Research On The Association Between Serum Vitamin A,D,E Levels And Hypertensive Disorders Complicating Pregnancy In The Western Yunnan

ObjectTo analyze the relationship between serum vitamin A,D,E levels and hypertensive disorder complicating pregnancy(HDP)in pregnant women at 5-20 weeks of pregnancy in western Yunnan plateau,and to explore the significance of vitamin A,D,E in HDP patients in western Yunnan.MethodFrom June 2020 to October 2022,1489 pregnant women who came to the obstetrics clinic of the First Affiliated Hospital of Dali University for routine prenatal examination and serum vitamin A,D and E levels were detected at 5-20 weeks of pregnancy.698 pregnant women who dropped out due to loss of follow-up,abortion,induced labor and other reasons and did not give birth in our hospital were excluded.833 pregnant women who gave birth in our hospital and had complete data were finally selected.According to the HDP-related diagnosis and treatment guidelines formulated by the Chinese Medical Association in2020,according to the inclusion and exclusion criteria,excluding confounding variables Propensity score matching(PSM),there were 106 cases in the normal group and 122 cases in the HDP group(including 27 cases of chronic hypertension with pregnancy,29 cases of gestational hypertension,31 cases of preeclampsia,and 35 cases of severe preeclampsia).High performance liquid chromatography tandem mass spectrometry was used to measure the levels of serum vitamins A,D,and E.The statistical analysis was performed using SPSS 27.0.Result1.General situation:After eliminating confounding factors by PSM,there were 122 pregnant women in the HDP group and 106 pregnant women in the normal group.There was no significant difference in age,gravidity,parity,gestational age of blood collection and prenatal BMI between the groups(P>0.05).2.Geographical distribution:The patients included in the western Yunnan region this time are 193 in Dali Prefecture,9 in Lijiang City,13 in Diqing Prefecture,and 13 in Nujiang Prefecture,totaling 228.The highest incidence of chronic hypertension combined with pregnancy is 30.8%(4/13)in Diqing Prefecture,while the highest incidence of pregnancy induced hypertension is 33.3%(3/9)in Lijiang City.The highest incidence of preeclampsia is 23.3%(3/13)in Diqing Prefecture and Nujiang Prefecture,and the highest incidence of severe preeclampsia is 23.0%(3/13)in Diqing Prefecture.3.Vitamin A and HDP:The highest proportion of vitamin A deficiency was 10.4%(3/29)in the hypertensive disorder complicating pregnancy group;the highest proportion was94.2% in the severe preeclampsia group and 94.2% in the severe preeclampsia group;and12.9%(4/31).in the preeclampsia group with excessive vitamin A There was no significant difference between HDP group and normal group(P>0.05).Vitamin A deficiency,normal and excess of pregnant women in the plateau area of western Yunnan were 5.2%,89.1% and 5.7%,respectively;the highest proportion of vitamin A deficiency was 11.1%(1/9)in Lijiang Prefecture;the highest proportion was 92.3%(12/13)in Diqing Prefecture and Nujiang Prefecture;and the highest proportion was 7.7%(1/13)in Diqing Prefecture with excessive Vitamin A.Spearman grade analysis showed that there was no correlation between vitamin A and HDP groups(P>0.05).Multiple Logistic regression analysis showed that vitamin A deficiency and excess were not the risk factors of HDP groups(P>0.05).4.Vitamin D and HDP:The serum vitamin D level of pregnant women in HDP groups was significantly different from that in the normal group(P<0.05).Vitamin D deficiency: the highest proportion of severe preeclampsia group was 74.3%(26/35);vitamin D deficiency:the highest proportion of chronic hypertension with pregnancy group was 44.4%(12/27);the appropriate amount of vitamin D: the highest proportion of 49.1%(52/106)in the normal group.There was significant difference in HDP between each group and the normal group(P<0.05).Spearman grade analysis showed that the level of vitamin D was negatively correlated with each group of HDP(P<0.05).Multiple logistic regression analyses showed that vitamin D deficiency was a risk factor for each HDP group(P<0.05),and vitamin D deficiency was a risk factor for chronic hypertension complicated with pregnancy(P<0.05).5.Vitamin E and HDP:serum vitamin E levels in pregnant women in HDP groups were significantly higher than in the normal group(P<0.05).Vitamin E deficiency: the highest proportion of severe preeclampsia group was 37.1%(13/35);the proportion of vitamin E was normal: the highest proportion was 96.2%(102/106)in the normal group;and the highest proportion of vitamin E excess was 3.5%(1/29)in the hypertensive disorder complicating pregnancy group.The vitamin E deficiency,normal and excess of pregnant women in western Yunnan plateau were 13.6%,84.2% and 2.2%,respectively.Vitamin E deficiency,Diqing Prefecture accounted for the highest proportion of 15.4%(2/13);Vitamin E was normal,Nujiang Prefecture accounted for the highest proportion of 92.3%(12/13);excessive Vitamin E,Dali Prefecture accounted for the highest proportion of 2.6%(5/193).Spearman grade analysis showed that vitamin E levels were negatively correlated with each HDP group(P<0.05).Multivariate logistic regression showed that vitamin E deficiency was a risk factor for HDP groups(P<0.05).Excess vitamin E was not a risk factor for HDP groups(P>0.05).Conclusion1.Serum vitamin A levels in 5-20 week pregnant women of western Yunnan were independent of HDP.2.Serum vitamin D and E levels in 5-20 week pregnant women of western Yunnan were negatively correlated with HDP,vitamin D and E deficiency is the risk factor of HDP,and vitamin D deficiency is the risk factor of chronic hypertension complicated with pregnancy.3.Vitamin D,E should be supplemented timely and appropriately in the early pregnancy in western Yunnan.