Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis.
Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis.
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DOI：
10.1111/j.1365-3016.2012.01283.x
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发表时间：
2012-07
影响因子：
2.8
通讯作者：
Fawzi WW
中科院分区：
文献类型：
--
作者：
Thorne-Lyman A;Fawzi WW
维生素D具有与钙代谢和骨骼健康相关的明确的经典功能，但也具有可能影响健康其他方面的非经典效应。最近，人们对维生素D对怀孕和幼儿健康相关结果的作用产生了相当大的兴趣，但很少作出努力，系统地巩固这一证据，为低收入国家的研究和政策议程提供信息。我们进行了一项系统综述，以确定维生素D补充、摄入或妊娠期间状态（25-羟基维生素D）对围产期和婴儿健康结局的干预和观察性研究。从试验和观察性研究中提取了维生素D补充和摄入影响的数据，并评估了研究质量。荟萃分析用于汇总效应估计。我们确定了5个随机试验，其结果与我们的综述相关。所有的样本量都很小，剂量、持续时间和频率随着纠正缺陷的能力而变化。使用固定效应模型的试验汇总分析表明，补充剂对低出生体重有保护作用(3项试验，风险比（RR)=0.40[95%置信区间（CI）， 0.23, 0.71]），每日补充剂对小胎龄（SGA）有不显著但有提示作用（2项试验，RR=0.67,[0.40, 1.11]）。早产（<37周）无明显影响（2项试验，RR=0.77[0.35, 1.66]）。几乎没有试验证据来评估妊娠期间补充维生素D对孕产妇、围产期或婴儿健康结果的影响。基于试验和观察性研究，我们建议未来的研究探索SGA、早产、先兆子痫和母婴感染，作为感兴趣的结果。试验应侧重于维生素D缺乏症高发人群，探索补充时间的相关性，试验中使用的剂量应足以纠正缺乏症。
Vitamin D has well-defined classical functions related to calcium metabolism and bone health but also has non-classical effects that may influence other aspects of health. There has been considerable recent interest in the role of vitamin D on outcomes related to pregnancy and young child health but few efforts have been made to systematically consolidate this evidence to inform the research and policy agenda for low income countries. A systematic review was undertaken to identify intervention and observational studies of vitamin D supplementation, intake, or status (25-hydroxy-vitamin D) during pregnancy on perinatal and infant health outcomes. Data from trials and observational studies isolating the effect of vitamin D supplementation and intake were extracted and study quality was evaluated. Meta-analysis was used to pool effect estimates. We identified 5 randomized trials with outcomes of relevance to our review. All had small sample size and dosage amount, duration, and frequency varied as did the ability to correct deficiency. Pooled analysis of trials using fixed effects models suggested protective effects of supplementation on low birthweight (3 trials, Risk ratio (RR)=0.40 [95% confidence interval (CI), 0.23, 0.71]) and non-significant but suggestive effects of daily supplementation on small-for-gestational age (SGA) (2 trials, RR=0.67, [0.40, 1.11]. No effect on preterm delivery (<37 weeks) was evident (2 trials, RR=0.77 [0.35, 1.66]). Little evidence from trials exists to evaluate the effect of vitamin D supplementation during pregnancy on maternal, perinatal or infant health outcomes. Based on both trials and observational studies, we recommend that future research explore SGA, preterm delivery, pre-eclampsia, and maternal and childhood infections, as outcomes of interest. Trials should focus on populations with a high prevalence of vitamin D deficiency, explore the relevance of timing of supplementation, and the dosage used in such trials should be sufficient to correct deficiency.
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