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

妊娠期維生素D補(bǔ)充對妊娠期糖尿病或肥胖孕婦的心血管代謝風(fēng)險(xiǎn)標(biāo)志物的影響：一項(xiàng)隨機(jī)臨床試驗(yàn)

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)或肥胖的孕婦易發(fā)生妊娠期心血管健康(CVH)受損，并增加未來患心血管疾病(CVD)的風(fēng)險(xiǎn)。目前，尚不清楚妊娠期補(bǔ)充維生素D是否能改善妊娠期CVH，尤其是在CVD高風(fēng)險(xiǎn)的孕婦中。本研究的目標(biāo)是探討妊娠期補(bǔ)充維生素D是否能改善孕婦CVH，尤其是GDM或肥胖的孕婦。

方法 本研究將血清25(OH)D濃度<75 nmol/L的孕婦，在妊娠24-28周隨機(jī)分配至干預(yù)組（1600 IU/d維生素D3）或?qū)φ战M（400 IU/d維生素D3），干預(yù)兩個(gè)月。主要結(jié)局是妊娠期CVH生物標(biāo)志物（血脂、炎性因子、內(nèi)皮因子等）。

結(jié)果 共有1537名參與者被分為干預(yù)組（766人）和對照組（771人）。各組在基線時(shí)，CVH標(biāo)志物無統(tǒng)計(jì)學(xué)差異。在干預(yù)后，干預(yù)組的HDL-C水平（2.01±0.39 VS 1.96±0.39 mmol/L）顯著高于對照組，而hs-CRP水平顯著低于對照組（3.28±2.02 VS 3.64±2.42 mg/L）。分層分析發(fā)現(xiàn)，在GDM或超重/肥胖的孕婦中，干預(yù)組的HDL-C、TC、hs-CRP、E-Selectin和SBP有所改善，而未患有GDM或超重/肥胖的女性未出現(xiàn)顯著變化。此外，維生素D補(bǔ)充在GDM女性中顯著降低了甘油三酯/葡萄糖指數(shù)。

結(jié)論 孕中期的維生素D補(bǔ)充可能有助于改善孕婦的心血管健康狀況，特別是在GDM或肥胖的孕婦中，這對于預(yù)防未來心血管疾病具有潛在益處。

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