25(OH)D Moderates The Relationship Between Dietary Inflammatory Potential And Cardiovascular Health Risk During The Second Trimester Of Pregnancy

ObjectiveBased on a prospective birth cohort study in Hefei,we analyzed the association between pro-inflammatory diet and cardiovascular health risk,and further investigated the role of serum 25(OH)D concentration in this association.To provide scientific basis for guiding diet during pregnancy and promoting maternal and child health.MethodsFrom March 2018 to June 2021,3,713 eligible pregnant women were enrolled at baseline(16-23 weeks)from three hospitals in Hefei City and followed up until delivery.At the time of enrollment,a self-made questionnaire was conducted to collect the participants basic socio-demographic data and dietary information during pregnancy.According to the effective eating frequency questionnaire,the dietary inflammation pattern scoring was used to evaluate the dietary inflammation potential.OGTT(Oral glucose tolerance test)was performed at 24-28 weeks for all participants.Pregnant women in the middle of pregnancy to fill in questionnaires,collecting social demographic information and health information,collection of fasting venous blood in pregnant women in peripheral blood of serum 25(OH)D concentration and serum hypersensitive C-reactive protein(hs-CRP,high sensitivity C reactive protein)concentration detection.Cardiovascular health risk score(CVR)was composed of body mass index,blood lipid,blood glucose,blood pressure and smoking status.Using linear and logistic regression model analysis of EDIP scores and the middle of a pregnancy pregnant women CVR score and the relationship between CRP levels,limiting risk of cubic spline model is set up,control of the main factors,according to the different vitamin D status(Enough,≥50 nmol/L.Deficiency,<50 nmol/L)stratification,to investigate the effect of vitamin D on the association between EDIP score(continuity variable)and risk of cardiovascular disease during the second trimester.Mediating models were used to evaluate the effects of serum 25(OH)D concentration in the second trimester on EDIP score and CVR in pregnant women,the effects of serum 25(OH)D concentration in the second trimester on hs-CRP concentration and CVR in pregnant women,and the effects of hs-CRP concentration in the second trimester on EDIP score and CVR in the second trimester.Potential confounding factors adjusted for included maternal age,place of residence,education,mean monthly household income,pre-pregnancy body mass index,birth time,weight gain during pregnancy,family history of hypertension,family history of diabetes,physical activity,outdoor activities,sedentary time,and frequency of vitamin D supplementation.ResultsAmong the 3 713 participants,the mean age of the participants was(29.1±4.2)years,the mean pre-pregnancy BMI was(21.5±2.9)kg/m2,the proportion of all ideal CVR groups was 46.3%,and the proportion of ≥1 intermediate level(no poor level)group was 25.2%.The proportion of ≥1 poor level group was 28.5%.91.8 percent of participants with ideal BMI,81.9 percent with ideal blood pressure,77.7 percent with ideal TC(total cholesterol),83.0 percent with ideal blood sugar,and 99.3 percent with never smoking.After adjusting for potential confounding factors during pregnancy,EDIP score in early pregnancy was positively correlated with CVR score in mid-pregnancy.EDIP scores were divided into three groups:low EDIP score(<P25),medium EDIP score(P25-P75),and high EDIP score(≥ P75).The trend test P value of the three groups was 0.041.The CVR scores in the second trimester were divided into all ideal level groups(risk-free group)and at-risk group.Compared with low EDIP,the RR(95%CI)for medium EDIP was 1.23(1.05,1.44),and the RR(95%CI)for high EDIP was 1.31(1.09,1.58).After adjusting for potential confounding factors during pregnancy,EDIP score in early pregnancy was negatively correlated with serum 25(OH)D concentration in the second trimester.Serum 25(OH)D concentration(nmol/L)of low EDIP(<P25),medium EDIP(P25-P75)and high EDIP(≥ P75)were 39.45±17.00,38.42±16.41 and 37.90±15.36,respectively.The EDIP score in early trimester was positively correlated with the serum hs-CRP concentration in mid-trimester.With each SD increase in EDIP score,hs-CRP increased by 14.5%(95%CI:4.4,30).The serum 25(OH)D concentration during the second trimester was negatively correlated with CVR score and serum hsCRP level(P<0.01).Serum 25(OH)D concentration was divided by quartile method.CVR score and hs-CRP level were decreased by 11.4%(95%CI:-21.7,-11.0)and 28.0%(95%CI:-49.5,-65.0)with each increase of IQR.Compared with the group with the lowest serum 25(OH)D concentration(Q1),the CVR scores in group Q2,Q3 and Q4 were decreased by 3.3%(95%CI:-13.4,6.8),5.5%(95%CI:-15.6,4.7)and 11.4%(21.4,-4.7),respectively.Serum hs-CRP levels in group Q2,Q3 and Q4 were decreased by 7.7%(95%CI:-29.0,13.6),13.4(95%CI:-34.5,7.8)and 28.0(95%CI:-49.5,-6.5),respectively.Stratified analysis of serum 25(OH)D concentration in the second trimester showed that the score of EDIP in the first trimester was positively correlated with the score of CVR in the second trimester when serum 25(OH)D concentration was deficient(<50 nmol/L),and low EDIP was grouped(<P25)(RR=1.41,95%CI:1.03,1.94),medium EDIP(P25-P75)(RR=1.70,95%CI:1.26,2.29),and high EDIP(≥ P75)(RR=1.85,95%CI:1.35,2.54)had an increased risk of CVR.In pregnant women with adequate serum 25(OH)D concentration(≥50 nmol/L),EDIP score and CVR risk were not statistically significant.There was no statistically significant increase in CVR risk from low EDIP(<P25),medium EDIP(P25-P75),and high EDIP(≥P75).There was a correlation between EDIP score in the first trimester,CVR score in the second trimester and serum 25(OH)D concentration in the second trimester(P<0.01),which met the conditions of mediating analysis.This study explored the mediating effect of serum 25(OH)D concentration in the second trimester on EDIP score in the first trimester and CVR score in the second trimester.The direct effect of 25(OH)D concentration on EDIP score and CVR risk was 7.7%(2.8%to 12.5%),and the mediating effect ratio was 28.7%.Secondly,the hs-CRP concentration in the second trimester was correlated with the CVR score in the second trimester(P<0.01),the hsCRP concentration in the second trimester was correlated with the serum 25(OH)D concentration in the second trimester(P<0.01),and the CVR score in the second trimester was correlated with the serum 25(OH)D concentration in the second trimester(P<0.01),which could be used for mediation analysis.This study explored the mediating effect of serum 25(OH)D concentration in the second trimester on hs-CRP concentration and CVR score in the second trimester.The results showed that the direct effect of 25(OH)D on hs-CRP concentration and CVR risk was 3.0%(2.0%-6.0%),and the mediating effect ratio was 21.9%.In addition,the EDIP score in the first trimester was correlated with the CVR score in the second trimester(P<0.01),the EDIP score in the first trimester was correlated with the serum hs-CRP concentration in the second trimester(P<0.01),and the CVR score in the second trimester was correlated with the serum hs-CRP concentration in the second trimester(P<0.01).This study explored the mediating effect of serum hs-CRP concentration in the second trimester on EDIP score and CVR score in the second trimester.The direct effect of hs-CRP concentration on EDIP score and CVR risk was 7.7%(2.8%to 12.5%),and the mediating effect ratio was 13.6%.ConclusionsA higher inflammatory dietary pattern score exacerbates poor cardiovascular health in pregnant women by promoting inflammation,and adequate vitamin D can play an anti-inflammatory role and alter this association.