孕期膳食维生素C摄入与子痫前期及其临床亚型的关系

李金波; 李汪俊; 任庆文; 郭孟竹; 冯永亮; 杨海澜; 张亚玮; 王素萍; 邬惟为

doi:10.16462/j.cnki.zhjbkz.2022.09.007

孕期膳食维生素C摄入与子痫前期及其临床亚型的关系

doi: 10.16462/j.cnki.zhjbkz.2022.09.007

1.
030001 太原，山西医科大学公共卫生学院流行病学教研室
2.
030001 太原，山西医科大学第一医院妇产科
3.
100021北京，国家癌症中心、国家肿瘤临床研究中心、中国医学科学院北京协和医学院肿瘤医院

基金项目:

国家自然科学基金 81703314

中央引导地方科技发展资金项目 YDZX20201400001058

山西省高等学校科技创新项目 2019L0439

山西省留学回国人员科技活动择优资助项目 20210042

详细信息

通讯作者:
邬惟为，E-mail：wuweiwei2008@sina.com

中图分类号: R714.24
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出版历程
- 收稿日期: 2021-11-22
- 修回日期: 2022-05-13
- 网络出版日期: 2022-09-17
- 刊出日期: 2022-09-10

Association of dietary vitamin C intake during pregnancy with preeclampsia and its clinical subtypes

1.
Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
2.
Obstetrics and Gynecology, The First Hospital of Shanxi Medical University, Taiyuan 030001, China
3.
National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Funds:

National Natural Science Foundation of China 81703314

The Central Government Guides Local Science and Technology Development Fund Project YDZX20201400001058

Scientific and Technological Innovation Project of Higher Education Institutions in Shanxi Province 2019L0439

Fund Program for the Scientific Activities of Selected Returned Overseas Professionals in Shanxi Province 20210042

More Information

Corresponding author: WU Wei-wei, E-mail: wuweiwei2008@sina.com

摘要

摘要: 目的探讨孕期膳食维生素C摄入与子痫前期(preeclampsia，PE)及其临床亚型的关系。方法选取2012年3月1日—2016年9月30日于山西医科大学第一医院妇产科住院分娩的孕妇为研究对象，其中861例PE孕妇作为病例组，7 987例非PE孕妇作为对照组，收集其一般人口学特征、疾病史、家族史及孕期膳食摄入情况等。采用非条件logistic回归分析模型分析孕期膳食维生素C摄入对PE及其临床亚型的发生风险的影响。结果调整孕妇年龄、文化程度等影响因素后，孕妇孕早期膳食维生素C摄入达到Q₃水平(OR=0.80, 95% CI: 0.64~0.99)、孕晚期达到Q₃水平(OR=0.78, 95% CI: 0.63~0.97)会降低PE的发生风险。按照孕前BMI进行分层后，孕前BMI < 24.0 kg/m²的孕妇孕早期膳食维生素C摄入达到Q₃水平(OR=0.73, 95% CI: 0.55~0.96)、孕中期达到Q₃水平(OR=0.71, 95% CI: 0.54~0.93)、孕晚期达到Q₃水平(OR=0.67, 95% CI: 0.51~0.88)是PE的保护因素。进一步探讨不同孕前BMI孕妇膳食维生素C摄入与PE临床亚型的关系后发现，孕前BMI < 24.0 kg/m²的孕妇孕晚期膳食维生素C摄入达到Q₃水平(OR=0.66, 95% CI: 0.47~0.93)会降低晚发型子痫前期(late-onset preeclampsia, LOPE)的发生风险。结论孕前BMI < 24.0 kg/m²的孕妇Q₃水平的膳食维生素C摄入可降低PE的发生风险，尤其是对于LOPE。
- 维生素C /
- 子痫前期 /
- BMI /
- 晚发型子痫前期
Abstract: Objective To investigate the relationship between dietary vitamin C intake during pregnancy and preeclampsia (PE) and its clinical subtypes. Methods Pregnant women who were delivered in the Department of Obstetrics and Gynecology of the First Hospital of Shanxi Medical University from March 1, 2012 to September 30, 2016 were selected as the research subjects. Among them, 861 PE pregnant women were used as the case group and 7 987 non-PE pregnant women were used as the control group. Information on demographic characteristics, disease history, family history and dietary intake during pregnancy were collected. Unconditional logistic regression was used to analyze the influence of dietary vitamin C intake during pregnancy on the risk of PE and its clinical subtypes. Results After adjusting for maternity age, educational level and other influencing factors, the dietary vitamin C intake of pregnant women reached Q₃ level in the first trimester (OR=0.80, 95% CI: 0.64-0.99) and the third trimester (OR=0.78, 95% CI: 0.63-0.97) were negatively related with the risk of PE. After stratifying according to the pre-pregnancy BMI, the dietary vitamin C intake of pregnant women with pre-pregnancy BMI < 24.0 kg/m² reached Q₃ level in the first trimester (OR=0.73, 95% CI: 0.55-0.96), the second trimester (OR=0.71, 95% CI: 0.54-0.93) and the third trimester (OR=0.67, 95% CI: 0.51-0.88) were protective factors for PE. After further exploring the relationship between dietary vitamin C intake of pregnant women with different pre-pregnancy BMI and PE clinical subtypes, it was found that the dietary vitamin C intake of pregnant women with pre-pregnancy BMI < 24.0 kg/m² Q₃ level in the third trimester (OR=0.66, 95% CI: 0.47-0.93) reduced risk of late-onset preeclampsia (LOPE). Conclusion Dietary vitamin C intake of pregnant women with Pre-pregnancy BMI < 24.0 kg/m² at Q₃ level had reduced risk of PE, especially for LOPE.
- Vitamin C /
- Preeclampsia /
- Body mass index /
- Late-onset preeclampsia

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表 1 病例组与对照组孕妇基本特征比较[n(%)]

Table 1. Comparison of the basic characteristics of pregnant women between the case group and the control group [n(%)]

变量	总例数(N=8 848)	病例组(n=861)	对照组(n=7 987)	χ²值	P值
孕妇年龄(岁)				1.69 ^a	0.194
< 25	947(10.70)	140(16.26)	807(10.10)
25~ < 30	4 004(45.25)	333(38.68)	3 671(45.96)
≥30	3 897(44.05)	388(45.06)	3 509(43.94)
文化程度				317.41 ^a	< 0.001
初中及以下	1 529(17.28)	321(37.28)	1 208(15.13)
高中/中专/大专	3 101(35.05)	339(39.37)	2 762(34.58)
大学及以上	4 218(47.67)	201(23.35)	4 017(50.29)
孕前BMI (kg/m²)				149.85 ^a	< 0.001
< 18.5	1 188(13.43)	62(7.20)	1 126(14.10)
18.5~ < 24.0	5 950(67.25)	494(57.38)	5 456(68.31)
≥24.0	1 710(19.32)	305(35.42)	1 405(17.59)
居住地				371.25	< 0.001
城市	6 872(77.67)	445(51.68)	6 427(80.47)
农村	1 976(22.33)	416(48.32)	1 560(19.53)
人均月收入(元)				119.88 ^a	< 0.001
< 2 000	1 468(16.59)	237(27.53)	1 231(15.41)
2 000~ < 4 000	4 982(56.31)	497(57.72)	4 485(56.15)
≥4 000	2 398(27.10)	127(14.75)	2 271(28.44)
孕前健康教育				97.11	< 0.001
是	3 353(37.90)	193(22.42)	3 160(39.56)
否	5 495(62.10)	668(77.58)	4 827(60.44)
孕期被动吸烟				21.32	< 0.001
是	1 166(13.18)	157(18.23)	1 009(12.63)
否	7 682(86.82)	704(81.77)	6 978(87.37)
孕期体育活动				3.54	0.060
是	8 244(93.17)	789(91.64)	7 455(93.34)
否	604(6.83)	72(8.36)	532(6.66)
孕期增重				75.21 ^a	< 0.001
不足	1 523(17.21)	108(12.54)	1 415(17.72)
适宜	3 552(40.15)	258(29.97)	3 294(41.24)
过多	3 773(42.64)	495(57.49)	3 278(41.04)
产次				17.78	< 0.001
初产	6 647(75.12)	596(69.22)	6 051(75.76)
经产	2 201(24.88)	265(30.78)	1 936(24.24)
妊娠期糖尿病				9.15	0.003
是	1 306(14.76)	157(18.23)	1 149(14.39)
否	7 542(85.24)	704(81.77)	6 838(85.61)
高血压家族史				59.81	< 0.001
是	1 409(15.92)	216(25.09)	1 193(14.94)
否	7 439(84.08)	645(74.91)	6 794(85.06)
膳食维生素C摄入(mg/d)				15.90 ^a	< 0.001
Q₁ (< 84.30)	2 270(25.66)	274(31.82)	1 996(24.99)
Q₂ (84.30~ < 101.82)	2 203(24.90)	207(24.04)	1 996(24.99)
Q₃ (101.82~ < 127.25)	2 192(24.77)	193(22.42)	1 999(25.03)
Q₄ (≥127.25)	2 183(24.67)	187(21.72)	1 996(24.99)
注：^a表示进行秩和检验的χ²值。

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表 2 孕妇膳食维生素C摄入与PE关系的非条件logistic回归分析

Table 2. Unconditional logistic regression analysis of the relationship between dietary vitamin C intake and PE in pregnant women

维生素C摄入(mg/d)	病例人数/对照人数	OR(95% CI)值	OR(95% CI)值^a
孕早期
Q₁ (< 84.06)	276/1 996	1.00	1.00
Q₂ (84.06~ < 101.82)	208/1 983	0.76(0.63~0.92)	0.93(0.75~1.15)
Q₃ (101.82~ < 127.34)	189/2 011	0.68(0.56~0.83)	0.80(0.64~0.99)
Q4 (≥127.34)	188/1 998	0.68(0.56~0.83)	0.90(0.69~1.16)
孕中期
Q₁ (< 84.28)	275/1 997	1.00	1.00
Q₂ (84.28~ < 102.18)	208/1 997	0.76(0.63~0.92)	0.92(0.75~1.14)
Q₃ (102.18~ < 127.75)	189/1 997	0.69(0.57~0.84)	0.82(0.66~1.02)
Q4 (≥127.75)	189/1 996	0.69(0.57~0.84)	0.92(0.71~1.20)
孕晚期
Q₁ (< 83.84)	279/1 995	1.00	1.00
Q₂ (83.84~ < 102.06)	210/1 998	0.75(0.62~0.91)	0.91(0.73~1.12)
Q₃ (102.06~ < 127.61)	184/1 998	0.66(0.54~0.80)	0.78(0.63~0.97)
Q₄ (≥127.61)	188/1 996	0.67(0.55~0.82)	0.88(0.68~1.14)
注：^a调整因素包括孕妇年龄、文化程度、孕前BMI、居住地、人均月收入、孕前健康教育、孕期被动吸烟、孕期增重、产次、妊娠期糖尿病、高血压家族史、总能量摄入。

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表 3 不同孕前BMI孕妇膳食维生素C摄入与PE关系的非条件logistic回归分析

Table 3. Unconditional logistic regression analysis of the relationship between dietary vitamin C intake and PE in pregnant women with different pre-pregnancy BMI

维生素C摄入(mg/d)	BMI < 24.0 kg/m²		BMI≥24.0 kg/m²		交互作用P值
维生素C摄入(mg/d)	病例人数/对照人数	OR(95% CI)值^a	病例人数/对照人数	OR(95% CI)值^a	交互作用P值
孕早期					< 0.001
Q₁ (< 84.06)	177/1 600	1.00	99/396	1.00
Q₂ (84.06~ < 101.82)	131/1 643	0.84(0.65~1.09)	77/340	1.18(0.81~1.72)
Q₃ (101.82~ < 127.34)	110/1 643	0.73(0.55~0.96)	79/368	1.01(0.69~1.47)
Q₄ (≥127.34)	138/1 696	0.89(0.65~1.20)	50/301	0.94(0.57~1.54)
孕中期					< 0.001
Q₁ (< 84.28)	177/1 597	1.00	98/400	1.00
Q₂ (84.28~ < 102.18)	134/1 646	0.86(0.66~1.11)	74/351	1.10(0.75~1.62)
Q₃ (102.18~ < 127.75)	108/1 642	0.71(0.54~0.93)	81/355	1.16(0.79~1.69)
Q₄ (≥127.75)	137/1 697	0.88(0.65~1.19)	52/299	1.06(0.64~1.74)
孕晚期					< 0.001
Q₁ (< 83.84)	179/1 592	1.00	100/403	1.00
Q₂ (83.84~ < 102.06)	135/1 651	0.83(0.64~1.07)	75/347	1.11(0.76~1.62)
Q₃ (102.06~ < 127.61)	105/1 640	0.67(0.51~0.88)	79/358	1.11(0.76~1.62)
Q₄ (≥127.61)	137/1 699	0.84(0.62~1.14)	51/297	0.99(0.61~1.63)
注：^a调整因素包括孕妇年龄、文化程度、居住地、人均月收入、孕前健康教育、孕期被动吸烟、孕期增重、产次、妊娠期糖尿病、高血压家族史、总能量摄入。

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表 4 不同孕前BMI孕妇不同时期维生素C摄入量与PE临床亚型的关系

Table 4. The relationship between vitamin C intake and PE clinical subtypes in pregnant women with different pre-pregnancy BMI

维生素C摄入(mg/d)	对照组(n=7 987)	EOPE(n=376)	EOPE OR(95% CI)值^a	LOPE(n=485)	LOPE OR(95% CI)值^a
BMI < 24.0 kg/m²
孕早期
Q₁ (< 84.06)	1 600(24.31)	74(30.96)	1.00	103(32.49)	1.00
Q₂ (84.06~ < 101.82)	1 643(24.96)	53(22.18)	0.88(0.60~1.30)	78(24.61)	0.83(0.60~1.14)
Q₃ (101.82~ < 127.34)	1 643(24.96)	45(18.83)	0.77(0.51~1.16)	65(20.50)	0.71(0.50~1.00)
Q₄ (≥127.34)	1 696(25.77)	67(28.03)	1.14(0.73~1.77)	71(22.40)	0.76(0.51~1.12)
孕中期
Q₁ (< 84.28)	1 597(24.26)	73(30.54)	1.00	104(32.81)	1.00
Q₂ (84.28~ < 102.18)	1 646(25.01)	59(24.69)	0.99(0.68~1.44)	75(23.66)	0.79(0.57~1.10)
Q₃ (102.18~ < 127.75)	1 642(24.95)	42(17.57)	0.72(0.47~1.09)	66(20.82)	0.71(0.50~1.01)
Q₄ (≥127.75)	1 697(25.78)	65(27.20)	1.10(0.71~1.72)	72(22.71)	0.76(0.51~1.13)
孕晚期
Q₁ (< 83.84)	1 592(24.19)	72(30.13)	1.00	107(33.75)	1.00
Q₂ (83.84~ < 102.06)	1 651(25.08)	60(25.10)	0.99(0.68~1.44)	75(23.66)	0.74(0.54~1.03)
Q₃ (102.06~ < 127.61)	1 640(24.92)	41(17.15)	0.70(0.46~1.07)	64(20.19)	0.66(0.47~0.93)
Q₄ (≥127.61)	1 699(25.81)	66(27.62)	1.13(0.72~1.76)	71(22.40)	0.70(0.47~1.04)
BMI≥24.0 kg/m²
孕早期
Q₁ (< 84.06)	396(28.19)	40(29.20)	1.00	59(35.11)	1.00
Q₂ (84.06~ < 101.82)	340(24.20)	34(24.82)	1.21(0.71~2.04)	43(25.60)	1.11(0.69~1.80)
Q₃ (101.82~ < 127.34)	368(26.19)	36(26.28)	1.02(0.60~1.72)	43(25.60)	0.95(0.58~1.53)
Q₄ (≥127.34)	301(21.42)	27(19.71)	1.20(0.62~2.30)	23(13.69)	0.73(0.37~1.43)
孕中期
Q₁ (< 84.28)	400(28.47)	41(29.92)	1.00	57(33.93)	1.00
Q₂ (84.28~ < 102.18)	351(24.98)	32(23.36)	1.02(0.60~1.73)	42(25.00)	1.13(0.70~1.84)
Q₃ (102.18~ < 127.75)	355(25.27)	38(27.74)	1.14(0.68~1.92)	43(25.59)	1.14(0.70~1.87)
Q₄ (≥127.75)	299(21.28)	26(18.98)	1.13(0.58~2.18)	26(15.48)	0.99(0.52~1.93)
孕晚期
Q₁ (< 83.84)	403(28.68)	41(29.92)	1.00	59(35.12)	1.00
Q₂ (83.84~ < 102.06)	347(24.70)	33(24.09)	1.09(0.65~1.83)	42(25.00)	1.09(0.67~1.76)
Q₃ (102.06~ < 127.61)	358(25.48)	38(27.74)	1.14(0.68~1.92)	41(24.40)	1.05(0.65~1.72)
Q₄ (≥127.61)	297(21.14)	25(18.25)	1.08(0.57~2.07)	26(15.48)	0.93(0.49~1.76)
注：^a调整因素包括孕妇年龄、文化程度、居住地、人均月收入、孕前健康教育、孕期被动吸烟、孕期增重、产次、妊娠期糖尿病、高血压家族史、总能量摄入。

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变量	总例数(N=8 848)	病例组(n=861)	对照组(n=7 987)	χ²值	P值
孕妇年龄(岁)				1.69 ^a	0.194
< 25	947(10.70)	140(16.26)	807(10.10)
25~ < 30	4 004(45.25)	333(38.68)	3 671(45.96)
≥30	3 897(44.05)	388(45.06)	3 509(43.94)
文化程度				317.41 ^a	< 0.001
初中及以下	1 529(17.28)	321(37.28)	1 208(15.13)
高中/中专/大专	3 101(35.05)	339(39.37)	2 762(34.58)
大学及以上	4 218(47.67)	201(23.35)	4 017(50.29)
孕前BMI (kg/m²)				149.85 ^a	< 0.001
< 18.5	1 188(13.43)	62(7.20)	1 126(14.10)
18.5~ < 24.0	5 950(67.25)	494(57.38)	5 456(68.31)
≥24.0	1 710(19.32)	305(35.42)	1 405(17.59)
居住地				371.25	< 0.001
城市	6 872(77.67)	445(51.68)	6 427(80.47)
农村	1 976(22.33)	416(48.32)	1 560(19.53)
人均月收入(元)				119.88 ^a	< 0.001
< 2 000	1 468(16.59)	237(27.53)	1 231(15.41)
2 000~ < 4 000	4 982(56.31)	497(57.72)	4 485(56.15)
≥4 000	2 398(27.10)	127(14.75)	2 271(28.44)
孕前健康教育				97.11	< 0.001
是	3 353(37.90)	193(22.42)	3 160(39.56)
否	5 495(62.10)	668(77.58)	4 827(60.44)
孕期被动吸烟				21.32	< 0.001
是	1 166(13.18)	157(18.23)	1 009(12.63)
否	7 682(86.82)	704(81.77)	6 978(87.37)
孕期体育活动				3.54	0.060
是	8 244(93.17)	789(91.64)	7 455(93.34)
否	604(6.83)	72(8.36)	532(6.66)
孕期增重				75.21 ^a	< 0.001
不足	1 523(17.21)	108(12.54)	1 415(17.72)
适宜	3 552(40.15)	258(29.97)	3 294(41.24)
过多	3 773(42.64)	495(57.49)	3 278(41.04)
产次				17.78	< 0.001
初产	6 647(75.12)	596(69.22)	6 051(75.76)
经产	2 201(24.88)	265(30.78)	1 936(24.24)
妊娠期糖尿病				9.15	0.003
是	1 306(14.76)	157(18.23)	1 149(14.39)
否	7 542(85.24)	704(81.77)	6 838(85.61)
高血压家族史				59.81	< 0.001
是	1 409(15.92)	216(25.09)	1 193(14.94)
否	7 439(84.08)	645(74.91)	6 794(85.06)
膳食维生素C摄入(mg/d)				15.90 ^a	< 0.001
Q₁ (< 84.30)	2 270(25.66)	274(31.82)	1 996(24.99)
Q₂ (84.30~ < 101.82)	2 203(24.90)	207(24.04)	1 996(24.99)
Q₃ (101.82~ < 127.25)	2 192(24.77)	193(22.42)	1 999(25.03)
Q₄ (≥127.25)	2 183(24.67)	187(21.72)	1 996(24.99)
注：^a表示进行秩和检验的χ²值。

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孕期膳食维生素C摄入与子痫前期及其临床亚型的关系

doi: 10.16462/j.cnki.zhjbkz.2022.09.007

通讯作者:
邬惟为，E-mail：wuweiwei2008@sina.com

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Association of dietary vitamin C intake during pregnancy with preeclampsia and its clinical subtypes

Corresponding author: WU Wei-wei, E-mail: wuweiwei2008@sina.com

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孕期膳食维生素C摄入与子痫前期及其临床亚型的关系

doi: 10.16462/j.cnki.zhjbkz.2022.09.007

通讯作者: 邬惟为，E-mail：wuweiwei2008@sina.com

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Association of dietary vitamin C intake during pregnancy with preeclampsia and its clinical subtypes

Corresponding author: WU Wei-wei, E-mail: wuweiwei2008@sina.com

计量

出版历程

目录

通讯作者:
邬惟为，E-mail：wuweiwei2008@sina.com