媽媽的維他命D狀態與小孩長大時的發育結果有關


  【24drs.com】根據針對5篇已發表的子研究總回顧,媽媽的維他命D缺乏與小孩的多種長期健康結果有關。
  
  一篇包括901對母嬰縱向前瞻型研究的結果指出,妊娠第18週時血清25-hydroxy-vitamin D(25-OH-D)值低於50 nmol/L的媽媽生下的小孩,在6歲時肺部發育不良、10歲時發生神經認知問題、青春期時飲食異常、20歲時骨量峰值較低的風險都比較高;西澳大利亞大學Telethon兒童研究中心Prue H. Hart博士等人在12月15日的小兒科期刊線上發表他們的研究。
  
  研究者使用「Western Australian Pregnancy Cohort (Raine) Study」的資料,該研究是以社區居民為主的白人婦女、未特別篩選為研究對象之下進行研究,檢視母親維他命D狀態與小孩在各年齡時的健康結果關聯,該研究於1989-1991年在西澳大利亞的伯斯進行。作者們寫道,最重要的是,在於反映器官(例如肺功能、語言能力、骨量峰值)的發育變化,而且,在某些情況下,可能會導致影響後來的健康情況。
  
  研究的媽媽們有323人(36%)在妊娠第18週時屬於維他命D缺乏,29名(3%)孕婦屬於嚴重缺乏,也就是25-OH-D值小於25 nmol/L。
  
  子研究結果總結如下:
  * 媽媽的25-OH-D值和孩童6歲時的最大肺活量Z值有明顯正相關。研究者校正共變項之後,維他命D值對肺功能測量的影響也隨之改變。有260對母嬰的這個子研究發現「維他命D缺乏與呼吸道疾病之關聯」,是因為對肺功能發育的影響導致。
  * 與5歲和10歲時的語言發展有顯著關聯。有743對母嬰的這個子研究中,多變項回歸分析顯示,妊娠18週時,相較於25-OH-D值最高之前25%的孕婦,維他命D值最低者的小孩發生臨床語言功能不佳的風險增加近2倍。
  * 在有406對母嬰的子研究中,依據自閉症光譜量表的「注意力切換次量表」,維他命D缺乏母親的小孩在青年時的風險增加(量表分數越高、至少是平均值的2個標準差以上)。
  * 母親的維他命D狀態較低,與女兒發生飲食異常風險較高有顯著正相關;特別的是,校正多個潛在共變項之後,血清25-OH-D值最低的25%,在20歲時發生飲食異常的風險是血清25-OH-D值前25%者的2倍。
  * 母親維他命D值缺乏和小孩在20歲時的骨量峰值較低有關,相較於維他命D充足的母親,整體骨質含量減少2.7%,整體骨質密度減少1.7% (納入樣本蒐集原因以及母親與小孩的因素之後)。
  
  作者們寫道,整體而言,來自觀察型研究的結果認為維他命D對於胎兒肺、腦、骨骼發育扮演重要角色,但尚未證明。可能是維他命D缺乏之孕婦的小孩,其肺、腦、骨骼發育減緩,但是未反映出缺乏維他命D,不過,母親本身可能有與維他命D缺乏相關的其他健康因素。
  
  雖然研究者校正了許多潛在的相關共變項,作者們指出,不可能校正每個可能的共變項。這篇研究報告令人震驚的是,蒐集的研究結果所報告之關聯性的廣度;若要以母親健康狀況的共變項來解釋觀察到的關聯是相當不可能的。
  
  根據蒐集到的結果,研究者認為,胎兒在子宮內的維他命D值不只對骨骼有影響,對許多器官的適當發育也很重要。
  
  作者們結論表示,除非有針對孕婦維他命D補充進行隨機控制試驗的明確資料,孕婦25(OH)D值維持在 >50 nmol/L可以被視為合理目標。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7145&x_classno=0&x_chkdelpoint=Y
  

Maternal Vitamin D Status Tied to Long-term Outcomes in Kids

By Diana Phillips
Medscape Medical News

Maternal vitamin D deficiency is associated with multisystem long-term health outcomes in offspring, according to a summative review of five published substudies.

Findings from a longitudinal, prospective study of 901 mother and offspring pairs indicate that children born to mothers with serum 25-hydroxy-vitamin D (25-OH-D) levels less than 50 nmol/L at 18 weeks' gestation were at increased risk for impaired lung development at 6 years, neurocognitive problems at 10 years, eating disorders during adolescence, and lower peak bone mass at 20 years. Prue H. Hart, PhD, from the Telethon Kids Institute at the University of Western Australia, and colleagues report their findings in an article published online December 15 in Pediatrics.

The researchers used data from the Western Australian Pregnancy Cohort (Raine) Study, an unselected, community-based cohort comprising predominantly white women, to examine the relationship between maternal vitamin D status and health outcomes over time of offspring who were born in Perth, Western Australia, from 1989 to 1991. "Of importance, the emphasis was on changes that reflect organ development (eg, lung capacity, language ability, peak bone mass) and that may predispose, in some cases, to ill health later in life," the authors write.

Of the full maternal cohort, 323 (36%) were vitamin D-deficient at 18 weeks' gestation. Twenty-nine of the pregnant women (3%) were severely deficient, with 25-OH-D levels less than 25 nmol/L.

The findings from the substudies reported in the summation demonstrate:

  • A significant, positive association between maternal serum 25-OH-D levels and Z scores for forced vital capacity in children at 6 years of age. The effects on lung measures titrated with levels of vitamin D after the researchers adjusted for confounders. The findings of this substudy of 260 mother–offspring pairs suggest "an association of vitamin D deficiency with respiratory disease is due to an impact on lung development," the researchers report.

  • A significant association with language development at ages 5 and 10 years. In this 743 mother–offspring pair substudy, multivariable regression analyses showed that the risk of having a child with clinically significant language impairment was increased by nearly twofold in women with the lowest vitamin D levels at 18 weeks' gestation compared with those in the highest quartile of the 25-OH-D distribution.

  • An increased risk for high scores (at least 2 standard deviations above the mean) in early adulthood on the Attention Switching subscale of the Autism-Spectrum Quotient for children of vitamin D-deficient mothers in a substudy of 406 mother-offspring pairs.

  • A significant predictive relationship between lower maternal vitamin D status and eating disorder risk in female offspring. Specifically, a serum 25-OH-D level in the lowest quartile was associated with a twofold increase in odds for having an eating disorder by age 20 years relative to concentrations in the highest quartile, after adjustment for multiple potential confounders.

  • A significant association between maternal vitamin D deficiency and lower peak bone mass in offspring at 20 years. Total body bone mineral content was reduced by 2.7% and total body bone mineral density was reduced by 1.7% (after accounting for season of sample collection and maternal and offspring factors) compared with children of vitamin D-sufficient mothers.

Taken together, the findings from the observational studies "suggest, but do not prove, that vitamin D plays an active role in fetal lung, brain, and bone development," the authors write. "The possibility remains that the reduced lung, brain, and bone development in the offspring of vitamin D-deficient mothers may not reflect vitamin D deficiency per se but some other health factor in the women that is associated with maternal vitamin D deficiency."

Although the researchers adjusted for a range of potentially relevant confounders, "it was not possible to adjust for every possible confounder," the authors note. ”What is striking with the studies reported here is the breadth of the health outcomes for which an association is reported in the collection of studies; confounding by maternal health status as the explanation for the observed associations is highly unlikely," they contend.

On the basis of the collective findings, the researchers suggest that sufficient level vitamin D in utero "is permissive for optimal development of multiple organs, not just bone as would be historically proposed."

Until definitive data from randomized controlled trials of vitamin D supplementation of pregnant women are available, the authors conclude, "maintaining a 25(OH)D level of>50 nmol/L in pregnant women must be considered a reasonable target."

Raine Study core management funding has been provided by the University of Western Australia; Telethon Kids Institute; Raine Medical Research Foundation' University of Western Australia Faculty of Medicine, Dentistry and Health Sciences; Women’s and Infant’s Research Foundation; Curtin University; and Edith Cowan University. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 15, 2014.

    
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