维生素D对体重指数正常妊娠期糖尿病孕妇的血糖控制及妊娠结局的影响
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摘要
目的探讨维生素D(VD)对妊娠期糖尿病(GDM)孕妇血糖控制及妊娠结局的影响。方法选取我院2016年1月～2017年1月收治的280例VD缺乏(<20 ng/ml)的GDM孕妇作为研究对象,根据随机方法分为实验组(140例)与对照组(140例)。实验组采用医学营养治疗(MNT)联合口服VD 1200 IU/d,对照组采用MNT联合口服VD 400 IU/d。比较两组孕妇的血糖控制情况及妊娠结局。结果两组孕妇治疗后的空腹血糖(FPG)、餐后2 h血糖(2 h PG)均较治疗前下降,25-羟维生素D3[25-(OH)D3]水平提高,差异有统计学意义(P<0.05)。实验组治疗后的FPG、2 h PG、糖化血红蛋白(HbA1c)水平以及妊娠期高血压、羊水过多、胎儿窘迫、产钳助产率、早产、产后出血、产程延长或停滞、新生儿窒息与巨大儿发生率低于对照组,差异有统计学意义(P<0.05)。实验组的25-(OH)D3水平、顺产率显著高于对照组,差异有统计学意义(P<0.05)。两组的剖宫产率、死胎、足月低体重儿、新生儿低血糖发生率比较,差异无统计学意义(P>0.05)。结论 VD有助于控制GDM孕妇血糖,降低某些妊娠期并发症,改善妊娠结局。
Objective To explore the influence of vitamin D(VD) on blood glucose and pregnancy outcome in pregnant women with gestational diabetes mellitus(GDM). Methods From January 2016 to January 2017, 280 cases of GDM pregnant women with VD deficiency(<20 ng/ml) admitted to our hospital were selected as the research object. According to the random method, they were divided into the experimental group and the control group, 140 cases in each group. The experimental group was given medical nutrition therapy(MNT) and oral VD 1200 IU/d, and the control group was given MNT and oral VD 400 IU/d. Blood glucose and pregnancy outcomes were compared between the two groups. Results Compared with before treatment, the fasting plasma glucose(FPG) and postprandial 2-hour plasma glucose(2 h PG) of pregnant women in both groups decreased after treatment, and the level of 25-hydroxyvitamin D3(25-[OH]D3) increased after treatment, the difference was statistically significant(P <0.05). The level of FPG, 2 h PG,HbA1 c and the incidence rate of hypertension during pregnancy, polyhydramnios, fetal distress, forceps delivery rate,premature delivery, postpartum hemorrhage, prolonged or stagnation labor, neonatal asphyxia, macrosomia in the experimental group were significantly lower than those in the control group, with significant difference(P<0.05). The rate of spontaneous delivery and the level of 25-(OH)D3 in the experimental group was significantly higher than that in the control group, and the difference was significant(P<0.05). There were no statistically significant differences in the incidence rates of cesarean section, stillbirth, low birth weight children and neonatal hypoglycemia between the two groups(P>0.05). Conclusion VD is helpful to control the blood glucose of GDM pregnant women, reduce some complications during pregnancy and improve pregnancy outcomes.
Objective To explore the influence of vitamin D(VD) on blood glucose and pregnancy outcome in pregnant women with gestational diabetes mellitus(GDM). Methods From January 2016 to January 2017, 280 cases of GDM pregnant women with VD deficiency(<20 ng/ml) admitted to our hospital were selected as the research object. According to the random method, they were divided into the experimental group and the control group, 140 cases in each group. The experimental group was given medical nutrition therapy(MNT) and oral VD 1200 IU/d, and the control group was given MNT and oral VD 400 IU/d. Blood glucose and pregnancy outcomes were compared between the two groups. Results Compared with before treatment, the fasting plasma glucose(FPG) and postprandial 2-hour plasma glucose(2 h PG) of pregnant women in both groups decreased after treatment, and the level of 25-hydroxyvitamin D3(25-[OH]D3) increased after treatment, the difference was statistically significant(P <0.05). The level of FPG, 2 h PG,HbA1 c and the incidence rate of hypertension during pregnancy, polyhydramnios, fetal distress, forceps delivery rate,premature delivery, postpartum hemorrhage, prolonged or stagnation labor, neonatal asphyxia, macrosomia in the experimental group were significantly lower than those in the control group, with significant difference(P<0.05). The rate of spontaneous delivery and the level of 25-(OH)D3 in the experimental group was significantly higher than that in the control group, and the difference was significant(P<0.05). There were no statistically significant differences in the incidence rates of cesarean section, stillbirth, low birth weight children and neonatal hypoglycemia between the two groups(P>0.05). Conclusion VD is helpful to control the blood glucose of GDM pregnant women, reduce some complications during pregnancy and improve pregnancy outcomes.
引文
[1]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.
[2]Heather H.Burris MD,MPH.Vitamin D and gestational diabetes mellitus[J].Curr Diab Rep,2014,14(1):451.
[3]Mutlu N,Esra H,Begum A,et al.Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome[J].Afr Health Sci,2015,15(2):523-531.
[4]宋鸿碧,杨慧霞.维生素D对妊娠期糖尿病发病的影响[J].中华妇产科杂志,2014,49(1):59-60.
[5]哈尼克孜·阿不都艾尼,玛依努·玉苏甫.维生素D结合降糖治疗对妊娠期糖尿病患者血清TLR4、VCAM-1的影响[J].中国妇幼保健,2018,33(1):77-79.
[6]刘佳,杨春波,李现玲,等.孕中期预防性应用维生素D降低妊娠期糖尿病发病率的临床效果[J].中国妇幼健康研究,2017,28(5):584-586.
[7]杨立颖,张巍.维生素D与妊娠糖尿病的研究进展[J].医学综述,2014,20(22):4143-4145.
[8]Lacroix M,Battista MC,Doyon M,et al.lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus[J].Acta Diabetol,2014,51(4):609-616.
[9]Yap C,Cheung NW,Gunton JE,et al.Vitamin D supplementation and the effects on glucose metabolism during pregnancy:a randomized controlled trial[J].Diabetes Care,2014,37(7):1837-1844.
[10]陈龙丁,牛建民,周宇恒,等.妊娠早期血清25-羟基维生素D3与妊娠期糖尿病的相关研究[J].中国糖尿病杂志,2015,6(3):152-155.
[11]管小芳,王永业.妊娠糖尿病患者维生素D的测定及临床意义[J].中国妇幼保健,2016,31(6):1170-1172.
[12]Zostautiene I,Jorde R,Schirmer H,et al.Genetic variations in the vitamin D receptor predict type 2 diabetes and myocardial infarction in a community-based population.The Troms Study[J].PLoS One,2015,10:e0145359.
[13]Li L,Wu B,Liu JY,et al.Vitamin D receptor gene polymorphisms and type 2 diabetes:a Meta-analysis[J].Archives Med Res,2013,44:235-241.
[14]Pilz S,Kienreich K,Rutters F,et al.Role of vitamin D in the development of insulin resistance and type 2 diabetes[J].Curr Diab Rep,2013,13:261-270.
[15]Sisley SR,Arble DM,Chambers AP,et al.Hypothalamic vitamin D improves glucose homeostasis and reduces weight[J].Diabetes,2016,65:2732-2741.
[16]中国营养学会.中国居民膳食营养素参考摄入量2013版[M].北京:科学出版社,2014:89.
[17]Hollis BW,Johnson D,Hulsey TC,et al.Vitamin D supplementation during pregnancy:double-blind,randomized clinical trial of safety and effectiveness[J].J Bone Miner Res,2011,26(10):2341-2357.
[18]Institute of medicine of the national academics(US).Dietary reference intake for calcium and vitamin D[M].Washington,DC:National Academy Press,2010:345-402.
[19]陆帆,龚丽,雷后康.维生素D与围生期母儿不良结局的关系[J].世界最新医学信息文摘,2016,16(86):98-101.
[20]蔡蔚,潘石蕾.维生素D与早产的研究进展[J].妇产与遗传(电子版),2016,6(1):56-59.
[2]Heather H.Burris MD,MPH.Vitamin D and gestational diabetes mellitus[J].Curr Diab Rep,2014,14(1):451.
[3]Mutlu N,Esra H,Begum A,et al.Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome[J].Afr Health Sci,2015,15(2):523-531.
[4]宋鸿碧,杨慧霞.维生素D对妊娠期糖尿病发病的影响[J].中华妇产科杂志,2014,49(1):59-60.
[5]哈尼克孜·阿不都艾尼,玛依努·玉苏甫.维生素D结合降糖治疗对妊娠期糖尿病患者血清TLR4、VCAM-1的影响[J].中国妇幼保健,2018,33(1):77-79.
[6]刘佳,杨春波,李现玲,等.孕中期预防性应用维生素D降低妊娠期糖尿病发病率的临床效果[J].中国妇幼健康研究,2017,28(5):584-586.
[7]杨立颖,张巍.维生素D与妊娠糖尿病的研究进展[J].医学综述,2014,20(22):4143-4145.
[8]Lacroix M,Battista MC,Doyon M,et al.lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus[J].Acta Diabetol,2014,51(4):609-616.
[9]Yap C,Cheung NW,Gunton JE,et al.Vitamin D supplementation and the effects on glucose metabolism during pregnancy:a randomized controlled trial[J].Diabetes Care,2014,37(7):1837-1844.
[10]陈龙丁,牛建民,周宇恒,等.妊娠早期血清25-羟基维生素D3与妊娠期糖尿病的相关研究[J].中国糖尿病杂志,2015,6(3):152-155.
[11]管小芳,王永业.妊娠糖尿病患者维生素D的测定及临床意义[J].中国妇幼保健,2016,31(6):1170-1172.
[12]Zostautiene I,Jorde R,Schirmer H,et al.Genetic variations in the vitamin D receptor predict type 2 diabetes and myocardial infarction in a community-based population.The Troms Study[J].PLoS One,2015,10:e0145359.
[13]Li L,Wu B,Liu JY,et al.Vitamin D receptor gene polymorphisms and type 2 diabetes:a Meta-analysis[J].Archives Med Res,2013,44:235-241.
[14]Pilz S,Kienreich K,Rutters F,et al.Role of vitamin D in the development of insulin resistance and type 2 diabetes[J].Curr Diab Rep,2013,13:261-270.
[15]Sisley SR,Arble DM,Chambers AP,et al.Hypothalamic vitamin D improves glucose homeostasis and reduces weight[J].Diabetes,2016,65:2732-2741.
[16]中国营养学会.中国居民膳食营养素参考摄入量2013版[M].北京:科学出版社,2014:89.
[17]Hollis BW,Johnson D,Hulsey TC,et al.Vitamin D supplementation during pregnancy:double-blind,randomized clinical trial of safety and effectiveness[J].J Bone Miner Res,2011,26(10):2341-2357.
[18]Institute of medicine of the national academics(US).Dietary reference intake for calcium and vitamin D[M].Washington,DC:National Academy Press,2010:345-402.
[19]陆帆,龚丽,雷后康.维生素D与围生期母儿不良结局的关系[J].世界最新医学信息文摘,2016,16(86):98-101.
[20]蔡蔚,潘石蕾.维生素D与早产的研究进展[J].妇产与遗传(电子版),2016,6(1):56-59.