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妊娠期和哺乳期补充维生素D和婴儿生长
Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth


Daniel E. Roth ... 妇产科和儿科 • 2018.08.09
相关阅读
• 围生期补充维生素D的结果令人失望 • 妊娠期补充维生素D可能对婴儿有益

摘要


背景

目前尚不清楚母亲在妊娠和哺乳期补充维生素D能否改善维生素D缺乏多发地区的胎儿和婴儿生长。

 

方法

我们在孟加拉国开展了一项随机、双盲、安慰剂对照试验,根据世界卫生组织(WHO)儿童生长标准,评估产前每周补充维生素D(从妊娠17~24周开始,直至分娩)和产后每周补充维生素D对主要结局1岁时婴儿年龄别身长z评分的影响。一组产前和产后均未补充维生素D(安慰剂组)。三组仅产前补充维生素D,剂量分别为4,200 IU(产前4,200组)、16,800 IU(产前16,800组)和28,000 IU(产前28,000组)。第5组产前补充28,000 IU,并在产后补充28,000 IU 26周(产前和产后28,000组)。

 

结果

在1岁时评估的1,164名婴儿(1,300例妊娠的89.5%)中,年龄别身长z评分平均值(±SD)无显著组间差异。评分如下:安慰剂,-0.93±1.05;产前4,200,-1.11±1.12;产前16,800,-0.97±0.97;产前28,000,-1.06±1.07;产前和产后28,000,-0.94±1.00(对于各组差异的总体检验,P=0.23)。其他人体测量指标、出生结局和发病率无显著组间差异。补充维生素D对母亲和婴儿血清25-羟维生素D和钙浓度、母亲尿钙排泄和母亲甲状旁腺激素浓度有预期影响。除了在服用最高剂量的女性中,可能的高钙尿症发生率较高之外,各组不良事件发生率无显著差异。

 

结论

在普遍存在产前维生素D缺乏以及胎儿和婴儿生长受限的人群中,母亲从妊娠中期至分娩或至产后6个月补充维生素D并未改善胎儿或婴儿生长(由比尔和梅林达·盖茨基金会[Bill and Melinda Gates Foundation]资助;在ClinicalTrials.gov注册号为NCT01924013)。





作者信息

Daniel E. Roth, M.D., Ph.D., Shaun K. Morris, M.D., Stanley Zlotkin, M.D., Ph.D., Alison D. Gernand, Ph.D., Tahmeed Ahmed, M.B., B.S., Ph.D., Shaila S. Shanta, M.B., B.S., Eszter Papp, Ph.D., Jill Korsiak, M.Sc., Joy Shi, M.Sc., M. Munirul Islam, M.B., B.S., Ph.D., Ishrat Jahan, M.B., B.S., M.P.H., Farhana K. Keya, M.B., B.S., Andrew R. Willan, Ph.D., Rosanna Weksberg, M.D., Minhazul Mohsin, M.B., B.S., Qazi S. Rahman, M.Sc., Prakesh S. Shah, M.D., Kellie E. Murphy, M.D., Jennifer Stimec, M.D., Lisa G. Pell, Ph.D., Huma Qamar, M.Sc., and Abdullah Al Mahmud, M.S.S., M.M.Sc.
From the Department of Pediatrics (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., P.S.S., L.G.P., H.Q.) and the Dalla Lana School of Public Health (A.R.W.), University of Toronto, and the Centre for Global Child Health (D.E.R., S.K.M., S.Z., E.P., J.K., J. Shi, R.W., L.G.P., H.Q.), the Department of Diagnostic Imaging (J. Stimec), and the Ontario Child Health Support Unit (A.R.W.), Hospital for Sick Children, and the Departments of Pediatrics (P.S.S.), and Obstetrics and Gynecology (K.E.M.), Mt. Sinai Hospital — all in Toronto; the Department of Nutritional Sciences, Penn State University, University Park, PA (A.D.G.); and the Maternal and Child Health Training Institute (I.J.) and the Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh (T.A., S.S.S., M.M.I., F.K.K., M.M., Q.S.R., A.A.M.), Dhaka, Bangladesh. Address reprint requests to Dr. Roth at the Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada, or at daniel.roth@sickkids.ca.

 

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