妊娠期维生素D补充对妊娠期糖尿病或肥胖孕妇的心血管代谢风险标志物的影响：一项随机临床试验

Vitamin D supplementation for cardiometabolic risk markers in pregnant women based on the gestational diabetes mellitus or obesity status : a randomized clinical trial

妊娠期维生素D补充对妊娠期糖尿病或肥胖孕妇的心血管代谢风险标志物的影响：一项随机临床试验

Authors: Wan-jun Yin, Peng Wang, Shuang-shuang Ma, Rui-xue Tao, Hong-lin Hu, Xiao-min Jiang, Ying Zhang, Fang-biao Tao, Peng Zhu

Source：European Journal of Nutrition, 2024 Jun 15. doi: 10.1007/s00394-024-03443-6

Abstract

Purpose

Women with gestational diabetes mellitus (GDM) or obesity are vulnerable to impaired gestational cardiovascular health (CVH) and cardiovascular disease (CVD) in the future. It is unclear if prenatal vitamin D supplementation improves gestational CVH, especially in women at high risk for developing CVD. Our goal was to find out if vitamin D supplementation could protect against gestational CVH, including the women with GDM or obesity.

Design

We randomly assigned women with a serum 25(OH)D concentration < 75 nmol/L to receive 1600 IU/d (intervention group) or 400 IU/d (control group) of vitamin D3 for two months at 24–28 weeks’ gestation. The primary outcome was gestational CVH marks (lipids, inflammatory cytokines, endothelial function).

Results

There were 1537 participants divided into the intervention (N = 766) and control groups (N = 771). No baseline differences existed among study groups in CVH markers. At the two-month visit, the intervention group’s HDL-C levels (2.01 ± 0.39 VS 1.96 ± 0.39 mmol/L) were significantly higher than those of the control group, while the hs-CRP levels were significantly lower (3.28 ± 2.02 VS 3.64 ± 2.42 mg/L). Subgroup analysis found that HDL-C, TC, hs-CRP, E-Selectin, and SBP were improved in the intervention group among women with GDM or overweight/obesity, and the improvement was not found in women without GDM or overweight/obesity. Vitamin D supplementation significantly decreased the mean triglyceride-glucose index at the two-month visit in women with GDM.

Conclusions

Vitamin D supplementation at mid-gestation might optimize the gestational CVH status for pregnant women, particularly the women with GDM or obesity, which is advantageous for later-life primary prevention of CVD.

摘要

目的 妊娠期糖尿病(GDM)或肥胖的孕妇易发生妊娠期心血管健康(CVH)受损，并增加未来患心血管疾病(CVD)的风险。目前，尚不清楚妊娠期补充维生素D是否能改善妊娠期CVH，尤其是在CVD高风险的孕妇中。本研究的目标是探讨妊娠期补充维生素D是否能改善孕妇CVH，尤其是GDM或肥胖的孕妇。

方法 本研究将血清25(OH)D浓度<75 nmol/L的孕妇，在妊娠24-28周随机分配至干预组（1600 IU/d维生素D3）或对照组（400 IU/d维生素D3），干预两个月。主要结局是妊娠期CVH生物标志物（血脂、炎性因子、内皮因子等）。

结果 共有1537名参与者被分为干预组（766人）和对照组（771人）。各组在基线时，CVH标志物无统计学差异。在干预后，干预组的HDL-C水平（2.01±0.39 VS 1.96±0.39 mmol/L）显著高于对照组，而hs-CRP水平显著低于对照组（3.28±2.02 VS 3.64±2.42 mg/L）。分层分析发现，在GDM或超重/肥胖的孕妇中，干预组的HDL-C、TC、hs-CRP、E-Selectin和SBP有所改善，而未患有GDM或超重/肥胖的女性未出现显著变化。此外，维生素D补充在GDM女性中显著降低了甘油三酯/葡萄糖指数。

结论 孕中期的维生素D补充可能有助于改善孕妇的心血管健康状况，特别是在GDM或肥胖的孕妇中，这对于预防未来心血管疾病具有潜在益处。