孕晚期妇女与新生儿血浆维生素A水平的相关性分析

doi:10.19723/j.issn.1671-167X.2020.03.011

Abstract

Abstract:

Objective: To study the correlation of plasma vitamin A (VitA) levels between neonates and pregnant women in third trimester.Methods: A total of 688 pregnant women were recruited in Yuanshi and Laoting counties of Hebei Province, from May to June 2009. Venous blood samples of women before delivery and cord blood samples of newborns were collected and measured for retinol (retinol concentration was used to reflect VitA level) using high performance liquid chromatography assay. According to venous blood plasma retinol concentration, maternal VitA nutritional status was divided into deficiency (<0.70 μmol/L), marginal deficiency (0.70-<1.05 μmol/L), and sufficiency (≥1.05 μmol/L). According to cord blood plasma retinol concentration, neonatal VitA nutritional status was divided into deficiency (<0.35 μmol/L), marginal deficiency (0.35-<0.70 μmol/L), and sufficiency (≥0.70 μmol/L); neonatal VitA relative deficiency was further defined as cord blood plasma retinol concentration lower than the 10th percentile. VitA placental transport ratio was defined as retinol concentration in the neonates divided by that in pregnant women. Multivariable fractional polynomials (MFP) model and Pearson correlation were used to study the dose-response relationship between maternal and neonatal plasma VitA levels, Logistic regression model to estimate the effect of maternal VitA nutritional status on neonatal VitA deficiency, and MFP model and Spearman correlation to describe the relationship between maternal VitA level and VitA placental transport ratio.Results: The average retinol concentration of the pregnant women was (1.15±0.30) μmol/L, and the prevalence of VitA deficiency and marginal deficiency were 4.5% and 37.8%, respectively. Average retinol concentration of the neonates was (0.78±0.13) μmol/L, and no neonates were VitA deficiency, 28.2% of the neonates were marginal deficiency. After multivariable adjustment, the VitA level of the neonates was positively and linearly related to maternal VitA level (p^m=1, P<0.05), with the corresponding Pearson correlation coefficient of 0.13 (P<0.01). As compared with the women with sufficient VitA, those with VitA deficiency (crude OR=2.20, 95%CI:1.04-4.66) and marginal deficiency (crude OR=1.43, 95%CI:1.01-2.02) had higher risks to deliver neonates with VitA marginal deficiency; while the risks turned to be non-significant after multivariable adjustment. The pregnant women with VitA deficiency had higher risk to deliver neonates with relative VitA deficiency before and after multivariable adjustment (crude OR=3.02, 95%CI:1.21-7.50; adjusted OR=2.76, 95%CI:1.05-7.22). The maternal VitA level was negatively and non-linearly correlated with placental transport ratio (p^m= -0.5, P<0.05), with corresponding adjusted Spearman correlation coefficient of -0.82 (P<0.001).Conclusion: There was a positive linear dose-response relationship between VitA levels of newborns and pregnant women in third trimester, indicating that neonatal VitA storing levels at birth was affected by maternal VitA nutritional status.

Key words: Vitamin A, Neonate, Pregnant woman, Third trimester

CLC Number:

R172

Xiu-cui LI,Yu-bo ZHOU,Ke-yi SI,Hong-tian LI,Le ZHANG,Ya-li ZHANG,Ju-fen LIU,Jian-meng LIU. Relationship of plasma vitamin A levels between neonates and pregnant women in third trimester[J].Journal of Peking University (Health Sciences), 2020, 52(3): 464-469.

Figures/Tables 6

Table 1

Characteristics and plasma VitA levels for pregnant women and newborns"

Characteristics	Values
Pregnant women
Retinol concentration /(μmol/L), $x ?$ ±s	1.15±0.30
Age/years, n(%)
<25	509 (74.0)
≥25	179 (26.0)
Gestational age at enrollment/weeks, $x ?$ ±s	11.5±4.7
Gestational age at delivery/weeks, $x ?$ ±s	39.5±1.7
County, n(%)
Yuanshi	383 (55.7)
Laoting	305 (44.3)
Ethnicity, n(%)
Han	683 (99.3)
Other	5 (0.7)
Occupation, n(%)
Farmer	606 (88.0)
Other	82 (12.0)
Education, n(%)
Middle school or less	553 (80.4)
High school	72 (10.5)
University or higher	63 (9.1)
Body mass index at enrollment/ (kg/m²), n(%)
<18.5	38 (5.5)
18.5-23.9	483 (70.2)
>23.9	167 (24.3)
Hemoglobin level/(g/L), n(%)
≥110	663 (96.4)
<110	25 (3.6)
Newborns
Retinol concentration/(μmol/L), $x ?$ ±s	0.78±0.13
Gender, n(%)
Male	314 (45.6)
Female	353 (51.3)
Missing	21 (3.1)
Preterm birth, n(%)
Yes (28 weeks≤ gestational age<37 weeks)	29 (4.2)
No (gestational age≥37 weeks)	659 (95.8)
Birth length/cm, $x ?$ ±s	50.28±1.02
Birth weight/g, $x ?$ ±s	3 291.5±459.7

Table 1

Table 2

Pearson correlation analysis between maternal and neonatal VitA levels"

Maternal VitA status	Neonatal retinol concentration/(μmol/L)	r^a	P	$r adj b$	P
VitA deficiency (n=31)	0.74±0.17	0.34	0.05	0.45	0.03
Marginal VitA deficiency(n=260)	0.77±0.13	0.11	0.06	0.11	0.10
Sufficient (n=397)	0.78±0.13	0.13	<0.01	0.13	<0.01
Total (n=688)	0.78±0.13	0.14	<0.001	0.13	<0.01

Table 2

Figure 1

Table 3

Table 4

Spearman correlation analysis between maternal VitA level and VitA-PTR"

Items	$r s a$	P	$r sadj b$	P
Maternal VitA nutritional status
VitA deficiency	-0.08	0.65	-0.03	0.91
Marginal VitA deficiency	-0.48	<0.001	-0.48	<0.001
Sufficient	-0.62	<0.001	-0.61	<0.001
Neonatal VitA nutritional status
First definition method^c
Marginal VitA deficiency	-0.95	<0.001	-0.94	<0.001
Sufficient	-0.91	<0.001	-0.90	<0.001
Second definition method^d
Relative VitA deficiency	-0.95	<0.001	-0.94	<0.001
Sufficient	-0.88	<0.001	-0.86	<0.001
Total	-0.84	<0.001	-0.82	<0.001

Table 4

Figure 2

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Neonatal VitA deficiency	Maternal VitA nutritional status
Neonatal VitA deficiency	VitA deficiency	Marginal VitA deficiency	Sufficient
Marginal VitA deficiency ^a
Crude OR (95%CI)	2.20 (1.04-4.66)	1.43 (1.01-2.02)	1.00
Adjusted OR (95%CI)	2.14 (0.98-4.65)	1.45 (0.99-2.12)	1.00
Relative VitA deficiency ^b
Crude OR (95%CI)	3.02 (1.21-7.50)	1.15 (0.67-1.96)	1.00
Adjusted OR (95%CI)	2.76 (1.05-7.22)	1.14 (0.64-2.04)	1.00

Relationship of plasma vitamin A levels between neonates and pregnant women in third trimester

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