Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies
Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies
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DOI：
10.1093/ajcn/88.2.520s
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发表时间：
2008-08-01
影响因子：
7.1
通讯作者：
Kovacs, Christopher S.
中科院分区：
文献类型：
--
作者：
Kovacs, Christopher S.
在怀孕和哺乳期间，母亲需要大量的钙分别传递给发育中的胎儿和哺乳的新生儿。鉴于成人钙浓度和骨代谢对维生素 D 的依赖，人们可能会预计，在怀孕和哺乳期间维生素 D 的充足性将更加重要。然而，怀孕和哺乳期间的母体适应以及胎儿的适应相对独立于维生素 D 状态提供必要的钙。维生素 D 缺乏或不足的新生儿面临低钙血症和佝偻病等问题的风险。由于维生素 D 和 25-羟基维生素 D [25(OH)D] 在牛奶中的渗透性较差，纯母乳喂养的婴儿比配方奶喂养的婴儿缺乏维生素 D 的风险更高。针对妊娠期和哺乳期妇女的剂量建议可能最好是确保新生儿维生素 D 充足，并在婴儿期及以后维持这种充足的维生素 D。在怀孕期间为母亲提供充足 25(OH)D 的维生素 D 剂量应提供正常的脐带血浓度 25(OH)D。研究表明，在哺乳期间，直接给婴儿服用补充剂可以轻松实现维生素 D 充足；母亲需要更高的剂量（每天 100 微克或 4000 IU）才能使纯母乳喂养的婴儿达到成人正常的 25(OH)D 浓度。此外，还需要研究胎儿或新生儿维生素 D 不足与长期非骨骼结局（如 1 型糖尿病和其他慢性疾病）之间的关系（如果有）。
During pregnancy and lactation, mothers require significant amounts of calcium to pass on to the developing fetus and suckling neonate, respectively. Given the dependence of adult calcium concentrations and bone metabolism on vitamin D, one might anticipate that vitamin D sufficiency would be even more critical during pregnancy and lactation. However, maternal adaptations during pregnancy and lactation and fetal adaptations provide the necessary calcium relatively independently of vitamin D status. It is the vitamin D-deficient or insufficient neonate who is at risk of problems, including hypocalcemia and rickets. Due to poor penetrance of vitamin D and 25-hydroxyvitamin D [25(OH)D] into milk, exclusively breastfed infants are at higher risk of vitamin D deficiency than are formula-fed infants. Dosing recommendations for women during pregnancy and lactation might be best directed toward ensuring that the neonate is vitamin D-sufficient and that this sufficiency is maintained during infancy and beyond. A dose of vitamin D that provides 25(OH)D sufficiency in the mother during pregnancy should provide normal cord blood concentrations of 25(OH)D. Research has shown that during lactation, supplements administered directly to the infant can easily achieve vitamin D sufficiency; the mother needs much higher doses (100 mu g or 4000 IU per day) to achieve adult-normal 25(OH)D concentrations in her exclusively breastfed infant. In addition, the relation (if any) of vitamin D insufficiency in the fetus or neonate to long-term nonskeletal outcomes such as type 1 diabetes and other chronic diseases needs to be investigated.