Study On The Relationship Between 25 Hydroxy Vitamin D And Hypertensive Disorders Complicating Pregnancy

Objective: 1.To investigate the relationship between serum level of 25 hydroxyvitamin D and gestational hypertension,preeclampsia and severe preeclampsia.To provide basis for prediction,prevention and treatment of hypertensive disorders complicating pregnancy.2.To analyse the change of 25 hydroxyvitamin D levels during pregnancy and the relationship between this change and hypertensive disorders complicating pregnancy,and to guide reasonable supplementation of vitamin D during pregnancy.Methods: During the period from July 1,2015 to March 1,2016 in Shenyang Women,s and Children,s hospital to select cases who were primiparous singleton pregnant women who were in early pregnancy and would do regular antenatal examination during pregnancy.Collected the basic information.Patients with chronic complications and endocrine metabolic diseases were excluded.In the final,2008 cases were included in the study.Gestational weeks were measured by early ultrasound.Collected fasting venous blood 3ml during 8~13+6 gestational weeks and 32~36 gestational weeks,and then isolated serum was placed at-80 degrees Celsius.According to the outpatient case and hospital delivery,the pregnancy outcome was observed.The cases were followed up to October 31,2016.According to the outcome,the patients were divided into gestational hypertension group(A group),preeclampsia group(B group),severe preeclampsia group(C group),normal pregnancy group(group D).Group D was 200 pregnant women randomly selected from who did not suffer from hypertensive disorder complicating pregnancy.Blood samples of the four groups were tested for 25 hydroxyvitamin D.SPSS21.0 software was used for statistical analysis,the difference between groups was compared using variance analysis.Within group comparisons used the paired T test.Logistic regression model was used to estimate the OR value and 95% confidence interval of the incidence of hypertensive disorder complicating pregnancy with the level of vitamin D.P < 0.05 represents that the difference is statistically significant.Result : During pregnancy,206 people were unable to track the outcome of pregnancy due to loss to follow-up,abortion,premature delivery,induction of labor.A total of 1802 people completed the blood collection both in the early pregnancy and the late pregnancy.Finally,78 cases were gestational hypertension,46 cases were preeclampsia,37 cases were severe preeclampsia,and 1641 cases were normal pregnancy,0 cases with eclampsia.Finnally,A group had 78 cases,B group had 46 cases,C group had 37 cases,and D group had 200 cases.All groups had no significant difference in age,BMI before pregnancy,pregnany times and the gestational weeks of drawing blood(P > 0.05).The levels of the serum 25 hydroxy vitamin D in the early pregnancy of A,B,C,D group respectively were 17.47±6.41,14.33±5.60,11.26±4.54,18.21±6.73.In the third trimester of pregnancy,the levels of the serum 25 hydroxy vitamin D of A,B,C,D group respectively were 20.66±7.06,16.54±6.51,13.03±5.79,21.04±7.63.When group B and group C were compared with the group D,the serum 25 hydroxy vitamin D levels of the early pregnancy and the late pregnancy were both significantly reduced,the difference was statistically significant(P < 0.05).When group A compared with group D,the difference was not statistically significant(P > 0.05).After the two-two comparison,in the early or late pregnancy,the serum 25 hydroxy vitamin D level of A,B,C group decreased by degree,the difference was statistically significant(P < 0.05).When compared with the early pregnancy,the serum level of 25 hydroxyvitamin D in each group was higher in late pregnancy(P < 0.05).When the serum level of 25 hydroxyvitamin D was below 20ng/ml(deficiency)in early or late pregnancy,group C accounted for the largest proportion(89.19%,81.08%),group B and group A followed,group D had the smallest percentage(66.5%,60.5%).When the vitamin D level was normal(30-100ng/ml),the proportions were the smallest both in early and late pregnancy(7.2%,12.19%).Compared the early pregnancy serum level of 25 hydroxyvitamin D <20ng/ml with >20ng/ml,the risk of group B and group C were significantly increased(OR 6.84,95%CI 1.91-24.53;OR 5.19,95%CI 1.28-21.09).When the increase of serum 25 hydroxyvitamin D levels during pregnancy was greater than or equal to 5ng/ml,compared with the increase of less than 5ng/ml,the risk of group C decreased significantly,with statistical significance(OR 0.17,95%CI 0.05-0.60).Conclusion: 1.The decrease of serum 25 hydroxy vitamin D level in early or late pregnancy is related to the incidence of preeclampsia,but not to the incidence of hypertension in pregnancy.The level of serum 25 hydroxyvitamin D in early pregnancy can be used as a predictor of the risk of preeclampsia.2.The level of serum 25 hydroxy vitamin D in early pregnancy below 20ng/ml is an independent risk factor for preeclampsia.Vitamin D deficiency in early pregnancy should be timely supplemented.3.Serum 25 hydroxyvitamin D level is negatively correlated with the severity of hypertensive disorders complicating pregnancy.4.The level of vitamin D in late pregnancy is higher than that in early pregnancy.When vitamin D is added,the supplementary dose should be adjusted in late pregnancy.5.Regardless of the level of vitamin D in early pregnancy,when the level of serum 25 hydroxy vitamin D increases by more than 5ng/ml during pregnancy,the risk of severe preeclampsia decreases significantly.