妊娠早、中期妇女血清25-羟维生素D-3与妊娠期糖尿病的关系探讨-东南大学学报医学版

妊娠早、中期妇女血清25-羟维生素D-3与妊娠期糖尿病的关系探讨

单位：1. 丹阳市人民医院/南通大学附属丹阳医院产科, 江苏丹阳 212300;
2. 东南大学附属中大医院, 江苏南京 210009

分类号：R714.256

出版年·卷·期（页码）：2022·41·第五期（675-680）

摘要：

目的：探讨妊娠早、中期妇女血清25-羟维生素D-3（25-OHD-3）与妊娠期糖尿病（GDM）的关系。方法：随机选取2018年1月至2021年12月在本院进行常规孕期检查的产妇作为研究对象，孕8~12周检测其空腹血糖（FBG）及糖化血红蛋白（HbAlc）水平，孕13~15周检测其血清25-OHD-3水平，孕24~28周行75 g口服葡萄糖耐量试验（OGTT），包括FBG、餐后1 h血糖（1 h PBG）、餐后2 h血糖（2 h PBG），并在空腹、服糖水后1 h和2 h均检测血清25-OHD-3。根据OGTT筛查结果，将其分为GDM组（n=100）及对照组（n=100）。比较2组孕早期FBG、HbAlc，孕中期血清25-OHD-3及孕中后期空腹、服糖水后1、2 h的血糖及25-OHD-3等指标的差异，并分析血清25-OHD-3水平与GDM发病的关系。结果：GDM组孕早期FBG、HbAlc及OGTT中FBG、1 h PBG、2 h PBG均高于对照组（P<0.05）；GDM组血清25-OHD-3水平低于对照组，差异具有统计学意义（P<0.05）；两组孕妇存在孕期血清25-OHD-3不足且缺乏的情况，血清25-OHD-3指标GDM组充足率为6.00%，对照组为7.00%；GDM组不足率为30.00%，对照组为32.00%；GDM组缺乏率为64.00%，对照组为61.00%。综合比较显示，两组血清25-OHD-3充足率、不足率及缺乏率差异无统计学意义（P>0.05）；GDM组中FBG正常组的25-OHD-3水平显著高于FBG异常组（P<0.05）；而服糖后1 h及2 h，血糖正常组及异常组的25-OHD-3水平比较差异无统计学意义（P>0.05）。结论：随着孕龄的增加，孕妇血清25-OHD-3水平逐渐下降，而妊娠中期较低的血清25-OHD-3水平与GDM的发生存在相关性，增加了GDM发生的风险，对于高危人群需要加强早期监测，积极补充维生素D，以预防及减少GDM的发生。

Objective: To investigate the relationship between blood 25-hydroxyvitamin D-3(25-OHD-3) and gestational diabetes mellitus(GDM) in women in the early and mid trimesters of pregnancy. Methods: The parturients who had routine pregnancy examination in our hospital from January 2018 to December 2021 were randomly selected as the objects of study. The levels of fasting blood glucose(FBG) and glycosylated hemoglobin(HbAlc) were tested in 8-12 weeks of gestation, while the levels of 25-OHD-3 were detected in 13-15 weeks of gestation. 75 g oral glucose tolerance test(OGTT), including FBG, 1 hour postprandial blood glucose(1 h PBG), and 2 hours postprandial blood glucose(2 h PBG), was performed in 24-28 weeks of gestation, and serum 25-OHD-3 was detected in fasting, 1 hour and 2 hours after taking sugar water. Subsequently, they were divided into GDM group(n=100) and control group(n=100), according to the screening results. The differences of FBG, HbAlc in the early trimester, 25-OHD-3 in the mid and empty, 1 h and 2 h after taking sugar water blood glucose and 25-OHD-3 in the mid to late trimester of pregnancy were compared between the two groups.The relationship between serum 25-OHD-3 level and GDM was analyzed. Results: The levels of FBG, HbAlc and OGTT in early trimester of pregnancy in the GDM group were increased,compared with those in the control group(P<0.05); The level of serum 25-OHD-3 in the GDM group was lower than that in the control group, with statistical difference between the two groups(P<0.05); Pregnant women in the two groups were both deficient and insufficient in serum 25-OHD-3. The serum 25-OHD-3 adequacy rate was 6.00% in the GDM group and 7.00% in the control group, the deficiency rate was 30.00% in the GDM group, 32.00% in the control group, and the insufficient rate was 64.00% in the GDM group and 61.00% in the control group. Comprehensive comparison showed that there were no significant differences in the serum 25-OHD-3 adequacy rate, deficiency rate and insufficient rate between the two groups(P>0.05). In the GDM group,25-OHD-3 level in normal FBG group was significantly higher than that in abnormal FBG group(P<0.05); No significant difference was revealed for the level of 25-OHD-3 between the normal and abnormal blood sugar group, while 1 h and 2 h after taking sugar(P>0.05). Conclusion: With gestational age increasing, the serum 25-OHD-3 levels of pregnant women gradually decreased, and the lower serum 25-OHD-3 level in the mid trimester is closely related to the occurrence of GDM. In the mid trimester of pregnancy, the low vitamin D level can increase the incidence of GDM. For high-risk groups, it is necessary to strengthen early monitoring, active supplement of vitamin D, and to prevent and suppress the occurrence of GDM.

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