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[大学生论坛]:维生素D在妊娠和哺乳期以及婴儿生长中的补充

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Gavin918 发表于 2019-1-4 09:17:21 | 显示全部楼层 |阅读模式
Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth
维生素D在妊娠和哺乳期以及婴儿生长中的补充

Background
It is unclear whether maternal vitamin D supplementation during pregnancy and lactation improves fetal and infant growth in regions where vitamin D deficiency is common.
目前尚不清楚在维生素D普遍缺乏的地区,怀孕和哺乳期间补充母体维生素D是否能改善胎儿和婴儿生长。

Methods
We conducted a randomized, double-blind, placebo-controlled trial in Bangladesh to assess the effects of weekly prenatal vitamin D supplementation (from 17 to 24 weeks of gestation until birth) and postpartum vitamin D supplementation on the primary outcome of infants’ length-for-age z scores at 1 year according to World Health Organization (WHO) child growth standards. One group received neither prenatal nor postpartum vitamin D (placebo group). Three groups received prenatal supplementation only, in doses of 4200 IU (prenatal 4200 group), 16,800 IU (prenatal 16,800 group), and 28,000 IU (prenatal 28,000 group). The fifth group received prenatal supplementation as well as 26 weeks of postpartum supplementation in the amount of 28,000 IU (prenatal and postpartum 28,000 group).
我们在孟加拉国进行了一项随机双盲的安慰剂对照试验来评测每周产前补充维生素D(从妊娠的17至24周直到出生)和产后维生素D补充对婴儿年龄长度为1年时的主要结果的影响,且该测评是根据世界卫生组织(WHO)的儿童生长标准。其中一组既不接受产前维生素D也不接受产后维生素D(安慰剂组)。另外再有三组仅接受产前补充,剂量为4200 IU(产前4200组),16,800 IU(产前16,800组)和28,000 IU(产前28,000组)。第五组接受产前补充以及26周产后补充28,000 IU(产前和产后28,000组)。

Results
Among 1164 infants assessed at 1 year of age (89.5% of 1300 pregnancies), there were no significant differences across groups in the mean (±SD) length-for-age z scores. Scores were as follows: placebo, −0.93±1.05; prenatal 4200, −1.11±1.12; prenatal 16,800, −0.97±0.97; prenatal 28,000, −1.06±1.07; and prenatal and postpartum 28,000, −0.94±1.00 (P=0.23 for a global test of differences across groups). Other anthropometric measures, birth outcomes, and morbidity did not differ significantly across groups. Vitamin D supplementation had expected effects on maternal and infant serum 25-hydroxyvitamin D and calcium concentrations, maternal urinary calcium excretion, and maternal parathyroid hormone concentrations. There were no significant differences in the frequencies of adverse events across groups, with the exception of a higher rate of possible hypercalciuria among the women receiving the highest dose.
在1164名1岁时评估的婴儿中(1300名妊娠中占89.5%),各组间的平均(±SD)年龄长度的z评分没有显着差异。评分如下:安慰剂组,-0.93±1.05; 产前4200,-1.11±1.12; 产前16,800,-0.97±0.97; 产前28,000,-1.06±1.07; 和产前和产后28,000,-0.94±1.00(对于不同组间的差异的全局测试,P = 0.23)。其他人体测量指标,生育结果和发病率在各组之间都没有显着差异。补充维生素D对孕妇和婴儿的血清25-羟基维生素D和钙浓度,母体尿钙排泄和母体甲状旁腺激素浓度有预期的影响。并且各组间的不良事件发生率并没有明显的差异,除了那些接受最高剂量的女性有较高比例会出现高钙尿症。

Conclusions
In a population with widespread prenatal vitamin D deficiency and fetal and infant growth restriction, maternal vitamin D supplementation from midpregnancy until birth or until 6 months post partum did not improve fetal or infant growth.
在产前普遍维生素D缺乏以及胎儿和婴儿生长受限的人群中,从妊娠中期到产出宝宝或产后6个月补充母体维生素D并没有提高胎儿或婴儿的生长。

作者:Daniel E. Roth et al
期刊名称:New England Journal of Medicine
发布时间:2018-08-09
N Engl J Med 2018; 379:535-546 DOI: 10.1056/NEJMoa1800927

本文来自:https://www.nejm.org/doi/full/10.1056/NEJMoa1800927

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