目的 了解妊娠期维生素A、E营养状况对母体和胎儿结局的影响。方法 收集2015-03至2017-07在北京市顺义区妇幼保健院产科门诊建档并规律产检的孕妇4788名,采集妊娠早期(≤12周)、中期(24~28周)、晚期(≥32周)血清标本10 289份,采用高效液相色谱法定量测定血清维生素A、E的浓度。分析孕妇孕期维生素A、E营养状况,了解维生素A、E异常对妊娠结局的影响。结果 孕妇维生素A整体营养状态良好,94.14%孕妇维生素A水平适宜,5.17%孕妇存在维生素A缺乏,0.69%孕妇存在维生素A过量。孕期维生素A异常以缺乏为主,孕晚期维生素A缺乏率(9.79%)明显高于孕早期(5.74%)和中期(2.31%),差异具有统计学意义(P＜0.05)。维生素A缺乏的孕妇在妊娠糖尿病、贫血、早产、低体重儿发生率方面均明显高于维生素A正常孕妇,差异具有统计学意义(P＜0.05)。孕期维生素E整体营养状态良好,94.38%孕妇维生素E水平适宜,0.12 %孕妇存在维生素E缺乏,5.50%孕妇存在维生素E过量。孕期维生素E异常以过量为主,孕晚期维生素E过量率(20.18%)明显高于孕早期(0.34%)和孕中期(4.75%),差异具有统计学意义(P＜0.05)。维生素E过量孕妇妊娠糖尿病发病率明显高于维生素E正常孕妇,差异有统计学意义(P＜0.05)。结论 孕期应加强维生素A、E水平监测,及时调整到适宜水平,以减少对母体和胎儿结局的不良影响。

Objective To explore the effect of nutritional status of vitamin A and E on maternal and fetal outcomes during pregnancy. Methods The clinical data on a total of 4788 pregnant women under regular prenatal examination was collected in the obstetric clinic of our hospital. 10289 serum samples were collected at T₁ (≤ 12 weeks), T₂ (24-28 weeks) and T₃ (≥ 32 weeks) in the early stage of pregnancy. The concentrations of serum vitamin A and E were determined quantitatively by HPLC. The nutritional status of vitamin A and E during pregnancy was analyzed to study the effect of abnormal vitamin A and E on pregnancy outcomes. Results The overall nutritional status of vitamin A in pregnant women was good. 94.14% of these pregnant women had appropriate levels of vitamin A, 5.17% had vitamin A deficiency and 0.69% had excessive vitamin A. Vitamin A deficiency was the main abnormality during pregnancy. The rate of vitamin A deficiency in the third trimester (9.79%) was significantly higher than in the first trimester (5.74%) and the second trimester (2.31%).The incidence of gestational diabetes, anemia, premature delivery and low birth weight was significantly higher among pregnant women with vitamin A deficiency than among pregnant women with normal levels of vitamin A, and the difference was statistically significant (P<0.05). The overall nutritional status of vitamin E during pregnancy was good. 94.38% of these pregnant women had appropriate vitamin E levels, 0.12% had vitamin E deficiency and 5.50% had excessive vitamin E. Excessive vitamin E during pregnancy was the leading abnormality. The excess rate of vitamin E in the third trimester (20.18%) was significantly higher than in the first trimester (0.34%) and the second trimester (4.75%). The difference was statistically significant (P<0.05). The incidence of gestational diabetes mellitus among pregnant women with excessive vitamin E was significantly higher than among those with normal levels of vitamin E (P<0.05). Conclusions The monitoring of vitamin A and E levels should be strengthened during pregnancy and adjusted to an appropriate level in time to reduce the adverse effects on maternal and fetal outcomes.