{"title":"孕晚期母体维生素 d 状态与婴儿期急性下呼吸道感染和急性腹泻之间的关系 - 一项队列研究。","authors":"Amritha Vinod, Vikneswari Karthiga, Soma Venkatesh Chakraborty, Soundararajan Palanisamy, Setu Rathod","doi":"10.1016/j.clnesp.2024.10.157","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Acute lower respiratory tract infection (ALRI) and acute diarrheal disease (ADD) are the leading causes of mortality in children globally. There is emerging evidence of an association between maternal hypovitaminosis D and ALRI/ADD during infancy.</p><p><strong>Objective: </strong>To determine whether maternal hypovitaminosis D (25(OH)D [<20 ng/ml] during late pregnancy is associated with increased risk of ALRI/ADD in their offspring during infancy.</p><p><strong>Methods: </strong>This South Indian hospital-based, ambispective cohort study included 140 mother-baby dyads with known maternal vitamin D status before delivery in late third trimester (72 mothers with hypovitaminosis D and 68 mothers with adequate vitamin D level). Babies with cord blood vitamin D deficiency were treated as per consensus guidelines and those with adequate levels were supplemented with 400 IU vitamin D daily for 1 year. All infants were followed up at 6,10,14 weeks and 6, 9, 12 months for the occurrence, frequency, and severity of ALRI (pneumonia, bronchiolitis, viral induced wheezing) and ADD.</p><p><strong>Results: </strong>Overall incidence of ALRI was 0.23 per child year during infancy. Incidence of ALRI was 0.12 per child year in adequate maternal vitamin D group versus 0.32 per child year in maternal hypovitaminosis D group (p value = 0.024) and that of bronchiolitis/viral wheeze was 0.07 per child year in adequate maternal vitamin D group versus 0.21 per child year in maternal hypovitaminosis D group (p value = 0.047). Cox regression analysis with maternal hypovitaminosis D level as predictor variable, adjusted for gestational age at birth and other covariates, revealed a hazard ratio of 3.18 (95 % CI: 1.17-8.65, p = 0.023) and 3.63 (95 % CI 1.36-9.65, p = 0.010) for ALRI and ADD respectively. No increased risk for occurrence of pneumonia was observed and none had severe pneumonia.</p><p><strong>Conclusion: </strong>Maternal hypovitaminosis D is associated with increased risk of ALRI and ADD in their babies during infancy. Routine screening of pregnant women at risk for hypovitaminosis D and supplementation based on 25(OH)D level may decrease the burden of ALRI, for which further studies are needed.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between maternal vitamin D status during late pregnancy and acute lower respiratory tract infections and acute diarrheal disease during infancy - A cohort study.\",\"authors\":\"Amritha Vinod, Vikneswari Karthiga, Soma Venkatesh Chakraborty, Soundararajan Palanisamy, Setu Rathod\",\"doi\":\"10.1016/j.clnesp.2024.10.157\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Acute lower respiratory tract infection (ALRI) and acute diarrheal disease (ADD) are the leading causes of mortality in children globally. There is emerging evidence of an association between maternal hypovitaminosis D and ALRI/ADD during infancy.</p><p><strong>Objective: </strong>To determine whether maternal hypovitaminosis D (25(OH)D [<20 ng/ml] during late pregnancy is associated with increased risk of ALRI/ADD in their offspring during infancy.</p><p><strong>Methods: </strong>This South Indian hospital-based, ambispective cohort study included 140 mother-baby dyads with known maternal vitamin D status before delivery in late third trimester (72 mothers with hypovitaminosis D and 68 mothers with adequate vitamin D level). Babies with cord blood vitamin D deficiency were treated as per consensus guidelines and those with adequate levels were supplemented with 400 IU vitamin D daily for 1 year. All infants were followed up at 6,10,14 weeks and 6, 9, 12 months for the occurrence, frequency, and severity of ALRI (pneumonia, bronchiolitis, viral induced wheezing) and ADD.</p><p><strong>Results: </strong>Overall incidence of ALRI was 0.23 per child year during infancy. Incidence of ALRI was 0.12 per child year in adequate maternal vitamin D group versus 0.32 per child year in maternal hypovitaminosis D group (p value = 0.024) and that of bronchiolitis/viral wheeze was 0.07 per child year in adequate maternal vitamin D group versus 0.21 per child year in maternal hypovitaminosis D group (p value = 0.047). Cox regression analysis with maternal hypovitaminosis D level as predictor variable, adjusted for gestational age at birth and other covariates, revealed a hazard ratio of 3.18 (95 % CI: 1.17-8.65, p = 0.023) and 3.63 (95 % CI 1.36-9.65, p = 0.010) for ALRI and ADD respectively. No increased risk for occurrence of pneumonia was observed and none had severe pneumonia.</p><p><strong>Conclusion: </strong>Maternal hypovitaminosis D is associated with increased risk of ALRI and ADD in their babies during infancy. Routine screening of pregnant women at risk for hypovitaminosis D and supplementation based on 25(OH)D level may decrease the burden of ALRI, for which further studies are needed.</p>\",\"PeriodicalId\":10352,\"journal\":{\"name\":\"Clinical nutrition ESPEN\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-10-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical nutrition ESPEN\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.clnesp.2024.10.157\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nutrition ESPEN","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.clnesp.2024.10.157","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:急性下呼吸道感染(ALRI)和急性腹泻病(ADD)是全球儿童死亡的主要原因。有新证据表明,母体维生素 D 不足与婴儿期 ALRI/ADD 之间存在关联:目的:确定妊娠晚期母体维生素 D(25(OH)D [< 20 ng/ml])过低是否与婴儿期后代患 ALRI/ADD 的风险增加有关:这项以南印度医院为基础的前瞻性队列研究包括 140 个在孕晚期三个月分娩前已知母体维生素 D 状态的母婴二元组合(72 位维生素 D 过低的母亲和 68 位维生素 D 水平充足的母亲)。患有脐带血维生素 D 缺乏症的婴儿按照共识指南接受治疗,维生素 D 水平充足的婴儿则在 1 年内每天补充 400 IU 维生素 D。在 6、10、14 周和 6、9、12 个月时对所有婴儿进行随访,以了解 ALRI(肺炎、支气管炎、病毒性喘息)和 ADD 的发生率、频率和严重程度:结果:婴儿期 ALRI 的总发病率为每儿童年 0.23 例。母体维生素 D 充足组的 ALRI 发病率为 0.12/年,而母体维生素 D 不足组为 0.32/年(P 值=0.024);母体维生素 D 充足组的支气管炎/病毒性喘息发病率为 0.07/年,而母体维生素 D 不足组为 0.21/年(P 值=0.047)。以孕产妇维生素 D 过低水平作为预测变量并调整出生时胎龄和其他协变量的 Cox 回归分析显示,ALRI 和 ADD 的危险比分别为 3.18(95% CI:1.17-8.65,p=0.023)和 3.63(95% CI:1.36-9.65,p=0.010)。没有发现发生肺炎的风险增加,也没有发现重症肺炎:结论:母体维生素 D 不足与婴儿期 ALRI 和 ADD 风险增加有关。对存在维生素 D 过低风险的孕妇进行常规筛查,并根据 25(OH)D 水平进行补充,可能会减轻 ALRI 的负担,但这还需要进一步的研究。
Association between maternal vitamin D status during late pregnancy and acute lower respiratory tract infections and acute diarrheal disease during infancy - A cohort study.
Background: Acute lower respiratory tract infection (ALRI) and acute diarrheal disease (ADD) are the leading causes of mortality in children globally. There is emerging evidence of an association between maternal hypovitaminosis D and ALRI/ADD during infancy.
Objective: To determine whether maternal hypovitaminosis D (25(OH)D [<20 ng/ml] during late pregnancy is associated with increased risk of ALRI/ADD in their offspring during infancy.
Methods: This South Indian hospital-based, ambispective cohort study included 140 mother-baby dyads with known maternal vitamin D status before delivery in late third trimester (72 mothers with hypovitaminosis D and 68 mothers with adequate vitamin D level). Babies with cord blood vitamin D deficiency were treated as per consensus guidelines and those with adequate levels were supplemented with 400 IU vitamin D daily for 1 year. All infants were followed up at 6,10,14 weeks and 6, 9, 12 months for the occurrence, frequency, and severity of ALRI (pneumonia, bronchiolitis, viral induced wheezing) and ADD.
Results: Overall incidence of ALRI was 0.23 per child year during infancy. Incidence of ALRI was 0.12 per child year in adequate maternal vitamin D group versus 0.32 per child year in maternal hypovitaminosis D group (p value = 0.024) and that of bronchiolitis/viral wheeze was 0.07 per child year in adequate maternal vitamin D group versus 0.21 per child year in maternal hypovitaminosis D group (p value = 0.047). Cox regression analysis with maternal hypovitaminosis D level as predictor variable, adjusted for gestational age at birth and other covariates, revealed a hazard ratio of 3.18 (95 % CI: 1.17-8.65, p = 0.023) and 3.63 (95 % CI 1.36-9.65, p = 0.010) for ALRI and ADD respectively. No increased risk for occurrence of pneumonia was observed and none had severe pneumonia.
Conclusion: Maternal hypovitaminosis D is associated with increased risk of ALRI and ADD in their babies during infancy. Routine screening of pregnant women at risk for hypovitaminosis D and supplementation based on 25(OH)D level may decrease the burden of ALRI, for which further studies are needed.
期刊介绍:
Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.