Relationship between maternal and neonatal 25(OH)D3 levels and neonatal respiratory distress syndrome among women with gestational diabetes mellitus

doi:10.3877/cma.j.issn.1674-0785.2022.03.011

Abstract

Abstract:

Objective

To investigate the relationship between maternal and neonatal 25-hydroxy vitamin D₃ [25(OH)D] levels and neonatal respiratory distress syndrome (NRDS) among woman with gestational diabetes mellitus (GDM).

Methods

A total of 148 pregnant women with GDM at Fuyang Hospital Affiliated to Anhui Medical University from March 2018 to September 2020 were selected. The incidence of postpartum NRDS was recorded. The blood was collected at 28 to 36 weeks of gestation and at birth of the newborn, and the serum 25-(OH)D levels were detected. Binary Logistic regression model was used to analyze the independent influence factors of NRDS in pregnant women with GDM. The value of maternal and neonatal 25-(OH)D for predicting NRDS was evaluated by receiver operating characteristic (ROC) curve analysis.

Results

There were 28 cases of NRDS in the 148 newborns, with an incidence of 18.92%. There were statistically significant differences between the NRDS group and the non-NRDS group in Apgar scores at 1 min and 5 min, amniotic fluid inhalation, premature rupture of membranes, prenatal glucocorticoid treatment, and maternal and neonate 25(OH)D₃ levels (P＜0.05). Logistic regression analysis showed that Apgar scores at 1 min (odds ratio [OR]=2.243, 95% confidence interval [CI]: 1.795-2.803) and 5 min (OR=3.662, 95%CI: 2.074-6.466), amniotic fluid inhalation (OR=2.893, 95%CI: 1.325-6.317), neonatal 25(OH)D₃ (OR=0.483, 95%CI: 0.271-0.861), and maternal 25(OH)D₃ (OR=0.501, 95%CI: 0.282-0.890) were independent influence factors for postpartum NRDS (P＜0.05). ROC analysis results showed that the AUC of neonatal 25(OH)D₃ in predicting NRDS was 0.741, with a sensitivity and specificity of 86.7% and 54.6%, respectively. The AUC of maternal 25(OH)D₃ in predicting NRDS was 0.648, and the sensitivity and specificity were 89.2% and 35.7%, respectively. The prediction model was established based on the results of Logistic multi-factor analysis: logit(P)=0.119+0.808X₁+1.298X₂+1.062X₃-0.728X₄-0.691X₅ [1 min Apgar score=X₁, 5 min Apgar score=X₂, inhalation of amniotic fluid=X₃, newborn 25(OH)D₃=X₄, and maternal 25(OH)D₃=X₅]. ROC analysis showed that the AUC value of the prediction model for diagnosing NRDS was 0.844 (SE=0.041, 95%CI: 0.764-0.924, P＜0.001), with a sensitivity of 0.929 and specificity od 0.675.

Conclusion

Maternal and neonatal 25(OH)D₃ levels in GDM woman are independent influencing factors of NRDS. It is helpful for early screening of NRDS and guiding clinical practice to monitor the maternal and neonatal 25(OH)D₃ levels in GDM woman.

Key words: Gestational diabetes mellitus, 25-hydroxyvitamin D₃, Neonatal respiratory distress syndrome, Newborn

Liang Chang, Guodong Wei, Yunxia Zhang. Relationship between maternal and neonatal 25(OH)D₃ levels and neonatal respiratory distress syndrome among women with gestational diabetes mellitus[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(03): 252-257.

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Figures/Tables 6

项目	NRDS组（28例）	非NRDS组（120例）	统计值	P值
性别［例（%）］			χ²=0.281	0.596
男	19（67.86）	75（62.50）
女	9（32.14）	45（37.50）
胎龄（周， $x ¯$ ±s）	39.02±1.84	38.83±2.15	t=0.432	0.667
新生儿体重（kg， $x ¯$ ±s）	4.16±0.79	4.26±0.64	t=0.711	0.478
分娩方式［例（%）］			χ²=0.096	0.756
自然分娩	11（39.29）	51（42.50）
剖宫产	17（60.71）	69（57.50）
1 min Apgar评分［例（%）］			χ²=24.497	＜0.001
＞7分	5（17.86）	68（56.67）
4~7分	8（28.57）	36（30.00）
＜4分	15（53.57）	16（13.33）
5 min Apgar评分［例（%）］			χ²=45.921	＜0.001
＞7分	3（10.71）	76（63.33）
4~7分	8（28.57）	34（28.33）
＜4分	17（60.71）	10（8.33）
吸入羊水［例（%）］			χ²=42.113	＜0.001
是	21（75.00）	18（15.00）
否	7（25.00）	102（85.00）
胎膜早破［例（%）］			χ²=32.983	＜0.001
是	17（60.71）	14（11.67）
否	11（39.29）	106（88.33）
产前糖皮质激素治疗［例（%）］			χ²=4.671	0.031
是	12（42.86）	78（65.00）
否	16（57.14）	42（35.00）
母体25（OH）D₃（ng/ml， $x ¯$ ±s）	24.48±8.56	32.70±10.34	t=3.903	＜0.001
新生儿25（OH）D₃（ng/ml， $x ¯$ ±s）	16.29±6.94	23.82±5.15	t=6.494	＜0.001

项目	NRDS组（28例）	非NRDS组（120例）	统计值	P值
性别［例（%）］			χ²=0.281	0.596
男	19（67.86）	75（62.50）
女	9（32.14）	45（37.50）
胎龄（周， $x ¯$ ±s）	39.02±1.84	38.83±2.15	t=0.432	0.667
新生儿体重（kg， $x ¯$ ±s）	4.16±0.79	4.26±0.64	t=0.711	0.478
分娩方式［例（%）］			χ²=0.096	0.756
自然分娩	11（39.29）	51（42.50）
剖宫产	17（60.71）	69（57.50）
1 min Apgar评分［例（%）］			χ²=24.497	＜0.001
＞7分	5（17.86）	68（56.67）
4~7分	8（28.57）	36（30.00）
＜4分	15（53.57）	16（13.33）
5 min Apgar评分［例（%）］			χ²=45.921	＜0.001
＞7分	3（10.71）	76（63.33）
4~7分	8（28.57）	34（28.33）
＜4分	17（60.71）	10（8.33）
吸入羊水［例（%）］			χ²=42.113	＜0.001
是	21（75.00）	18（15.00）
否	7（25.00）	102（85.00）
胎膜早破［例（%）］			χ²=32.983	＜0.001
是	17（60.71）	14（11.67）
否	11（39.29）	106（88.33）
产前糖皮质激素治疗［例（%）］			χ²=4.671	0.031
是	12（42.86）	78（65.00）
否	16（57.14）	42（35.00）
母体25（OH）D₃（ng/ml， $x ¯$ ±s）	24.48±8.56	32.70±10.34	t=3.903	＜0.001
新生儿25（OH）D₃（ng/ml， $x ¯$ ±s）	16.29±6.94	23.82±5.15	t=6.494	＜0.001

项目	单因素分析结果			多因素分析结果
项目	β	OR（95%CI）	P值	β	OR（95%CI）	P值
1 min Apgar评分	1.127	3.087（1.146~8.316）	0.026	0.808	2.243（1.795~2.803）	＜0.001
5 min Apgar评分	1.719	5.581（3.379~9.218）	＜0.001	1.298	3.662（2.074~6.466）	＜0.001
吸入羊水	1.466	4.331（2.261~8.296）	＜0.001	1.062	2.893（1.325~6.317）	0.008
胎膜早破	0.702	2.017（1.308~3.110）	0.001	0.811	2.251（0.871~5.817）	0.094
产前糖皮质激素治疗	0.284	1.328（0.622~2.835）	0.464	0.359	1.432（0.810~2.532）	0.217
新生儿25（OH）D₃	-0.660	0.517（0.428~0.625）	＜0.001	-0.728	0.483（0.271~0.861）	0.014
母体25（OH）D₃	-0.456	0.634（0.508~0.791）	＜0.001	-0.691	0.501（0.282~0.890）	0.018
常数	0.733	2.081（1.337~3.239）	0.001	0.119	1.126（1.074~1.181）	＜0.001

项目	曲线下面积	SE	P值	95%CI	敏感度（%）	特异度（%）	截断值（ng/ml）
新生儿25（OH）D₃	0.741	0.049	＜0.001	0.644~0.837	86.7	54.6	20.78
母体25（OH）D₃	0.648	0.065	0.036	0.500~0.755	89.2	357	27.06

项目	赋值
1 min Apgar评分（X₁）	Apgar评分＜4分=2，Apgar评分4~7分=1，Apgar评分＞7分=0
5 min Apgar评分（X₂）	Apgar评分＜4分=2，Apgar评分4~7分=1，Apgar评分＞7分=0
吸入羊水（X₃）	有=1，无=0
新生儿25（OH）D₃（X₄）	新生儿25（OH）D₃＜20.78 ng/ml=1，新生儿25（OH）D₃≥20.78 ng/ml=0
母体25（OH）D₃（X₅）	母体25（OH）D₃＜27.06 ng/ml=1，母体25（OH）D₃≥27.06 ng/ml=0

References 20

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