一项随机对照试验的二次分析:孕妇产前、产后或不产后补充维生素D3并不能改善分娩时孕妇的铁状态或6个月大时婴儿的铁状态

IF 3.3 Q2 NUTRITION & DIETETICS BMJ Nutrition, Prevention and Health Pub Date : 2023-11-14 DOI:10.1136/bmjnph-2023-000758
Karen M O'Callaghan, Huma Qamar, Alison D Gernand, AK Onoyovwi, Stanley Zlotkin, Abdullah A Mahmud, Tahmeed Ahmed, Farhana K Keya, Daniel E Roth
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In this secondary analysis (n=998), we examined effects of prenatal;postpartum vitamin D on serum ferritin and other biomarkers of maternal iron status (transferrin saturation, total iron binding capacity, soluble transferrin receptor and hepcidin) at delivery, and infant ferritin and haemoglobin at 6 months of age. Using linear regression, we estimated per cent mean differences between each intervention group and placebo with 95% CIs, with and without adjustment for baseline ferritin or inflammatory biomarkers (C reactive protein and α-1-acid glycoprotein (AGP)). Results At delivery, ferritin concentrations were similar between each intervention group and placebo in unadjusted (n=998) and baseline ferritin-adjusted analyses (n=992; p>0.05). Compared with placebo, AGP was lower in each intervention group (per cent difference (95% CI) = −11% (−21 to –1.0), −14% (−23 to –3.5) and −11% (−19 to –2.0) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=779). 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引用次数: 0

摘要

维生素D可能通过调节hepcidin和炎症途径来改变铁的状态。本研究旨在探讨孕妇补充维生素D对妊娠期和婴儿早期铁状态的影响。方法在孟加拉国达卡的一项试验中,妇女(n=1300)在妊娠17至24周至产后26周(产前;产后剂量):0;0,4200;0,16800;0,28000;0或28000;28000 IU/周。所有参与者都补充了标准的叶酸铁。在这个二级分析(n=998)中,我们检查了产前和产后维生素D对分娩时血清铁蛋白和其他母体铁状态生物标志物(转铁蛋白饱和度、总铁结合能力、可溶性转铁蛋白受体和hepcidin)以及6个月大时婴儿铁蛋白和血红蛋白的影响。使用线性回归,我们估计了每个干预组和安慰剂组之间95% ci的平均差异,无论是否调整基线铁蛋白或炎症生物标志物(C反应蛋白和α-1-酸性糖蛋白(AGP))。结果:分娩时,各组铁蛋白浓度在未调整(n=998)和基线铁蛋白调整分析(n=992;p> 0.05)。与安慰剂相比,每个干预组的AGP都较低(95% CI)分别为- 11%(- 21至-1.0),- 14%(- 23至-3.5)和- 11%(- 19至-2.0),分别为4200 IU/周,16 800 IU/周和28 000 IU/周组;n = 779)。基线25-羟基维生素D的妇女亚组;在4200 IU/周、16 800 IU/周和28 000 IU/周组中,每个干预组的铁蛋白含量分别低于安慰剂组(- 23%(- 37至-5.0)、- 20%(- 35至-1.9)和- 20%(- 33至-4.1);n = 645);调整炎症后,效果略有减弱(n=510)。在分娩妇女或6个月大的婴儿中,维生素D对其他铁生物标志物没有影响。结论维生素D对铁蛋白的影响可能反映了一种抗炎机制。
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Maternal prenatal, with or without postpartum, vitamin D3 supplementation does not improve maternal iron status at delivery or infant iron status at 6 months of age: secondary analysis of a randomised controlled trial
Background Vitamin D may modify iron status through regulation of hepcidin and inflammatory pathways. This study aimed to investigate effects of maternal vitamin D supplementation on iron status in pregnancy and early infancy. Methods In a trial in Dhaka, Bangladesh, women (n=1300) were randomised to one of five vitamin D 3 regimens from 17 to 24 weeks’ gestation until 26 weeks postpartum (prenatal; postpartum doses): 0;0, 4200;0, 16 800;0, 28 000;0 or 28 000;28 000 IU/week. All participants received standard iron-folic acid supplementation. In this secondary analysis (n=998), we examined effects of prenatal;postpartum vitamin D on serum ferritin and other biomarkers of maternal iron status (transferrin saturation, total iron binding capacity, soluble transferrin receptor and hepcidin) at delivery, and infant ferritin and haemoglobin at 6 months of age. Using linear regression, we estimated per cent mean differences between each intervention group and placebo with 95% CIs, with and without adjustment for baseline ferritin or inflammatory biomarkers (C reactive protein and α-1-acid glycoprotein (AGP)). Results At delivery, ferritin concentrations were similar between each intervention group and placebo in unadjusted (n=998) and baseline ferritin-adjusted analyses (n=992; p>0.05). Compared with placebo, AGP was lower in each intervention group (per cent difference (95% CI) = −11% (−21 to –1.0), −14% (−23 to –3.5) and −11% (−19 to –2.0) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=779). In the subgroup of women with baseline 25-hydroxyvitamin D < 30 nmol/L, ferritin was lower in each intervention group versus placebo (−23% (−37 to –5.0), −20% (−35 to –1.9) and −20% (−33 to –4.1) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=645); effects were slightly attenuated after adjustment for inflammation (n=510). There were no effects of vitamin D on other iron biomarkers among women at delivery or infants aged 6 months. Conclusion These findings do not support improvement of iron status by vitamin D. The effect of prenatal vitamin D supplementation on ferritin may reflect an anti-inflammatory mechanism.
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来源期刊
BMJ Nutrition, Prevention and Health
BMJ Nutrition, Prevention and Health Nursing-Nutrition and Dietetics
CiteScore
5.80
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0.00%
发文量
34
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