Maternal 25(OH)D concentrations ≥40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center.
Maternal 25(OH)D concentrations ≥40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center.
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DOI：
10.1371/journal.pone.0180483
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Wagner CL
中科院分区：
文献类型：
--
作者：
McDonnell SL;Baggerly KA;Baggerly CA;Aliano JL;French CB;Baggerly LL;Ebeling MD;Rittenberg CS;Goodier CG;Mateus Niño JF;Wineland RJ;Newman RB;Hollis BW;Wagner CL
鉴于全国早产 (PTB) 率较高，且随机对照试验数据显示补充维生素 D 可降低风险，南卡罗来纳医科大学 (MUSC) 为孕妇实施了新的护理标准，以接受维生素 D 检测和补充。为了确定所报告的孕产妇 25(OH)D 与 PTB 风险之间的负相关关系是否可以在 MUSC（一个治疗大量不同人群的城市医疗中心）复制。获取了 2015 年 9 月至 2016 年 12 月期间 18-45 岁孕妇的医疗记录数据。在此期间，启动了一项方案，其中包括在第一次产前检查时进行 25(OH)D 检测以及建议的后续检测。提供免费维生素D补充剂，治疗目标为≥40 ng/mL。计算 PTB 发生率（<37 周），并使用逻辑回归和局部加权回归 (LOESS) 探讨 25(OH)D 与 PTB 之间的关联。还进行了亚组分析。在妊娠期间至少进行过一次 25(OH)D 测试的活产单胎女性中 (N = 1,064)，总体 PTB 率为 13%。 LOESS 曲线显示胎龄随着 25(OH)D 的增加而增加。与 <20 ng/mL 的女性相比，25(OH)D ≥40 ng/mL 的女性发生 PTB 的风险降低 62% (p<0.0001)。在调整社会经济变量后，这种较低的风险仍然存在（OR = 0.41，p = 0.002）。在 PTB 亚型（自发性：58%，p = 0.02；指示性：61%，p = 0.006）、种族/族裔（白人：65%，p = 0.03；非白人：68%，p = 0.008）以及既往患有 PTB 的女性（80%，p = 0.02）中，观察到 PTB 风险也有类似的降低。在初始 25(OH)D <40 ng/mL 的女性中，后续测试中≥40 ng/mL 的女性的 PTB 率比 <40 ng/mL 的女性低 60% (p = 0.006)；白人为 38% (p = 0.33)，非白人为 78% (p = 0.01)。在大量不同的女性群体中，母亲 25(OH)D 浓度≥40 ng/mL 与 PTB 风险大幅降低相关。
Given the high rate of preterm birth (PTB) nationwide and data from RCTs demonstrating risk reduction with vitamin D supplementation, the Medical University of South Carolina (MUSC) implemented a new standard of care for pregnant women to receive vitamin D testing and supplementation. To determine if the reported inverse relationship between maternal 25(OH)D and PTB risk could be replicated at MUSC, an urban medical center treating a large, diverse population. Medical record data were obtained for pregnant patients aged 18–45 years between September 2015 and December 2016. During this time, a protocol that included 25(OH)D testing at first prenatal visit with recommended follow-up testing was initiated. Free vitamin D supplements were offered and the treatment goal was ≥40 ng/mL. PTB rates (<37 weeks) were calculated, and logistic regression and locally weighted regression (LOESS) were used to explore the association between 25(OH)D and PTB. Subgroup analyses were also conducted. Among women with a live, singleton birth and at least one 25(OH)D test during pregnancy (N = 1,064), the overall PTB rate was 13%. The LOESS curve showed gestational age rising with increasing 25(OH)D. Women with 25(OH)D ≥40 ng/mL had a 62% lower risk of PTB compared to those <20 ng/mL (p<0.0001). After adjusting for socioeconomic variables, this lower risk remained (OR = 0.41, p = 0.002). Similar decreases in PTB risk were observed for PTB subtypes (spontaneous: 58%, p = 0.02; indicated: 61%, p = 0.006), by race/ethnicity (white: 65%, p = 0.03; non-white: 68%, p = 0.008), and among women with a prior PTB (80%, p = 0.02). Among women with initial 25(OH)D <40 ng/mL, PTB rates were 60% lower for those with ≥40 vs. <40 ng/mL on a follow-up test (p = 0.006); 38% for whites (p = 0.33) and 78% for non-whites (p = 0.01). Maternal 25(OH)D concentrations ≥40 ng/mL were associated with substantial reduction in PTB risk in a large, diverse population of women.
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通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network