Vitamin A,D And E Levels Of Pregnant Women And Its Effects On Pregnancy Outcomes During The COVID-19 Epidemic

Objective:By investigation and analysis of the levels of vitamins A,D and E of pregnant women during the COVID-19 epidemic,the aims of this study were to understand the nutritional status of vitamins A,D and E,to study the influencing factors of serum vitamins A,D and E of pregnant women,and to analyze the relationship between vitamins A,D,E levels and pregnancy outcomes such as diabetes mellitus,anemia,embolism,subclinical hypothyroidism,obesity,hyperlipidemia,post-pelvic inflammatory disease,preterm delivery,cesarean section,etc,so as to provide theoretical basis for clinical adverse pregnancy outcomes reduction.Methods:Information of pregnant women who met the exclusion criteria in the First Hospital of Shanxi Medical University from May 2018 to May 2021 were collected,and their pre-pregnancy BMI,mode of pregnancy,age,birth order,fetal number,gestational week,season,vitamin A,D,and E levels,and pregnancy outcomes were investigated.Pregnant women were divided into three groups according to time period,May 2018–December2019[before COVID–19 epidemic],January 2020–May 2020[COVID-19 outbreak]and June 2020–May 2021[COVID–19 epidemic normalization].According to the subgroups,we explored the effects of the three phases of the epidemic on vitamins A,D,and E,and analyzed the relationship between vitamin A,D,E levels and pre-pregnancy BMI,mode of pregnancy,age,gestational week,number of pregnancies and season,as well as the relationship between different levels of vitamins A,D,E and pregnancy outcomes.Results:1.Nutritional status of vitamin A,D and E in pregnant womenThe serum vitamin A(VA)level of 1094 pregnant women was 0.43(0.37,0.50)mg/L,with deficiency rate of 5.94%and excess rate of 1.46%.The serum 25(OH)D level of 1679 pregnant women was 18.70(12.60,27.20)ng/ml,the deficiency rate was53.84%,and there were no cases of excessive vitamin D(VD).The serum vitamin E(VE)level of 1087 pregnant women was 11.3(9.40,13.80)mg/L,with overdose rate of1.29%and no VE deficiency case.2.vitamins A,D and E nutrition status of pregnant women before the epidemic,during the epidemic outbreak and the epidemic normalizationThere were statistically significant differences in serum 25(OH)D level of pregnant women among the three groups(before the epidemic,during the epidemic outbreak and the epidemic normalization)(H=98.86,P<0.001),and there were differences between any two groups.The differences were statistically significant when comparing the serum25(OH)D deficiency of pregnant women among three groups(χ~2=90.76,P<0.001).There were no statistically significant differences in comparison of VA and VE levels as well as the VA and VE deficiency among three groups(P>0.05).3.Influencing factors of vitamin A,D and E nutritional status in pregnant womenThere were significant differences in serum VA level of pregnant women in BMI before pregnancy,age,fetal number and gestational week groups(P<0.05).There were significant differences in serum VA deficiency of pregnant women in fetal number and gestational week groups(P<0.05).There were significant differences in the comparison of serum 25(OH)D level in gestation week,pregnancy method,age,and season groups(P<0.05).There were significant differences in serum VD deficiency of pregnant women in gestational week and season(P<0.05).There were statistically significant differences in comparing serum VE level of pregnant women in gestation week,pregnancy method,age,fetal number,and season groups(P<0.05).Fetal number was statistically significant for maternal VE overdose(P=0.047).4.Relationship between vitamin A,D,E nutritional levels and pregnancy outcomeVA level was statistically significant for gestational diabetes(OR=2.102,95%CI:1.082-4.083,P=0.028),VD level was statistically significant for subclinical hypothyroidism in pregnancy(OR=0.774,95%CI:0.668-0.896,P=0.001).After adjusting for the mode of pregnancy,age,birth order,fetal number,pre-pregnancy BMI,and gestational week,VA level still had statistical significance in gestational diabetes(OR=2.358,95%CI:1.067-5.209,P=0.034),and VD level still had statistical significance in subclinical hypothyroidism in pregnancy(OR=0.803,95%CI:0.676-0.954,P=0.013).VA excess is a risk factor for gestational diabetes(OR=2.358,95%CI:1.067-5.209,P<0.05),and VD deficiency is a risk factor for subclinical hypothyroidism in pregnancy(OR=0.803,95%CI:0.676-0.954,P<0.05).The association between VA level and anemia during pregnancy was statistically significant(OR=0.501,95%CI:0.281-0.894,P=0.019),the association between VE level and different delivery mode was statistically significant(OR=0.112,95%CI:0.014-0.918,P=0.041),while the association disappeared(P>0.05)after adjusting for the mode of pregnancy,age,birth order,fetal number,pre-pregnancy BMI,and gestational week.Conclusion:1.The prevalence of VD deficiency in pregnant women is high,VA abnormality is predominantly deficient,and VE abnormality is predominantly excessive.Gestational week and fetal number are independent influencing factors of VA deficiency in pregnant women.Gestational week and season are independent influencing factors of VD deficiency in pregnant women.Fetal number is an independent influencing factor for VE overdose in pregnant women.Clinicians need to provide a targeted education to pregnant women,a good overall assessment of vitamins during pregnancy,and a scientific and personal nutritional management program during pregnancy to reduce adverse maternal and fetal outcomes.2.The rate of serum VD deficiency in pregnant women is high during the COVID-19epidemic.At present,epidemic prevention and control is essential.While taking good self-protection,clinicians should guide pregnant women to supplement vitamins according to their current environmental condition,monitor serum vitamins status regularly,and provide nutrition education during pregnancy.3.VA excess is a risk factor for gestational diabetes and VD deficiency is a risk factor for subclinical hypothyroidism in pregnancy.By detecting the levels of VA and VD during pregnancy,clinicians can guide pregnant women to maintain pregnancy health management and reduce adverse pregnancy outcomes.