The Vitamin D Nutritional Status Of Pregnant Women In Guangzhou And Its Relationship With Glucolipid Metabolism And Pregnancy Outcomes

BackgroundVitamin D deficiency is widespread worldwide and has been described as a serious public health problem.Pregnant women are at high risk for vitamin D deficiency.The rate of vitamin D deficiency in pregnant women in China is as high as 80%.The status of vitamin D nutrition is not optimistic in pregnant women in China.It is urgent to investigate the main influencing factors of vitamin D in pregnant women and improve the nutritional status of vitamin D in pregnant women.As we all know,vitamin D plays an important role in maintaining the body's calcium-phosphorus balance and maintaining bone health.This is also the focus of previous research on vitamin D.Vitamin D plays an important role in maintaining the body's calcium-phosphorus balance and maintaining bone health.With the continuous deepening of research,a new understanding of the function of vitamin D has been obtained.Vitamin D receptors are widely present in almost all tissues and cells of the body,and play an important role in immune regulation,inflammatory response,blood pressure regulation,and glycolipid metabolism.It has gradually attracted more attention in the prevention and treatment of chronic diseases such as obesity,hypertension and diabetes.Current research suggests that vitamin D deficiency during pregnancy may be related to gestational diabetes,hypertension during pregnancy,and abnormal birth outcomes.Such adverse pregnancy outcomes are often accompanied by varying degrees of lipid metabolism disorders and insulin resistance.To investigate whether vitamin D regulates glycolipid metabolism during pregnancy and affects pregnancy outcomes provide a theoretical basis for the potential role of vitamin D deficiency during pregnancy in the occurrence and development of adverse pregnancy outcomes,and to provide a basis for maintaining a good vitamin D nutrition level during pregnancy promoting maternal and infant health.This study was conducted because there are few related studies on vitamin D and glycolipid metabolism,and its effect on pregnancy outcomes,on the other hand,the results are inconsistent.ObjectiveThe investigation and analysis of the status of vitamin D nutrition of pregnant women in Guangzhou and its main influencing factors provide a theoretical basis for the proposed targeted improvement measures.Analysis of the relationship between vitamin D levels during pregnancy and glucose and lipid metabolism and pregnancy outcomes provides a scientific basis for reasonable intake of vitamin D to prevent adverse pregnancy outcomes.MethodsThis study recruited healthy women in the third trimester of pregnancy in Maternal and Child Health Hospitals in Yuexiu District and Baiyun District of Guangzhou City as survey objects.A questionnaire survey of the basic situation of pregnant women,a 24-day diet review to investigate dietary status were done in the third trimester.A collection of pregnant women's blood during hospitalization and postnatal questionnaire of pregnant women's delivery conditions and basic conditions of the fetus,physical measurements of the newborn were done,and finally obtained 468 valid data,collected 398 available pregnant women's blood.The serum 25(OH)D of pregnant women was detected by ELISA,and vitamin D deficiency,insufficient,and sufficient were determined according to 25(OH)D concentrations<50 nmol/L,50?75 nmol/L,and?75 nmol/L.Colorimetric method and ELISA were used to detect fasting blood glucose,blood lipid and serum adiponectin in pregnant women.Following statistical analysis used SPSS 20.0.The Wilcoxon rank sum test and Kruskal-Wallis multi-sample rank sum test were used to analyze the differences in 25(OH)D concentration between different influencing factor groups,and logistic regression analysis was used for pregnant women's vitamin D nutrition status influencing factors.Covariance analysis and multiple linear regression analysis were used for the relationship between serum 25(OH)D levels and glucolipid metabolism in pregnant women;Pearson chi-square test or Fisher exact probability and conditional logistic regression analysis were used for the association between vitamin D nutritional status during pregnancy and adverse pregnancy outcomes.Results1.Vitamin D nutrition status of pregnant womenThe median and interquartile range of serum 25(OH)D concentration in pregnant women is 47.05(35.10,59.60)nmol/L,and 57%of pregnant women were vitamin D deficiency,33.7%with vitamin D insufficient,only 9.3%with vitamin D sufficient.2.Influencing factors of vitamin D nutrition level in pregnant womenThere was no significant difference in the concentration of 25(OH)D between vitamin D supplement or not,different pre-pregnancy BMI,and different gestational week groups(P>0.05).There were significant differences between the groups in different seasons and different duration of outdoor activities.The concentration of 25(OH)D was significantly higher in summer than that in other seasons(P<0.05).The concentration of 25(OH)D in the serum of pregnant women who did not spend more than half an hour outdoors was significantly lower than who had been outdoors longer3.The relationship between vitamin D nutrition level and glucose and lipid metabolism indexes in pregnant womenThe fasting blood glucose of pregnant women with vitamin D deficiency was slightly higher than insufficient and sufficient group,but there was no statistical difference(P>0.05).Spearman rank correlation analysis showed that the serum 25(OH)D concentration was significantly negatively correlated with fasting blood glucose(rs=-0.177,P=0.001).Multiple linear regression analysis showed that serum 25(OH)D concentration was negatively correlated with fasting blood glucose(?=-0.008,P=0.037)after correction for maternal age,gestational age,pre-pregnancy BMI,nutrition and exercise during pregnancy.The blood lipid levels of pregnant women in different vitamin D nutritional status groups were significantly different(P<0.05).TC and TG of vitamin D deficiency pregnant women were higher than vitamin D sufficient group(P<0.05)The maternal serum 25(OH)D concentration was negatively correlated with blood lipid concentration(P<0.01),and its negative correlation still remained after correction.Compared with vitamin D deficiency,pregnant women with a serum 25(OH)D? 50 nmol/L have a risk of hypertriglyceridemia OR=0.505(95%CI:0.310?0.822),and a risk of developing high total cholesterolemia OR=0.553(95%CI:0.360?0.851).The average adiponectin level of pregnant women in the vitamin D deficiency group was slightly higher than insufficient and sufficient group,but there was no statistical difference(P>0.05).The maternal serum 25(OH)D concentration was not related to adiponectin concentration(P>0.05)even after correction(P>0.05).4.The relationship between pregnant women's vitamin D nutrition level and pregnancy outcomesThe cesarean section rate in the vitamin D deficiency group was 52.9%,which was higher than insufficient and sufficient group(P<0.05).The risk of cesarean section for pregnant women with serum 25(OH)D?50 nmol/L was 0.609(95%CI:0.407 to 0.910)times for pregnant women with vitamin D deficiency.Corrected age and BMI before pregnancy and the birth weight of the newborn,the association disappeared(P>0.05).Among pregnant women with vitamin D deficiency,at least one pregnancy complications accounted for 45.7%,the prevalence rate was significantly higher than the group with better vitamin D nutrition level(P<0.05).Vitamin D nutritional status was inversely related to the risk of developing one or more complications of pregnancy(P<0.05).The prevalence of anemia in pregnant women with vitamin D deficiency during pregnancy was 38.5%,which was significantly higher than that of the vitamin D nutrition better group(P<0.05).The risk of anemia in pregnant women with serum 25(OH)D ? 50nmol/L is 0.563(95%CI:0.350?0.905)times for pregnant women with vitamin D deficiency,and the negative correlation was still significant after correction(P<0.05).There was no statistically significant difference in the distribution of gestational diabetes between vitamin D deficiency group pregnant women and the other(P>0.05).Vitamin D nutritional status was not significantly associated with gestational diabetes(P>0.05).There were significant differences of birth weights of between different vitamin D nutritional status groups.The birth weights of newborn whose mother in the vitamin D deficiency group were heavier than insufficient and sufficient group(P<0.05).There was no significant difference in birth length(P>0.05).Vitamin D nutritional status was negatively correlated with the risk of macrosomia(P<0.05).The risk of giving birth to macrosomia for pregnant women with serum 25(OH)D?50 nmol/L was 0.195(95%CI:0.043?0.877)times for pregnant women with vitamin D deficiency.After correction,the negative correlation was still significant(P<0.05).Conclusion1.Vitamin D deficiency or insufficient is common in the third trimester of Guangzhou pregnant women.Season and outdoor exercise duration are the main influencing factors of serum 25(OH)D concentration in pregnant women.It is necessary to strengthen education on vitamin D related knowledge during pregnancy,better instruct pregnant women to appropriately increase outdoor activities,and reasonably arrange sunlight exposure time according to weather and season.2.Serum 25(OH)D concentration is negatively correlated with fasting blood glucose and blood lipids in pregnant women.Good vitamin D nutritional levels in pregnant women may promote glucolipid metabolism to obtain good pregnancy outcomes.3.The vitamin D nutritional status of pregnant women affects the health of mothers and infants.On the one hand,vitamin D deficiency during pregnancy increases their risk of cesarean section and pregnancy complications.In addition,vitamin D deficiency during pregnancy affects the growth and development of the fetus,vitamin D deficiency during pregnancy increases the risk of macrosomia.