Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes.
Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes.
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DOI：
10.1097/aog.0000000000000621
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发表时间：
2015-02
影响因子：
7.2
通讯作者：
Simhan HN
中科院分区：
文献类型：
--
作者：
Bodnar LM;Platt RW;Simhan HN
评估母体羟基维生素 D（25-羟基维生素 D）浓度与早产亚型风险之间的关联。我们使用来自宾夕法尼亚州匹兹堡一家教学医院的患者数据和样本库进行了一项病例队列研究。符合资格的参与者是在妊娠 20 周或之前接受产前非整倍体筛查血清样本、随后产下单胎活产婴儿的女性。在 n=12,861 名符合资格的女性中，我们随机选择了 n=2327 名以及所有剩余的早产病例，总共 n=1126 名。使用液相色谱-串联质谱法测定血清 25-羟基维生素 D。使用多变量对数二项式回归模型来估计母亲维生素 D 状态与 <37 周早产（分别按自发或指示）和 <34 周早产之间的关联。总体而言，<37周的早产发生率为8.6%，而血清25-羟基维生素D<50、50-74.9和≥75nmol/L的母亲的早产发生率分别为11.3%、8.6%和7.3%（p<0.01）。调整母亲种族和民族、孕前 BMI、季节、吸烟和其他混杂因素后，随着 25-羟基维生素 D 增加至约 90 nmol/L，然后趋于稳定，<37 周的早产风险显着降低（非线性检验 p<0.01）。当仅限于有医学指征或自发发生的病例以及妊娠<34周时发生的病例时，结果相似。我们的数据支持孕产妇维生素 D 充足与早产之间存在保护性关联，结合现有的流行病学数据，可能为孕产妇维生素 D 替代或补充预防早产的随机临床试验提供理由。
To estimate the association between maternal hydroxyvitamin D (25-hydroxyvitamin D) concentrations and risk of preterm birth subtypes. We performed a case-cohort study using data and banked samples from patients at a teaching hospital in Pittsburgh, Pennsylvania. Eligible participants were women with a prenatal aneuploidy screening serum sample at or before 20 weeks of gestation who subsequently delivered a singleton, live-born infant. Of the n=12,861 eligible women, we selected n=2327 at random as well as all remaining preterm birth cases for a total of n=1126 cases. Serum 25-hydroxyvitamin D was measured using liquid chromatography–tandem mass spectrometry. Multivariable log-binomial regression models were used to estimate associations between maternal vitamin D status and preterm birth <37 weeks (separately by spontaneous or indicated) and preterm birth <34 weeks. The incidence of preterm birth <37 weeks was 8.6% overall and 11.3%, 8.6%, and 7.3% among mothers with serum 25-hydroxyvitamin D<50, 50–74.9, and ≥75nmol/L, respectively (p<0.01). After adjustment for maternal race and ethnicity, prepregnancy BMI, season, smoking, and other confounders, the risk of preterm birth <37 weeks significantly decreased as 25-hydroxyvitamin D increased to approximately 90 nmol/L and then plateaued (test of nonlinearity p<0.01). Results were similar when limiting to cases that were medically indicated or occurred spontaneously and cases occurring at <34 weeks of gestation. Our data support a protective association maternal vitamin D sufficiency and preterm birth that combined with extant epidemiologic data may provide justification for a randomized clinical trial of maternal vitamin D replacement or supplementation to prevent preterm birth.