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目的调查咸宁市糖耐量异常孕妇与正常孕妇维生素D缺乏情况,探究维生素D缺乏对新生儿的影响及相关预防对策。方法随机抽取咸宁市3所医院322例孕24~28周糖耐量异常孕妇(糖耐量异常组)及390例糖耐量正常孕妇(糖耐量正常组)为受试对象,均予以其口服葡萄糖耐量试验(OGTT)和维生素D水平检测。比较两组孕妇血清25-羟基维生素D[25(OH)D]水平及维生素D缺乏情况;两组受试孕妇均随访至分娩,比较其新生儿脐血血清25(OH)D水平、先天性佝偻病发生率及新生儿维生素D缺乏情况。结果 (1)分娩前,两组受试孕妇血清25(OH)D水平均较入组时显著降低,差异有统计学意义(t值分别为23.515、30.236,均P<0.05);糖耐量异常组孕妇入组时及分娩前血清25(OH)D水平均显著低于糖耐量正常组,差异均有统计学意义(t值分别为20.531、21.148,均P<0.05)。(2)糖耐量异常组受试孕妇维生素D不足率及缺乏率分别为49.07%和44.10%,均显著高于糖耐量正常组的38.21%和11.02%,差异有统计学意义(χ~2值分别为8.486、100.319,均P<0.05)。(3)母体糖耐量异常且维生素D缺乏的新生儿脐血血清25(OH)D水平均显著低于母体糖耐量正常的新生儿,差异有统计学意义(t值分别为8.494、25.905,均P<0.05);两组中母体维生素D缺乏的新生儿脐血血清25(OH)D水平也显著低于母体非维生素D缺乏的新生儿,差异均有统计学意义(t值分别为13.632、7.175,均P<0.05)。(4)两组母体维生素D缺乏的新生儿先天性佝偻病发生率及维生素D缺乏率比较,差异均无统计学意义(χ~2值分别为1.055、1.611,均P>0.05)。两组母体非维生素D缺乏的新生儿先天性佝偻病发生率比较,差异无统计学意义(χ~2=0.385,P>0.05),但维生素D缺乏比较差异有统计学意义(χ~2=5.318,P<0.05)。母体糖耐量异常且维生素D缺乏的新生儿先天性佝偻病发生率及维生素D缺乏率均明显高于同组母体非维生素D缺乏的新生儿和母体糖耐量正常且非维生素D缺乏的新生儿,差异均有统计学意义(χ~2值分别为28.362、38.403、51.198和88.004,均P<0.05);母体糖耐量正常的新生儿中,母体维生素D缺乏的新生儿先天性佝偻病发生率及维生素D缺乏率均显著高于母体非维生素D缺乏的新生儿,差异均有统计学意义(χ~2值分别为12.711、22.578,均P<0.05)。结论咸宁市孕妇普遍存在孕期维生素D缺乏情况,且糖耐量异常孕妇维生素D缺乏风险较正常孕妇高,可能影响新生儿脐血血清25(OH)D水平、增加先天性佝偻病发生几率,需引起重视。
Objective To investigate the vitamin D deficiency in pregnant women with impaired glucose tolerance and normal pregnant women in Xianning and to explore the influence of vitamin D deficiency on newborn and the related preventive strategies. Methods A total of 322 pregnant women with impaired glucose tolerance (IGT group) and 390 normal pregnant women with impaired glucose tolerance (normal glucose tolerance group) were randomly selected from 322 hospitals of three hospitals in Xianning City for oral glucose tolerance test (OGTT) and vitamin D levels. The levels of serum 25-hydroxyvitamin D [25 (OH) D] and vitamin D deficiency were compared between the two groups. The pregnant women in both groups were followed up until delivery. The levels of serum 25 (OH) D in neonates were compared. Rickets incidence and neonatal vitamin D deficiency. Results (1) Before delivery, serum 25 (OH) D levels in both groups were significantly lower than those in the control group (t = 23.515 and 30.236, respectively, P <0.05) The serum levels of 25 (OH) D in the group of pregnant women before admission and before delivery were significantly lower than those in the normal glucose tolerance group (t = 20.531, 21.148, all P <0.05). (2) The rate of vitamin D insufficiency and the lack of rate in pregnant women with impaired glucose tolerance were 49.07% and 44.10%, respectively, which were significantly higher than that of normal glucose tolerance group (38.21% and 11.02%, respectively) (χ ~ 2 Respectively 8.486,100.319, all P <0.05). (3) The levels of serum 25 (OH) D in umbilical blood of neonates with abnormal glucose tolerance and vitamin D deficiency were significantly lower than those with normal glucose tolerance (t = 8.494 and 25.905, respectively P <0.05). Serum 25 (OH) D levels in neonates with maternal vitamin D deficiency were also significantly lower than those without maternal vitamin D deficiency (t = 13.632, 7.175, all P <0.05). (4) There was no significant difference in incidence of congenital rickets and vitamin D deficiency between two groups of maternal vitamin D deficiency (χ ~ 2 = 1.055 and 1.611, all P> 0.05). The incidence of congenital rickets in non-vitamin D-deficient mothers was no significant difference between the two groups (χ ~ 2 = 0.385, P> 0.05), but the difference was statistically significant (χ ~ 2 = 5.318 , P <0.05). The incidence of congenital rickets and vitamin D deficiency in neonates with abnormal glucose tolerance and vitamin D deficiency were significantly higher than those in non-vitamin D-deficient and non-vitamin D-deficient neonates with the same group of maternal glucose tolerance (Χ ~ 2 values were 28.362,38.403,51.198 and 88.004, respectively, P <0.05); neonates with normal glucose tolerance in maternal vitamin D deficiency in neonates with congenital rickets incidence and vitamin D Lack of rate were significantly higher than the non-vitamin D maternal newborns, the difference was statistically significant (χ ~ 2 values were 12.711,22.578, all P <0.05). Conclusion Pregnant women in Xianning generally have vitamin D deficiency during pregnancy. And the risk of vitamin D deficiency in pregnant women with impaired glucose tolerance is higher than that of normal pregnant women, which may affect the serum 25 (OH) D levels in neonates and increase the incidence of congenital rickets. .