维生素D与母体妊娠相关疾病关系的研究进展

维生素D（Vitamin D,VD）作为人体所必需的营养素之一,参与调节体内多种生物学过程,其补充剂主要应用于预防和治疗佝偻病、骨质疏松症等疾病。VD受体广泛分布于机体组织细胞中,研究发现VD在调节免疫系统功能方面发挥重要的生理作用,同时参与了神经系统、内分泌系统及循环系统疾病的发病过程。妊娠期间,VD对维持母体及胎儿发育同样至关重要。有文献报道孕产妇VD水平偏低或缺乏与妊娠相关疾病发病率增加有关,严重的VD缺乏还可导致孕妇及胎儿不良妊娠结局。结合近年发表的国内外文献,对VD的不足或缺乏与母体妊娠相关疾病的关系进行综述,探讨疾病发生的病理机制,为早期预防、早期诊断和及时治疗提供理论依据。     

产前维生素D水平与产后盆底肌肉力量强度的相关性研究

目的:探讨产前维生素D水平与产后盆底肌肉力量强度的关系。方法:选取148例孕妇,孕36周时单次采集孕妇静脉血,采用ELISA法测定血清25(OH)D3水平,根据维生素D水平及分娩方式分为4组:维生素D水平15ng/ml、阴道分娩为Ⅰ组(n=42),维生素D水平15ng/ml、剖宫产为Ⅱ组(n=48),维生素D水平≥15ng/ml、阴道分娩为Ⅲ组(n=24),维生素D水平≥15ng/ml、剖宫产为Ⅳ组(n=34)。记录所有孕妇的每周妊娠状态,分娩方式,出生体重,孕前体质指数(BMI)。产后8~10周,采用排尿困扰量表(UDI-6)评估产妇盆底功能障碍症状,测量产妇盆底肌力(PFMS)。结果:阴道分娩组和剖宫产组分别有63.6%(42/66)和58.5%(48/82)的孕妇患有维生素D缺乏症。Ⅳ组产后PMFS最高,Ⅰ组最低。阴道分娩组中,维生素D缺乏组产妇PFMS显著低于正常产妇(t=3.213,P=0.001)。维生素D水平与肌肉力量耐力相关性分析显示,阴道分娩组、剖宫产组中,维生素D水平均与PMFS呈正相关(r=0.425,P=0.000;r=0.334,P=0.013)。阴道分娩组中新生儿出生体重和PFMS呈负相关(r=-0.209,P=0.044),而在剖宫产组两者无显著相关性(P0.05)。剖宫产组中,UDI评分和PMFS呈负相关(r=-0.522,P=0.000),而在阴道分娩组中两者无显著相关性(P0.05)。多因素回归分析结果显示,剖宫产组(B=0.451,P=0.001)、阴道分娩组(B=0.311,P=0.001)维生素D水平回归系数均大于0且P0.05,提示维生素D水平与PFMS呈正相关,在一定范围内,随着维生素D水平升高PFMS也升高。结论:维生素D缺乏可导致孕妇产后PMFS降低。     

妊娠期维生素D缺乏与母胎疾病相关性的研究进展

维生素D缺乏在妊娠妇女中普遍存在,与母胎疾病的发生发展有密切联系。维生素D参与妊娠免疫耐受,调节细胞增殖和分化,在胚胎植入过程中起着重要作用,与胎盘发育、血压调节和葡萄糖耐量存在相关性。维生素D缺乏导致母胎疾病的发生,如复发性流产、早产、子痫前期、妊娠期糖尿病和胎儿生长受限等。维生素D缺乏导致盆底肌肉力量减弱也可能与剖宫产分娩相关。补充维生素D减少母胎疾病的发生。本文总结了妊娠期维生素D缺乏与母胎疾病的研究进展。     

不同孕期及不同季节妊娠妇女25羟维生素D水平与新生儿生长发育的相关性研究

目的:探讨不同孕期、不同季节孕妇25羟维生素D[25-hydroxyvitamin D,25(OH)D]水平及其与新生儿生长发育的相关性,为指导孕妇及时补充维生素D提供理论依据。方法:选择2015年6月至2016年5月在我院产科及内分泌科就诊的孕妇1255例,将其分为妊娠早期组(≤12周)224例、妊娠中期组(12~28周)642例、妊娠晚期组(≥28周)389例。按抽血测定25(OH)D时间,分为冬春季(2015年12月至2016年5月)648例、夏秋季(2015年6月至2015年11月)607例。通过测定孕妇的25(OH)D,评估不同孕期及不同季节维生素D缺乏[25(OH)D30 nmol/L],维生素D不足[25(OH)D 30~50 nmol/L]、维生素D充足[25(OH)D≥50 nmol/L]状况及其与新生儿生长发育的相关性。结果:随着妊娠早、中、晚期进食鱼虾、鸡蛋、瘦肉量及进食奶制品量逐渐增加(P0.01),妊娠早、中、晚期孕妇25(OH)D水平逐渐增加(31.81±11.71 nmol/L,34.77±15.89 nmol/L,37.19±16.66 nmol/L),妊娠早期25(OH)D水平低于妊娠中期和晚期(P0.05),妊娠中期25(OH)D水平低于妊娠晚期(P0.05)。1255例孕妇中维生素D缺乏511例,占40.7%。妊娠早、中、晚期维生素D缺乏比例分别为43.8%、43.0%、35.2%。在妊娠各时期夏秋季25(OH)D水平均高于冬春季(P0.01)。孕妇的25(OH)D水平与新生儿体质量、身长、头围及出生后即刻、5分钟、10分钟的Apgar评分无明显相关性(P0.05)。结论:维生素D缺乏在未服用维生素D补充剂的孕妇中比较普遍,尤其是妊娠早期,因此,应及早监测25(OH)D水平,以便尽早补充。孕妇的25(OH)D水平与新生儿生长发育无明显关系。     

伴维生素D缺乏高危儿早期维生素D佐治干预的疗效观察

目的探讨维生素D缺乏状态对高危儿脑损伤的影响。方法鞍山市千山区妇幼保健所于2006-01-2006-12，对大运动发育落后的高危儿163例确诊后，进行骨源性碱性磷酸酶（BALP）检测，发现异常62例。将其随机分为维生素D治疗训练干预组32例及常规训练干预组30例。比较2组患几干预后的临床疗效。结果维生素D佐治组在改善大运动落后、肌张力异常方面有效率明显高于常规干预组（90．6％：70．0％，84．6％：60．0％，均P〈O．05），异常姿势的消失2组间无统计学差异（62．5％：50．0％，P〉O．05）。维生素D缺乏程度与月龄、喂养方式无明显相关性。结论正确补充维生素D是高危儿保健的重要内容。纠正维生素D缺乏状态可提高脑损伤治疗效果，有助于神经运动功能的康复。     

维生素D与女性生殖疾病的关系

维生素D调节钙和磷吸收,促进骨骼的生长和重构。越来越多的研究证实,维生素D在高血压、肿瘤、自身免疫性疾病、2型糖尿病等疾病的发生和发展中起重要作用。研究发现,维生素D受体(VDR)广泛分布于卵巢、子宫、输卵管、宫颈、乳腺、睾丸、精子等生殖器官、组织与细胞中。关于维生素D的活性代谢产物的生理作用已进行了广泛研究,但其在人类生殖中的报道较少。现本文就维生素D缺乏对女性生殖系统功能的影响做一综述。     

维生素D不足与妊娠期糖尿病的Meta分析

目的:探讨维生素D不足与妊娠期糖尿病的关系。方法:检索PubMed、Co-chrane图书馆、CNKI、CBM、万方资源数据库,纳入以妊娠期糖尿病和健康妊娠人群为对象,以维生素D不足的发病率及血25(OH)D3水平为主要研究指标的病例对照研究或横断面研究,质量评价后进行Meta分析。应用Review Manager5.0软件对主要数据进行合并分析。结果:共纳入13篇文献。Meta分析结果显示,妊娠期糖尿病人群维生素D不足的发生率显著高于健康妊娠人群(OR=1.32,95%CI 1.03～1.69,Z=2.18,P=0.03);妊娠期糖尿病患者维生素D水平显著低于健康妊娠人群(MD=-6.83nmol/L,95%CI(-8.62,-5.04),Z=7.49,P<0.00001)。结论:维生素D不足与妊娠期糖尿病的发生可能具有相关性。     

南京地区孕妇冬季与夏季血清25-羟维生素D水平的差异

目的 分析孕妇体内维生素D的水平在冬季与夏季的差异,为临床医师在不同季节指导孕妇补充维生素D提供依据.方法 选择2009年12月2日至2010年2月2日(冬季)以及2010年7月23日至2010年9月9日(夏季)在南京医科大学第一附属医院产科门诊进行产前保健的妊娠24～27+6周孕妇,排除妊娠期糖尿病、慢性肝病、甲状腺功能亢进和结缔组织疾病者.冬季组入选孕妇78例,夏季组76例.采用酶联免疫吸附法测定血清25-羟维生素D[25-hydroxy vitamin D,25(OH)D]水平,≤25.0 nmol/L定义为维生素D缺乏,25.0～50.0 nmol/L为维生素D不足,＞50.0 nmol/L为维生素D正常.采用t检验比较冬季和夏季25(OH)D水平,x2检验比较不同25(OH)D水平孕妇的构成比.结果 (1)夏季组血清25(OH)D[(26.4±10.7) nmol/L]高于冬季组[(22.7±4.8) nmol/L],差异有统计学意义(t=2.74,P=0.006).(2)冬季组维生素D缺乏、不足和正常的孕妇构成比分别为65.4％(51/78)、30.8％(24/78)和3.8％(3/78),夏季组分别为47.4％(36/76)、48.7％(37/76)和3.9％(3/76).冬季组维生素D缺乏孕妇的比例高于夏季组,差异有统计学意义(x2=5.084,P=0.024).结论 南京地区妊娠中期孕妇维生素D水平普遍偏低,冬季维生素D缺乏比夏季更严重,提示孕妇应适当进行户外活动,并补充维生素D.     

维生素D及其受体与妇科肿瘤

化疗是治疗妇科肿瘤的主要手段之一.但是,目前临床所应用的化疗药物存在较严重的毒性,限制了其在临床上的应用.近年研究发现维生素D(VD)和维生素D受体(VDR)除了已熟知的维持血清钙离子平衡和骨结构的生理功能外,还与肿瘤有密切关系.体内外试验证明VD有抑制肿瘤细胞增殖和诱导分化的作用.VD和VDR与妇科肿瘤关系的研究.     

Current Scenario of Vitamin D Status During Pregnancy in North Indian Population

Purpose of the Study

The aim of the study was to determine the prevalence and risk factor for vitamin D deficiency in our pregnant population.

Method

A total of 418 healthy primigravida with single live pregnancy and sure of dates attending the antenatal clinic between October 2011 and April 2013 were recruited. Women were excluded if they had history of current or past chronic medical disease. Women were also excluded if they had history of medication with drugs interfering with calcium and vitamin D metabolism.

Results

The prevalence of vitamin D deficiency during pregnancy has been found to be 391 (93.5 %). Severe vitamin D deficiency among pregnant patients was 34.44 % (144/418). The levels of serum 25(OH)D and serum calcium were significantly lower in severe deficient group than the adequate group [7.10 ± 1.49 vs. 38.90 ± 4.22 ng/ml (p = 0.001) and 7.13 ± 1.41 vs. 9.39 ± 0.88 ng/ml (p = 0.001)], respectively. Maternal education, husband education, socioeconomic status, serum calcium, serum phosphorous, and season were significant factors associated with vitamin D deficiency. Significant independent variables for severe vitamin D deficiency were low serum calcium, serum alkaline phosphatase, and serum phosphorus (OR 39.41, 95 % CI 10.30–150.85, p < 0.01), (OR 18.03, 95 % CI 3.95–82.44, p < 0.01), and (OR 8.40, 95 % CI 2.47–28.61, p < 0.01).

Conclusion

Vitamin D deficiency is highly prevalent among pregnant women in Northern India, and these raises concern about the health consequences for the mother and the offspring.     

High prevalence of vitamin D deficiency in Pakistani mothers and their newborns

Objective

To determine the prevalence of vitamin D deficiency in Pakistani parturients and their newborns and to assess the correlation between maternal and newborn serum levels of the vitamin D metabolite 25-hydroxy vitamin D3.

Methods

A prospective study of parturients presenting to the labor suite with a singleton pregnancy. Maternal and cord blood were collected for estimation of serum 25-hydroxy vitamin D3.

Results

In total, 89% of the gravidae were deficient in vitamin D (serum 25-hydroxy vitamin D3 < 30 ng/mL). There was a positive correlation between maternal and cord blood 25-hydroxy vitamin D3 levels(r = 0.68; P < 0.001). Inverse correlations were noted between cord blood 25-hydroxy vitamin D3 and a longer duration of gestation (r = − 0.33; P = 0.003) and with the newborn's birth weight (r = − 0.23; P = 0.048). Maternal 25-hydroxy vitamin D3 levels were inversely correlated with maternal mean arterial pressure (r = 0.029; P < 0.020).

Conclusion

There was a high prevalence of vitamin D deficiency in the Pakistani parturients and their newborns. There was a correlation between higher maternal vitamin D levels and lower blood pressure in the mothers.     

The Origin of the World: Science and Fiction of the Vagina

This study examined the course of psychological problems in women from late pregnancy to six months postpartum, the rates of psychiatric, especially depressive and post-traumatic stress symptoms and possible related antecedent variables. During late pregnancy, one to three days postpartum, six weeks and six months postpartum, 47 of the 60 participating women completed a battery of questionnaires including the General Health Questionnaire, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the PTSD Symptom Scale. In general, most women recovered from psychiatric and somatic problems over the period of investigation. However, depressive and post-traumatic stress symptoms in particular were not found to decline significantly. Six weeks postpartum, 22% of the women had depressive symptoms, with this figure remaining at 21.3% six months postpartum. In addition, 6% of the women studied reported clinically significant PTSD symptoms at six weeks postpartum with 14.9% reporting such symptoms at six months postpartum. The most important predictor for depressive and post-traumatic stress symptoms was the block variable “anxiety in late pregnancy”. Other predictors were the variables “psychiatric symptoms in late pregnancy”, “critical life events” and the “experience of delivery”. The results of our study show a high prevalence rate of psychiatric symptoms in women after childbirth and suggest, besides the experience of the delivery itself, a vulnerability or predisposing history that makes the development of psychiatric symptoms after childbirth more probable.     

Dysregulation of maternal and placental vitamin D metabolism in preeclampsia

IntroductionEpidemiology has linked preeclampsia (PET) to decreased maternal serum 25-hydroxyvitamin D3 (25(OH)D3). However, alterations in systemic and placental/decidual transport and metabolism of 25(OH)D3 during pregnancy suggest that other forms of vitamin D may also contribute to the pathophysiology of PET.MethodsIn a cross sectional analysis of normal pregnant women at 1st (n = 25) and 3rd trimester (n = 21), pregnant women with PET (n = 22), and non-pregnant female controls (n = 20) vitamin D metabolites were quantified in paired maternal serum, placental, and decidual tissue.ResultsSerum 25(OH)D3 was not significantly different in sera across all four groups. In normal 3rd trimester pregnant women serum active 1,25-dihydroxyvitamin D3 (1,25(OH)₂D3) was significantly higher than non-pregnant, normal 1st trimester pregnant, and PET women. Conversely, PET sera showed highest levels of the catabolites 3-epi-25(OH)D3 and 24,25-dihydroxyvitamin D3 (24,25(OH)₂D3). Serum albumin was significantly lower in normal 3rd trimester pregnant women and PET relative to normal 1st trimester pregnant women, but there was no change in free/bioavailable 25(OH)D3. In PET placental tissue, 25(OH)D3 and 3-epi-25(OH)D3 were lower than normal 3rd trimester tissue, whilst placental 24,25(OH)₂D3 was highest in PET. Tissue 1,25(OH)₂D3 was detectable in 1st trimester decidua, which also showed 10-fold higher 25(OH)D3 relative to paired placentae. 3-epi-25(OH)D3 and 24,25(OH)₂D3 were not different for decidua and placenta. In normal 3rd trimester pregnant women, total, free and bioavailable maternal 25(OH)D3 correlated with placental 25(OH)D3, but this was not conserved for PET.DiscussionThese data indicate that PET is associated with decreased activation, increased catabolism, and impaired placental uptake of 25(OH)D3.     

Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology

The objective of this study was to review and characterize the presentation, diagnostic dilemmas, management, and prognosis of postpartum septic pelvic thrombophlebitis. Medical records of postpartum women with the diagnosis of septic pelvic thrombophlebitis were reviewed for the 8-year period 1986–1994. Cases of documented ovarian vein thrombosis or those with other pelvic pathology on imaging study were excluded. Thirty-one women, four following vaginal delivery and 27 following cesarean delivery, with a final diagnosis of septic pelvic thrombophlebitis were identified. All patients demonstrated refractory febrile morbidity (mean 5.5 ± 1.9 days prior to instituting heparin therapy) despite multiagent antimicrobial therapy with ampicillin, gentamicin, and clindamycin. Imaging studies (CT and/or ultrasound) were performed in 20 women and revealed no pelvic pathology. The patients required an average of 4.7 ± 2.1 days (median 5, range 1–9 days) of heparin therapy before defervescence. Heparin levels were therapeutic at a mean of less than 24 h (range 6–24 h). The average dose of heparin required was 16.0 ± 3.0 U/kg/h. Nine women had 13 subsequent pregnancies without recurrent thromboembolic complications. Currently available imaging studies cannot diagnose the entity we now define as septic pelvic thrombophlebitis (once cases of ovarian vein thrombosis are excluded). Our findings do not support the time-honored rule that septic pelvic thrombophlebitis responds within 24–48 h to therapeutic anticoagulation with heparin. Therefore, criteria other than imaging studies or immediate defervescence following heparin therapy are necessary for diagnosis of septic pelvic thrombophlebitis. A more appropriate terminology for septic pelvic thrombophlebitis should be refractory postpartum fever of undetermined etiology.     

产后抑郁症及其相关因素的分析

目的 探讨产后抑郁症的临床特点及危险因素。以提高产科医师对产后抑郁症的认识,及早采取预防和治疗措施。方法 应用抑郁自评量表、焦虑自评量表、汉姆顿抑郁量表及自制问卷调查表,对２１０例产妇进行产后抑郁症及其相关因素的调查。结果 （１）产后抑郁症的发生率为３７．１４％（７８／２１０）,其中轻型为９１．０３％（７１／７８）,中型为８．９７％（７／７８）。生活空虚感、思维困难感、决断困难感、能力减退感、无用感和绝望感这６个症状,是产后抑郁症妇女最多见的主诉。１０．４８％（２２／２１０）的产妇患有焦虑症状。（２）产妇不良的处世表现、情绪控制差、分娩前的心理准备不足及分娩知识的掌握不够等社会心理因素与抑郁症发生有关,是产后抑郁症发生的危险因素。结论 （１）产后抑郁症在围产期妇女中具有较高的发生率,是产妇常见的精神及心理障碍。