补充不同剂量维生素D对妊娠期糖尿病糖代谢变化及妊娠结局的影响  

Effects of different doses of vitamin D supplementation on glucose metabolism and pregnancy outcome in gestational diabetes mellitus

作　　者：周平[1] 易菁[1] 刘明 雷琼[1] 邢佳玲 ZHOU Ping;YI Jing;LIU Ming;LEI Qiong;XING Jialing(Department of Obstetrics and Gynecology,Guangdong Provincial Maternal and Child Health Care Hospital,Guangzhou,Guangdong 511400,China)

机构地区：[1]广东省妇幼保健院妇产科,广东广州511400

出　　处：《现代医药卫生》2021年第15期2573-2576,共4页Journal of Modern Medicine & Health

基　　金：广东省中医药局科研项目(20201032)。

摘　　要：目的探讨补充不同剂量的维生素D对妊娠期糖尿病(GDM)孕妇糖代谢变化和妊娠结局的影响。方法选取2020年1-12月在该院门诊诊断为GDM的孕妇360例作为研究对象,随机分为试验组、常规组和对照组,每组120例。试验组孕妇给予口服维生素D滴剂胶囊2粒(800 U),每天1次,联合碳酸钙D 3片1片,每天1次;常规组孕妇给予口服维生素D滴剂胶囊1粒(400 U),每天1次,联合碳酸钙D 3片1片,每天1次;对照组孕妇给予口服碳酸钙D 3片1片,每天1次,均服用至分娩终止。分别于服药前及服药12周后,空腹抽血检测3组孕妇的25-羟维生素D 3[25-(OH)-VD 3]、空腹血糖(FPG)、空腹胰岛素(FINs)、糖化血红蛋白(HbA1c)和血钙,并计算出胰岛素抵抗指数(HOMA-IR),记录3组孕妇服药期间出现的不良反应并统计其妊娠结局。结果服药前,3组孕妇25-(OH)-VD 3、FPG、FINs、HbA1c、血钙水平及HOMA-IR值比较,差异均无统计学意义(P>0.05)。服药12周后,试验组孕妇25-(OH)-VD 3和血钙水平均明显高于常规组和对照组,差异均有统计学意义(P<0.05);试验组和常规组孕妇FPG、FINs水平及HOMA-IR值均明显低于对照组,差异均有统计学意义(P<0.05)。试验组巨大儿和早产比例均明显低于对照组和常规组,差异均有统计学意义(P<0.05);试验组和常规组羊水过多和剖宫产比例均明显低于对照组,差异均有统计学意义(P<0.05);而3组新生儿窒息率比较,差异无统计学意义(P>0.05)。3组孕妇在服用不同剂量的维生素D滴剂期间,不良反应发生率极低,且组间比较差异无统计学意义(P>0.05)。结论GDM孕妇补充维生素D可降低FPG、FINs水平及HOMA-IR,改善胰岛素抵抗,增加胰岛素敏感性,还可减少妊娠期并发症的发生,改善母婴结局,且每天服用800 U维生素D效果更佳。Objective To investigate the effects of different doses of vitamin D supplementation on the change of glucose metabolism and pregnancy outcome in pregnant women with gestational diabetes mellitus(GDM).Methods A total of 360 pregnant women diagnosed as GDM in the outpatient department of this hospital from January to December 2020 were selected as the study subjects and randomly divided into the experimental group,routine group and control group,120 cases in each group.The experimental group was given 2 oral vitamin D drop capsules(800 U)once daily,combined 1 calcium carbonate D 3 tablet once a day;the routine group was given 1 oral vitamin D drops capsule(400 U)once daily,combined with 1 calcium carbonate D 3 tablet once daily;the control group was given 1 oral calcium carbonate D 3 tablet once daily,which lasted until the termination of labor.The fasting blood samples before medication and in 12 weeks after medication in the three groups were collected for detecting 25-hydroxy vitamin D 3[25-(OH)-VD 3],fasting blood glucose(FPG),fasting insulin(FINs),glycosylated hemoglobin(HbA1c)and blood calcium.The insulin resistance index(HOMA-IR)was calculated.The adverse reactions of pregnant women of the three groups during taking the medicine were recorded and the pregnancy outcomes were statistically analyzed.Results There were no statistically significant differences in the 25-(OH)-VD 3,FPG,FINs,HbA1c and blood calcium levels and HOMA-IR values before medication among the three groups(P>0.05).The levels of 25-(OH)-VD 3 and blood calcium in 12 weeks after medication in the experimental group were significantly higher than those in the routine group and control group,and the differences were statistically significant(P<0.05).The FPG and FINs levels and HOMA-IR values in the experimental group and routine group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The proportion of macrosomia and preterm birth in the experimental group were significantly lower

关 键 词：维生素D 妊娠期糖尿病 糖代谢 妊娠结局 

分 类 号：R714[医药卫生—妇产科学]