Effects Of Vitamin D In The Association Of Lipid Profile And Systemic Inflammation In The Second Trimester

Background and Objectives The biological pathways through which vitamin D participates in the regulation of systemic inflammation remain largely unknown.The objective of this study was to evaluate the relationship between vitamin D,lipid profiles and systemic inflammatory response markers in pregnant women,the effect of vitamin D status on the relationship between lipid profile and systemic inflammatory response markers,and to further explore the relationship between vitamin D status and risk of abnormal systemic inflammatory response markers in pregnant women with abnormal lipid metabolism.Methods A total of 7,450 pregnant women aged 18-45,of gestational ages from 14to 27 weeks,were recruited in Hefei?latitude 32?,China,between March 2015 and February 2019.Participants were required to complete self-designed questionnaires to obtain pregnant anthropometric details and blood sample.A total of 3,500 people were randomly selected from the subjects?6,889?after exclusion,and 25?OH?D,high-density lipoprotein cholesterol?HDL-C?,low-density lipoprotein cholesterol?LDL-C?,triacylglyceride?TG?and total cholesterol?TC?,hypersensitive c-reactive protein?hs-CRP?,and white blood cell?WBC?levels were measured,excluded any one biological indicator result below the lower limit of detection,this study finally included in the statistical analysis sample of 3236 people.Cubic nonlinear fitting model was used to investigate the relationship between lipid profiles and systemic inflammatory response markers in pregnancy.The relationship between vitamin D states and lipid metabolism indicators,systemic inflammatory response markers was analyzed using multiple linear regression model.The relationship between lipid metabolism and hs-CRP and WBC concentrations in different vitamin D states was investigated using a multiple linear regression model,the association of vitamin D status with the risk of dyslipidemia(TC?P₈₀?TG?P₈₀?LDL-C?P₈₀or HDL-C<P₂₀)in pregnant women with high hs-CRP?hs-CRP?5 mg/L?and WBC abnormalities?wbc?10?×10⁹/L??and high inflammation?hs-CRP?5 mg/L and WBC?10?×109/L??were analyzed by multiple logistic regression model.Results The mean concentration of 25?OH?D in pregnant women was?39.4±16.7?nmol/L,and the vitamin D deficiency rate was 76.9%.The mean values of TC,TG,HDL-C,LDL-C,hs-CRP and WBC were?6.0±1.0?mmol/L,?2.7±1.2?mmol/L,?2.0±0.4?mmol/L,?2.8±0.7?mmol/L,?3.3±2.5?mgl/L,and?9.7±2.1??×10⁹/L?.In the present study,there were 697 pregnant women with hs-CRP?5 mg/L,with 41.0%abnormal WBC and 51.8%abnormal lipid metabolism.The concentrations of TC,TG,LDL-C and hs-CRP,WBC were non-linearly correlated,and U-type association between TC and hs-CRP.Compared with the medium lipid metabolism level group,the levels of hs-CRP were significantly higher in pregnant women with the low TC??=0.220,95%CI:0.008,0.433,P=0.042?,LDL-C??=0.282,95%CI:0.068,0.496,P=0.001?and high TG??=0.247,95%CI:0.029,0.465,P=0.026?,and the hs-CRP significantly decreased of pregnant women with low TG level??=-0.488,95%CI:-0.693,-0.282,P<0.001?.The WBC concentration significantly decreased of pregnant women with lower TC??=-0.402,95%CI:-0.594,-0.021,P<0.001?,TG??=-0.323,95%CI:-0.512,-0.135,P=0.001?level,and the WBC significantly decreased of pregnant women with high TG??=0.314,95%CI:0.123,0.505,P=0.001?level.The relationship between vitamin D status and lipid profiles and systemic inflammatory response markers showed that,compared with vitamin D deficiency group,the levels of 25?OH?D increased by 1nmol/L,the levels of TC,TG,LDL-C and hs-CRP decreased by 7.452?95%CI:4.594,11.714?,5.027?95%CI:1.218,8.837?,4.608?95%CI:2.182,7.035?mg/d L,and 0.319?95%CI:0.110,0.527?mg/L,respectively.The relationship between vitamin D status/lipid metabolites and systemic inflammatory response markers showed that,in the 25?OH?D<50 mmol/L group,compared with the middle lipid group,hs-CRP was significantly increased in pregnant women with lower TC??=0.366,95%CI:0.097,0.636,P=0.008?or LDL-C??=0.411,95%CI:0.141,0.681,P=0.003?levels,and lower TC level in pregnant women with lower WBC concentration??=-0.320,95%CI:-0.554,-0.086,P=0.007?.Hs-CRP??=0.672,95%CI:0.406,0.938,P<0.001?,WBC??=0.323,95%CI:0.102,0.545,P=0.004?were significantly higher in pregnant women with higher TG levels than in those with normal lipid profiles levels.In the 25?OH?D?50 mmol/L group,WBC concentration??=0.592,95%CI:0.106,1.079,P=0.017?in pregnant women with high TG level group was significantly increased.Both vitamin D deficiency and vitamin D non-deficient groups were found the concentration of hs-CRP?Vitamin D deficiency:?=-0.658,95%CI:-0.908,-0.408,P<0.001,Vitamin D non-deficiency:?=-0.658,95%CI:-0.908,-0.408,P<0.001?and WBC?Vitamin D deficiency:?=-0.371,95%CI:-0.605,-0.137,P=0.002,Vitamin D non-deficiency:?=-0.643,95%CI:-1.036,-0.250,P=0.001?in the low TG group were significantly lower compared with the middle lipid group.Differences in risk of high systemic inflammatory response markers in pregnant women with abnormal lipid metabolism in different vitamin D status showed that the risk of high hs-CRP(OR_adj=1.303,95%CI:1.074,0.97),WBC abnormalities(OR_adj=1.249,95%CI:1.069,1.459),and high inflammation(OR_adj=1.370,95%CI:1.058,1.774)were higher in pregnant women with abnormal lipid metabolism compared to those with normal lipid metabolism.In the vitamin D deficiency group,compared with the normal lipid metabolism group,the risk of high hs-CRP(OR_adj=1.339,95%CI:1.079,1.661),abnormal WBC(OR_adj=1.249,95%CI:1.069,1.459)and high inflammation(OR_adj=1.325,95%CI:1.110,1.583)in pregnant women with abnormal lipid metabolism was significantly higher,but no association was found in the vitamin D non-deficient group.Conclusion:Our findings suggest that higher level of vitamin D during pregnancy may improve lipid metabolism and inhibit inflammation inducted by hyperlipidemia.In addition,vitamin D non-deficiency may also be beneficial to reduce the risk of GDM in pregnant women with abnormal lipid metabolism.