J Clin Nutr, 2012, 96(1):57-63.
[7] Mäkinen M, Mykkänen J, Koskinen M, et al. Serum 25-hydroxyvitamin D concentrations in children progressing to autoimmunity and clinical type 1 diabetes[J]. J Clin Endocrinol Metab, 2016, 101(2):723-729.
[8] Chen J, Xin K, Wei J, et al. Lower maternal serum 25(OH)D in frst trimester associated with higher autism risk in Chinese offspring[J]. J Psychosom Res, 2016, 89:98-101.
[9] Dalgård C, Petersen MS, Steuerwald U, et al. Umbilical cord serum 25-hydroxyvitamin D concentrations and relation to birthweight, head circumference and infant length at age 14 days[J]. Paediatr Perinat Epidemiol, 2016, 30(3):238-245.
[10] Filteau S, Rehman AM, Yousafzai A, et al. Associations of vitamin D status, bone health and anthropometry, with gross motor development and performance of school-aged Indian children who were born at term with low birth weight[J]. BMJ Open, 2016, 6(1):e009268.
[11] Strøm M, Halldorsson TI, Hansen S, et al. Vitamin D measured in maternal serum and offspring neurodevelopmental outcomes:a prospective study with long-term follow-up[J]. Ann Nutr Metab, 2014, 64(3-4):254-261.
[12] Tergestina M, Jose A, Sridhar S, et al. Vitamin D status and adequacy of standard supplementation in preterm neonates from South India[J]. J Pediatr Gastroenterol Nutr, 2014, 58(5):661-665.
[13] Onwuneme C, Martin F, McCarthy R, et al. The association of vitamin D status with acute respiratory morbidity in preterm infants[J]. J Pediatr, 2015, 166(5):1175-1180.e1.
[14] Gallo S, Comeau K, Agellon S, et al. Methodological issues in assessing plasma 25-hydroxyvitamin D concentration in newborn infants[J]. Bone, 2014, 61:186-190.
[15] Institute of Medicine (US) Committee, Ross AC, Taylor CL, et al. Dietary reference intakes for calcium and vitamin D[M]. Washington (DC):National Academies Press (US), 2011:13-14.
[16] Cashman KD, Dowling KG, Škrabáková Z, et al. Vitamin D deficiency in Europe:pandemic?[J]. Am J Clin Nutr, 2016, 103(4):1033-1044.
[17] 张丽萍, 闫瑞霞, 孙玉敏, 等. 沧州市早产儿血清维生素D水平及其母亲认知情况调查分析[J]. 中国儿童保健杂志, 2013, 21(8):870-872.
[18] Yu X, Wang W, Wei Z, et al. Vitamin D status and related factors in newborns in Shanghai, China[J]. Nutrients, 2014, 6(12):5600-5610.
[19] Xiao JP, Zang J, Pei JJ, et al. Low maternal vitamin D status during the second trimester of pregnancy:a cross-sectional study in Wuxi, China[J]. PLoS One, 2015, 10(2):e0117748.
[20] Tao M, Shao H, Gu J, et al. Vitamin D status of pregnant women in Shanghai, China[J]. J Matern Fetal Neonatal Med, 2012, 25(3):237-239.
[21] El Koumi MA, Ali YF, Abd El Rahman RN. Impact of maternal vitamin D status during pregnancy on neonatal vitamin D status[J]. Turk J Pediatr, 2013, 55(4):371-377.
[22] Burris HH, Van Marter LJ, McElrath TF, et al. Vitamin D status among preterm and full-term infants at birth[J]. Pediatr Res, 2014, 75(1-1):75-80.
[23] Josefson JL, Reisetter A, Scholtens DM, et al. Maternal BMI associations with maternal and cord blood vitamin D levels in a North American subset of hyperglycemia and adverse pregnancy outcome (HAPO) study participants[J]. PLoS One, 2016, 11(3):e0150221.
[24] Zhang MX, Pan GT, Guo JF, et al. Vitamin D deficiency increases the risk of gestational diabetes mellitus:a metaanalysis of observational studies[J]. Nutrients, 2015, 7(10):8366-8375.
[25] Zhao X, Fang R, Yu R, et al. Maternal vitamin D status in the late second trimester and the risk of severe preeclampsia in Southeastern China[J]. Nutrients, 2017, 9(2):138.
[26] 任惠琼, 黄小霞, 贾金平. 妊娠期肝内胆汁淤积症患者脐血中维生素D水平及维生素D受体的表达相关性研究[J]. 中国优生与遗传杂志, 2015, 23(6):70-71.
[27] Chen Y H, Yu Z, Fu L, et al. Vitamin D3 inhibits lipopolysaccharide-induced placental inflammation through reinforcing interaction between vitamin D receptor and nuclear factor kappa B p65 subunit[J]. Sci Rep, 2015, 5:10871.
[28] Pena HR, de Lima MC, Brandt KG, et al. Influence of preeclampsia and gestational obesity in maternal and newborn levels of vitamin D[J]. BMC Pregnancy Childbirth, 2015, 15:112.
[29] Mohaghegh Z, Abedi P, Dilgouni T, et al. The relation of preeclampsia and serum level of 25-hydroxyvitamin D in mothers and their neonates:a case control study in Iran[J]. Horm Metab Res, 2015, 47(4):284-288.
江苏省自然科学基金专项（BL2014025）；江苏省卫计委妇幼健康科研项目（F201427）；无锡市“科教强卫工程”医学重点学科、医学青年人才项目（锡卫科教[2017]4号）。
