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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2020, Vol. 16 ›› Issue (05): 607 -614. doi: 10.3877/cma.j.issn.1673-5250.2020.05.016

Special Issue: ；

Original Article

Relationship of serum vitamin D, folic acid and blood lipid levels in pregnant women with preeclampsia

Lu Li1,†(), Ye Tian1, Yuanyuan Xie1   

  1. 1. Department of Obstetrics and Gynecology, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong Province, China
  • Received:2020-01-10 Revised:2020-08-21 Published:2020-10-01
  • Corresponding author: Lu Li
  • Supported by:
    Project of Development Research Center for Medical Science and Technology of National Health and Family Planning Commission of China(W2015CAE081)
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Objective

To explore correlation of vitamin D, folic acid and blood lipid in pregnant women with the risk of preeclampsia (PE).

Methods

A total of 33 pregnant women with PE who underwent prenatal examination and delivered in Central Hospital Affiliated to Shandong First Medical University after symptomatic treatment from April 2017 to December 2018 were selected as research subjects.According to mild and severe PE, they were included into mild PE group (n=21) and severe PE group (n=12), respectively. And 130 healthy pregnant women who gave birth in the same hospital during the same period were selected as control and were included into control group. General clinical data and serum triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), vitamin D and folic acid levels in the first trimester (<12 gestational weeks), second trimester (20-24 gestational weeks) and third trimester (32-34 gestational weeks) were collected. One-way ANOVA or chi-square test was used for statistical comparison of the above index. Spearman correlation coefficient was used to analyze the correlation of serum vitamin D, folic acid and blood lipid levels with the severity of PE. Multivariate unconditional logistic regression was used to analyze influencing factors of PE. This study was approved by Shandong Provincial Medical Ethics Committee (Approval No. IACUC20180105). Clinical research informed consent was obtained from all pregnant women and their family members. There were no statistical differences among three groups in serum levels of TG, TC, LDL, vitamin D and folic acid in the first trimester (P>0.05).

Results

①The age, systolic blood pressure, diastolic blood pressure, weight gain during pregnancy, gravidity, parity, menstrual cycle, menstrual period, and proportions of family history of PE, completion of prenatal examination as required, supplement of vitamin D and folic acid during pregnancy showed statistically significant differences among mild PE group, severe PE group and control group (P<0.05). ②There were statistically significant differences in serum levels of LDL, vitamin D and folic acid in second trimester, and serum levels of TG, LDL, vitamin D and folic acid in third trimester among three groups in overall comparison (second trimester: F=7.061, 100.268, 73.755, P≤0.001; third trimester: F=15.109, 18.157, 255.431, 194.986, P<0.001). Further comparison showed that in second trimester, serum levels of LDL in mild PE group and severe PE group were significantly higher than that of control group, while serum levels of vitamin D and folic acid were significantly lower than those of control group, moreover, serum levels of vitamin D and folic acid in severe PE group were significantly lower than those of mild PE group, and all differences were statistically significant (P<0.05). In third trimester, serum levels of TG and LDL in severe PE group were significantly higher than those in mild PE group and control group, while serum levels of vitamin D and folic acid were significantly lower than those in mild PE group and control group, moreover, serum levels of TG and LDL of pregnant women in mild PE group were significantly higher than those in control group, while serum vitamin D and folic acid levels were significantly lower than those in control group, and all differences were statistically significant (P<0.05). ③Among mild and severe PE pregnant women, serum levels of TG, TC and LDL were positively correlated with severity of PE (rs=0.529, 0.481, 0.533; P<0.001), while serum levels of vitamin D and folic acid were negatively correlated with severity of PE (rs=-0.458, -0.473; P<0.001). ④Results of multivariate unconditional logistic regression analysis showed that systolic blood pressure, diastolic blood pressure, gravidity, parity, menstrual cycle, vitamin D and folic acid supplementation during pregnancy, and serum TG, TC, LDL, vitamin D, and folic acid levels all were independent influencing factors of PE in pregnant women (OR=2.534, 3.547, 2.392, 2.879, 2.653, 2.490, 2.413, 3.319, 3.731, 2.936, 2.012, 2.176, 95%CI: 1.304-4.069, 1.363-7.613, 1.860-5.397, 1.954-6.878, 1.238-4.297, 1.922-4.874, 1.979-5.585, 1.027-9.902, 1.043-4.144, 1.933-4.492, 1.480-4.800, 1.010-4.309, P<0.05).

Conclusions

Serum vitamin D, folic acid and lipid levels are closely related to the severity of PE. Vitamin D and folic acid supplementation, and monitoring of blood lipid levels in time during pregnancy can effectively prevent onset of PE.

Key words: Vitamin D, Folic acid, Triglyceride, Cholesterol, LDL, Lipoproteins, LDL, Pre-eclampsia, Pregnant women
表1 3组孕妇一般临床资料比较(±s)
组别 例数 血清TG水平(mmoL/L) 血清TC水平(mmoL/L) 血清LDL水平(mmoL/L) 血清维生素D水平(ng/mL) 血清叶酸水平(nmoL/L)
轻度PE组 21 1.48±0.67 4.65±1.06 1.46±0.35 26.32±1.20 30.93±1.20
重度PE组 12 1.52±0.68 4.68±1.10 1.48±0.36 26.24±1.18 30.25±1.06
对照组 130 1.48±0.67 4.65±1.06 1.44±0.33 26.68±1.22 30.99±1.23
F值   0.118 0.026 0.107 1.367 2.037
P值   0.889 0.974 0.898 0.258 0.134
表2 孕期发生PE影响因素的单因素分析结果
组别 例数 年龄(岁，±s) 身高(cm，±s) 收缩压(mmHg，±s) 舒张压(mmHg，±s) 孕前体重(kg，±s) 孕期体重增加值(kg，±s) 孕次(次，±s) 产次(次，±s)
轻度PE组 21 25.6±1.2 159.8±2.0 141.5±22.6 72.3±12.3 50.2±2.1 22.1±1.4 1.2±0.3 1.0±0.4
重度PE组 12 26.6±1.3 160.0±1.8 159.8±23.0 62.0±11.6 50.1±2.2 25.8±1.8 1.0±0.3 0.8±0.5
对照组 130 25.1±1.2 160.5±1.7 132.0±22.5 86.3±11.9 50.1±2.2 18.6±1.6 1.4±0.3 1.3±0.5
检验值   F＝9.045 F＝1.752 F＝10.972 F＝32.089 F＝0.030 F＝134.164 F＝7.579 F＝7.148
P值   <0.001 0.177 <0.001 <0.001 0.971 <0.001 0.001 0.001
组别 例数 月经周期(d，±s) 月经期(d，±s) PE家族史[例数(%)] 吸烟史[例数(%)] 饮酒史[例数(%)] 按要求完成产前检查[例数(%)] 孕期补充维生素D[例数(%)] 孕期补充叶酸[例数(%)]
轻度PE组 21 28.1±1.3 5.1±1.1 13(61.9) 12(57.1) 11(52.3) 8(38.1) 7(33.3) 8(38.1)
重度PE组 12 28.0±1.3 6.6±1.1 8(66.7) 6(50.0) 7(58.3) 4(33.3) 3(25.0) 2(16.7)
对照组 130 29.6±1.3 4.6±1.1 52(40.0) 62(47.7) 60(46.2) 89(68.5) 92(70.8) 96(73.8)
检验值   F＝18.054 F＝21.209 χ2＝6.016 χ2＝0.651 χ2＝0.851 χ2＝11.578 χ2＝18.630 χ2＝23.485
P值   <0.001 <0.001 0.049 0.722 0.653 0.003 <0.001 <0.001
表3 3组孕妇中、晚孕期血清TG、TC、LDL、维生素、叶酸水平比较(±s)
组别 例数 中孕期
TG(mmoL/L) TC(mmoL/L) LDL(mmoL/L) 维生素D(ng/mL) 叶酸(nmoL/L)
轻度PE组 21 1.56±0.70 4.89±1.15 1.69±0.42 24.20±1.05 29.02±1.10
重度PE组 12 1.69±0.71 4.77±1.12 1.80±0.48 23.01±1.03 27.75±0.96
对照组 130 1.56±0.70 4.89±1.15 1.46±0.36 26.82±1.15 31.33±1.24
F值   0.191 0.061 7.061 100.268 73.755
P值   0.826 0.941 0.001 <0.001 <0.001
组别 例数 晚孕期
TG(mmoL/L) TC(mmoL/L) LDL(mmoL/L) 维生素D(ng/mL) 叶酸(nmoL/L)
轻度PE组 21 1.62±0.73 4.95±1.19 1.78±0.51 23.15±1.02 27.69±1.05
重度PE组 12 2.05±0.99 5.10±1.14 2.12±0.52 20.05±0.99 25.22±0.97
对照组 130 1.24±0.45 4.60±1.03 1.44±0.40 26.84±1.19 31.42±1.30
F值   15.109 1.997 18.157 255.431 194.986
P值   <0.001 0.139 <0.001 <0.001 <0.001
表4 孕妇发生子痫前期影响因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
年龄 -0.304 0.165 3.390 0.914 0.738 0.619～1.118
收缩压 0.930 0.290 10.259 0.001 2.534 1.304～4.069
舒张压 1.266 0.439 8.325 0.004 3.547 1.363～7.613
孕期体重增加值 -0.060 0.031 3.717 0.849 0.942 0.898～1.014
孕次 0.872 0.272 10.300 0.001 2.392 1.860～5.397
产次 1.057 0.321 10.850 0.001 2.879 1.954～6.878
月经周期 0.976 0.317 9.446 0.002 2.653 1.238～4.297
月经期 0.050 0.228 0.048 0.838 1.051 0.855～2.090
未按要求完成产前检查 0.360 0.316 1.297 0.258 1.433 1.126～3.885
孕期未补充维生素D 0.912 0.236 14.947 <0.001 2.490 1.922～4.874
孕期未补充叶酸 0.881 0.265 11.077 0.001 2.413 1.979～5.585
血清TG水平 1.200 0.578 4.307 0.038 3.319 1.027～9.902
血清TC水平 1.317 0.352 13.997 <0.001 3.731 1.043～4.144
血清LDL水平 1.077 0.215 25.070 <0.001 2.936 1.933～4.492
血清维生素D水平 0.699 0.300 5.426 0.020 2.012 1.480～4.800
血清叶酸水平 0.777 0.370 4.413 0.035 2.176 1.010～4.309
[1]
杨孜. 掌握辨析理论学习方法提升临床实践能力——再论不同地域产科问题的普遍性及多样性与质疑性[J/CD]. 中华妇幼临床医学杂志(电子版), 2020, 16(1): 8-15. DOI: 10.3877/cma.j.issn.1673-5250.2020.01.002.
[2]
赵舒，严滨. 子痫前期与全身炎症反应关系的研究进展[J/CD]. 中华妇幼临床医学杂志(电子版), 2017, 13(5): 616-620. DOI: 10.3877/cma.j.issn.1673-5250.2017.05.021.
[3]
Henderson JT, Thompson JH, Burda BU, et al. Preeclampsia screening[J]. JAMA, 2017, 317(16): 1668-1683. DOI: 10.1001/jama.2016.18315.
[4]
郭晗，张云聪，杨硕，等. 子痫前期发病机制的研究进展[J]. 临床检验杂志，2018, 36(6): 439-443. DOI: 10.13602/j.cnki.jcls.2018.06.11.
[5]
De Ocampo MPG, Araneta MRG, Macera CA, et al. Folic acid supplement use and the risk of gestational hypertension and preeclampsia[J]. Women Birth, 2018, 31(2): e77-e83. DOI: 10.1016/j.wombi.2017.08.128.
[6]
杨怡珂，漆洪波. 美国妇产科医师学会(ACOG)"妊娠期高血压和子痫前期指南2019版"要点解读(第一部分)[J]. 中国实用妇科与产科杂志，2019, 35(8): 895-899. DOI: 10.19538/j.fk2019080112.
[7]
黄玲，赵洁，杜鹃，等. 血清维生素A，D及胎盘组织中维生素D受体水平与子痫前期发病的相关性[J]. 临床和实验医学杂志，2020, 19(11): 1188-1191. DOI: 10.3969/j.issn.1671-4695.2020.11.020.
[8]
Yusuf AM, Kahane A, Ray JG. First and second trimester serum sFlt-1/PlGF ratio and subsequent preeclampsia: a systematic review[J]. J Obstet Gynaecol Can, 2018, 40(5): 618-626.DOI: 10.1016/j.jogc.2017.07.014.
[9]
于津，孙峰，郭玉娜，等. 妊娠早期同型半胱氨酸和血脂水平对重度子痫前期的预测价值[J]. 国际妇产科学杂志，2018, 45(1): 51-54. DOI: 10.3969/j.issn.1674-1870.2018.01.011.
[10]
Zhao X, Fang R, Yu R, et al. Maternal vitamin D status in the late second trimester and the risk of severe preeclampsia in Southeastern China[J]. Nutrients, 2017, 9(2): 138. DOI: 10.3390/nu9020138.
[11]
孙白云，乔东艳，于红. 滋养细胞焦亡与子痫前期发病机制的研究进展[J]. 国际妇产科学杂志，2017, 44(6): 610-613. DOI: 10.3969/j.issn.1674-1870.2017.06.002.
[12]
Meher S, Duley L, Hunter K, et al. Antiplatelet therapy before or after 16 weeks′ gestation for preventing preeclampsia: an individual participant data Meta-analysis[J]. Am J Obstet Gynecol, 2017, 216(2): 121.e2-128.e2. DOI: 10.1016/j.ajog.2016.10.016.
[13]
Bulloch RE, Lovell AL, Jordan VMB, et al. Maternal folic acid supplementation for the prevention of preeclampsia: a systematic review and Meta-analysis[J]. Paediatr Perinat Epidemiol, 2018, 32(4): 346-357. DOI: 10.1111/ppe.12476.
[14]
Liu C, Liu CD, Wang QS, et al. Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a Meta-analysis[J]. Arch Gynecol Obstet, 2018, 298(4): 697-704. DOI: 10.1007/s00404-018-4823-4.
[15]
李晓娟，钱源. 维生素D与子痫前期关系研究进展[J]. 中国计划生育和妇产科，2019, 11(3): 26-28, 40. DOI: 10.3969/j.issn.1674-4020.2019.03.07.
[16]
经连芳，潘新年，韦秋芬，等. 妊娠期肥胖和子痫前期与孕产妇及新生儿25-OH-维生素D缺乏的相关性研究[J]. 中国妇幼保健，2017, 32(2): 274-276. DOI: 10.7620/zgfybj.j.issn.1001-4411.2017.02.21.
[17]
Behjat Sasan S, Zandvakili F, Soufizadeh N, et al. The effects of vitamin D supplement on prevention of recurrence of preeclampsia in pregnant women with a history of preeclampsia[J]. Obstet Gynecol Int, 2017: 8249264. DOI: 10.1155/2017/8249264.
[18]
Zhang M, Lv D, Zhou W, et al. The levels of triglyceride and total cholesterol in methamphetamine dependence[J]. Medicine (Baltimore), 2017, 96(16): e6631. DOI: 10.1097/MD.0000000000006631.
[19]
李显莉，孟凡峰. 子痫前期产妇胎盘组织中生长阻滞特异性蛋白6、富集AT序列的特异性结合蛋白1的含量及其与氧化应激、炎性反应的相关性[J]. 中国妇幼保健，2019, 34(1): 47-49. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.01.16.
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