Nutritional Status Of Vitamin D In Early Preganncy Was Correlated With Blood Lipid,blood Glucose And Pregnancy Outcome In Late Pregnancy

Objective:To study the correlation between vitamin D nutritional status of pregnant women in the first trimester and blood lipid,fasting plasma glucose in the third trimester in shengze district of wujiang,and the effects of vitamin D nutritional status in early pregnancy on pregnancy outcomes.Methods:Retrospective analysis was performed on 750 pregnant women who visited the obstetrics department of jiangsu shengze hospital and gave birth from June 2017 to May 2018.According to the serum level of 25-hydroxyvitamin D[25(OH)D]in the early pregnancy(8-13 weeks),the above women was divided into the vitamin D control group[25(OH)D≥ 20ng/mL,248 cases]and the vitamin D deficiency group[25(OH)D<20ng/mL,502 cases].Meanwhile,triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-c),high density lipoprotein cholesterol(HDL-c)and fasting plasma glucose(FPG)levels in the third trimester(32-41 weeks)were analyzed.The pregnancy outcomes,neonatal weight and delivery mode of the above-mentioned pregnant women were statistically analyzed.SPSS17.0 software was used to analyze the following situations:(1)the nutritional status of vitamin D in pregnant women in the early pregnancy;(2)the correlation analysis of vitamin D nutritional status in early pregnancy and blood lipid indicators in late pregnancy;(3)the correlation analysis of vitamin D nutritional status in early pregnancy and FPG in late pregnancy;(4)the correlation between vitamin D nutritional status in early pregnancy and neonatal weight;(5)multiple linear regression analysis was used to study the correlation between 25(OH)D in the first trimester,the related parameters in the third trimester(age,gestational age,maternal height,weight in the third trimester,BMI),blood lipid indicators(TG,TC,LDL-c,HDL-c),FPG,and neonatal weight.(6)the correlation between vitamin D nutritional status in early pregnancy and pregnancy outcome(gestational diabetes,gestational hypertension,premature rupture of membranes,low birth weight,macrosomia postpartum hemorrhage,abnormal amniotic fluid,and delivery mode).Result:(1)Vitamin D nutritional status of pregnant women in the first trimester of pregnancy:The level of 25(OH)D of pregnant women in the first trimester ranged from 0.93 to 48.58 ng/mL,and the level of vitamin D was generally deficient.The number of women in the vitamin D deficiency group[25(OH)D<20 ng/mL]was 502,accounting for 66.9%of the total population;the number of women in the vitamin D control group[25(OH)D<20 ng/mL]was 248,accounting for 33.1%of the total population..(2)The correlation analysis between vitamin D nutritional status in early pregnancy and blood lipid index in late pregnancy:The comparison of TG,TC,LDL-c and HDL-c in the first trimester of pregnancy between the vitamin D deficiency group and the control group showed that the level of TG was higher in the vitamin D deficiency group(3.10±1.19 mmol/L)than in the control group(2.93±1.17 mmol/L),the difference was statistically significant(t=1.931,P=0.031),and the level of LDL-c was higher in the vitamin D deficiency group(3.01±0.95 mmol/L)was also higher than that of the control group(2.86±0.93 mmol/L),the difference was statistically significant(t=2.002,P=0.030),while there was no statistical difference between TC and HDL-c in the third trimester of pregnancy(P>0.05);According to Pearson correlation analysis,25(OH)D in early pregnancy was significantly negatively correlated with TG(r=-0.091,P=0.013)and LDL-c(r=-0.066,P=0.023)levels in late pregnancy,while 25(OH)D in early pregnancy was not correlated with TC(r=0.007,P=0.848)and HDL-c(r=0.023,P=0.526)levels in late pregnancy.(3)The correlation analysis of vitamin D in the first trimester with fasting blood glucose in the third trimester and neonatal birth weight:FPG level in the third trimester of vitamin D deficiency group(4.41±0.32mmol/L)was significantly higher than that in the control group(4.29±0.04mmol/L),the difference was statistically significant(t=3.103,P=0.002).There was no statistically significant difference(t=0.156,P=0.876)between the neonatal birth weight of vitamin D deficiency group(3358.67±434.28g)and the control group(3353.63±404.99g).According to Pearson correlation analysis,There was significant negative correlation between early pregnancy 25(OH)D and FPG level(r=-0.105,P=0.004),but not statistical significance between 25(OH)D and FPG level(r=-0.47,P=0.194).(4)The multiple linear regression analysis(stepwise method)was carried out to study the correlation between 25(OH)D in the first trimester,related parameters in the third trimester(age,gestational age,maternal height,weight in the third trimester,BMI),blood lipid indicators(TG,TC,LDL-c,HDL-c),FPG,and neonatal weight.The influencing factors of TG were age(β=0.103,p=0.005),vitamin D(β=-0.082,p=0.023),FPG(β=0.158,p=0.000)and BMI(β=0.086,p=0.017).The influencing factors of TC were FPG(β=0.097,p=0.008)and BMI(β=-0.082,p=0.024).The influencing factors of LDL-c were gestational age(β=0.094,p=0.010),vitamin D(β=-0.079,p=0.004),and BMI(β=-0.097,p=0.007).The influencing factors of HDL-c were BMI(β=-0.081,p=0.036).The influential factors of FPG were age(β=0.123,p=0.001),vitamin D(β=-0.097,p=0.007),and TG(β=0.176,p=0.000).The influencing factors of neonatal body weight were body weight in the third trimester(β=0.275,p=0.000),gestational weeks(β=0.213,p=0.000),and FPG(β=0.174,p=0.000).(5)The correlation analysis of vitamin D nutritional status in early pregnancy with delivery mode and pregnancy complications:In the correlation analysis of gestational diabetes mellitus(GDM),gestational hypertension(HDP),premature rupture of membranes(PROM),postpartum hemorrhage(PPH),polyhydramnios,oligohydramnios,cesarean section rate,low birth weight infants,macrosomia between vitamin D deficient group and control group,it was found that GDM(10.6%),HDP(8.6%),PROM(9.6%)and cesarean section rate(31.7%)of pregnant women in vitamin D deficient group were significantly higher than those of the vitamin D control group,and the difference were statistically significant,while there were no significant differences in low birth weight infants,macrosomia,PPH,and amniotic fluid abnormalities between the vitamin D deficiency group and the control group.In addition,the 25(OH)D levels of GDM,HDP,PROM and cesarean section delivery pregnant women were compared with those of non-GDM,non-HDP,non-PROM and spontaneous delivery pregnant women,and the difference between them were statistically significant(P<0.05).Conclusion:(1)vitamin D deficiency in pregnant women in the early stages of pregnancy is quite common in shengze area of wujiang.Pregnant women should be encouraged to take more outdoor activities,and Vitamin D supplementation can be individualized according to serum 25(OH)D status during pregnancy.(2)Vitamin D deficiency in the first trimester of pregnancy is prone to cause the marked increase of TG,LDL-c and FPG in the blood lipids of pregnant women in the third trimester,which in turn leads to the increased risk of gestational hyperlipidemia and gestational diabetes mellitus.Pregnant women with vitamin D deficiency in the first trimester of pregnancy should be strengthened by screening for blood lipids and blood glucose during pregnancy and dietary health guidance during pregnancy..(3)The nutritional status of vitamin D is an important adjustable factor,so the monitoring of vitamin D status in early pregnancy can help to prevent important adverse consequences.Therefore,the education and supplementary treatment of pregnant women with vitamin D deficiency in pregnancy should be strengthened,and the related complications of pregnancy(HDP,GDM,PROM)caused by vitamin D deficiency can be monitored and prevented purposely.