维生素 D 补充对中晚期妊娠血糖控制的影响：一项随机对照试验。

Effect of vitamin D supplementation on glucose control in mid-late gestation: A randomized controlled trial.

机构信息

Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, No 81 Mei-Shan Road, Hefei, Anhui, 230032, China.

Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, No 81 Mei-Shan Road, Hefei, Anhui, 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, No 81 Mei-Shan Road, Hefei, Anhui, 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, No 81 Mei-Shan Road, Hefei, Anhui, 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Mei-Shan Road, Hefei, Anhui, 230032, China.

出版信息

Clin Nutr. 2023 Jun;42(6):929-936. doi: 10.1016/j.clnu.2023.04.011. Epub 2023 Apr 14.

DOI:10.1016/j.clnu.2023.04.011

PMID:37087832

Abstract

BACKGROUND & AIMS: It is unclear whether vitamin D supplementation contributes to gestational glucose control and whether the specific effects vary in individuals with diverse genetic and metabolic contexts. The study aimed to assess the effect of vitamin D supplementation during pregnancy on subsequent glucose levels and to identify factors modulating the response to vitamin D3 intake.

METHODS

We conducted a multicenter randomized controlled trial, 1720 pregnant women recruited from the three antenatal clinics of Hefei city, China, who were allocated to receive either 1600 IU/d vitamin D3 (n = 858) or 400 IU/d vitamin D3 (n = 862) for 2 months at 24-28 weeks' gestation. Outcomes were changes in serum 25-hydroxyvitamin D (25(OH)D) and fasting plasma glucose (FPG) levels from baseline, 32-36 weeks' gestation to delivery (37-41 weeks) quantified using a linear mixed model.

RESULTS

After 2 months, FPG levels of the control group significantly increased by 0.22 mmol/L (from 4.6 [0.4] mmol/L to 4.8 [1.2] mmol/L, P < 0.001) at delivery, but that of the intervention group had no significant variation (from 4.6 [0.4] mmol/L to 4.7 [1.1] mmol/L; between-group difference in changes, -0.2 mmol/L, 95% CI, -0.3 to -0.08, P = 0.015). And differences in FPG variation were found in participants with the ApaI SNP CC genotype, or BsmI-CC, TaqI-AA, FokI-AA, respectively. Pregnant women with basal 25(OH)D concentrations higher than 50 nmol/L subgroup showed the greatest decline in FPG levels (between-group difference, -0.3 mmol/L; 95% CI, -0.5 to -0.1, P < 0.001). Moreover, pregnant women with GDM, multiple pregnancies or who were overweight were more likely to have FPG decline from vitamin D treatment.

CONCLUSIONS

Vitamin D supplementation significantly protected glucose homeostasis in mid-late gestation, and glycemic response to vitamin D may be dependent on basal 25(OH)D status, VDR gene polymorphism or their metabolic profiles.

TRIAL REGISTRATION NUMBER

ChiCTR2100051914. URL OF REGISTRATION: http://www.chictr.org.cn/showproj.aspx?proj=134700.

摘要

背景与目的

目前尚不清楚维生素 D 补充是否有助于控制妊娠期血糖，以及在不同遗传和代谢背景下，其具体作用是否存在差异。本研究旨在评估妊娠期间补充维生素 D 对随后血糖水平的影响，并确定调节维生素 D3 摄入反应的因素。

方法

我们开展了一项多中心随机对照试验，共纳入了来自中国合肥市 3 家产前诊所的 1720 名孕妇，她们被随机分配至接受 1600 IU/d 维生素 D3（n=858）或 400 IU/d 维生素 D3（n=862）治疗，在妊娠 24-28 周时开始治疗，持续 2 个月。采用线性混合模型评估血清 25-羟维生素 D（25(OH)D）和空腹血浆葡萄糖（FPG）水平从基线到妊娠 32-36 周（分娩时，妊娠 37-41 周）的变化。

结果

在 2 个月时，对照组的 FPG 水平在分娩时显著升高 0.22 mmol/L（从 4.6[0.4]mmol/L 升至 4.8[1.2]mmol/L，P<0.001），而干预组的 FPG 水平无显著变化（从 4.6[0.4]mmol/L 升至 4.7[1.1]mmol/L；组间变化差异，-0.2 mmol/L，95%CI，-0.3 至-0.08，P=0.015）。并且在 ApaI SNP CC 基因型、BsmI-CC、TaqI-AA、FokI-AA 存在差异的参与者中发现了 FPG 变异的差异。基础 25(OH)D 浓度高于 50 nmol/L 亚组的孕妇的 FPG 水平下降幅度最大（组间差异，-0.3 mmol/L；95%CI，-0.5 至-0.1，P<0.001）。此外，患有 GDM、多胎妊娠或超重的孕妇更有可能出现 FPG 下降。