维生素D缺乏与围生期抑郁症的相关性

doi:10.12280/gjfckx.20220463

摘要/Abstract

摘要：

维生素D（Vitamin D,VD）作为孕产期所必需的营养素之一,其不仅与骨代谢有关,而且具有影响脑内神经免疫调节、神经营养因子和神经传递在内的多重神经活性。近年研究发现,VD对抑郁症的发生有不同程度的影响。而产前和产后抑郁症作为抑郁症的分支,其与VD的关系也备受关注。VD缺乏不仅可能导致复发性流产、妊娠期糖尿病和子痫前期等,还与妊娠期和产后的抑郁症状有关。有文献报道VD缺乏可能是围生期抑郁症的重要危险因素之一。围生期合理补充VD对抑郁症有一定的防治作用,但对于VD补充的时机和剂量还需要更多的研究证实。结合近年发表的国内外文献,探讨VD缺乏与围生期抑郁症之间的相关性,以期为疾病的早期预防、早期诊断和及时治疗提供理论依据,并为后期的研究提供新思路。

关键词: 维生素D, 抑郁症, 抑郁症,产后, 妊娠, 治疗

Abstract:

Vitamin D (VD) is one of the essential nutrients in pregnancy and perinatal period. It is not only related to bone metabolism, but also has multiple neural activities affecting neuroimmune regulation, neurotrophic factors and neurotransmission in the brain. Recent studies have found that VD has varying degrees of influence on the occurrence of depression. Prenatal and postnatal depression as a branch of depression, their relationship with VD is also being studied. VD deficiency can not only lead to recurrent spontaneous abortion, gestational diabetes and pre-eclampsia, but also be associated with depression symptoms during pregnancy and postpartum. It has been reported that VD deficiency may be one of the important risk factors for perinatal depression. Reasonable perinatal VD supplementation has a certain prevention and treatment effect on depression, but more studies are needed to confirm the timing and dose of VD supplementation. Combined with the domestic and foreign literatures published in recent years, we reviewed the correlation between VD deficiency and perinatal depression in this article, providing theoretical basis for early prevention, early diagnosis and timely treatment of the disease, and providing new ideas for later research.

Key words: Vitamin D, Depressive disorder, Depression, postpartum, Pregnancy, Therapy

吴芳, 刘霞. 维生素D缺乏与围生期抑郁症的相关性[J]. 国际妇产科学杂志, 2022, 49(5): 585-589.

WU Fang, LIU Xia. Correlation between Vitamin D Deficiency and Perinatal Depression[J]. Journal of International Obstetrics and Gynecology, 2022, 49(5): 585-589.

参考文献 37

[1]	中华医学会妇产科学分会产科学组. 围产期抑郁症筛查与诊治专家共识[J]. 中华妇产科杂志, 2021, 56(8):521-527. doi: 10.3760/cma.j.cn112141-20210115-00022. doi: 10.3760/cma.j.cn112141-20210115-00022
[2]	Van Niel MS, Payne JL. Perinatal depression: A review[J]. Cleve Clin J Med, 2020, 87(5):273-277. doi: 10.3949/ccjm.87a.19054. doi: 10.3949/ccjm.87a.19054
[3]	韩艳艳, 李小琳, 贾萌萌, 等. 维生素D水平与产后抑郁相关性的Meta分析[J]. 临床与病理杂志, 2019, 39(6):1289-1296. doi: 10.3978/j.issn.2095-6959.2019.06.023. doi: 10.3978/j.issn.2095-6959.2019.06.023
[4]	Dzik KP, Kaczor JJ. Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state[J]. Eur J Appl Physiol, 2019, 119(4):825-839. doi: 10.1007/s00421-019-04104-x. doi: 10.1007/s00421-019-04104-x pmid: 30830277
[5]	陈丹, 郭玉金, 耿春梅, 等. 维生素D的多重神经活性及其潜在的抗抑郁机制研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2019, 9(1):48-51. doi: 10.3877/cma.j.issn.2095-123X.2019.01.011. doi: 10.3877/cma.j.issn.2095-123X.2019.01.011
[6]	Gáll Z, Székely O. Role of Vitamin D in Cognitive Dysfunction: New Molecular Concepts and Discrepancies between Animal and Human Findings[J]. Nutrients, 2021, 13(11):3672. doi: 10.3390/nu13113672. doi: 10.3390/nu13113672
[7]	Menon V, Kar SK, Suthar N, et al. Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions[J]. Indian J Psychol Med, 2020, 42(1):11-21. doi: 10.4103/IJPSYM.IJPSYM_160_19. doi: 10.4103/IJPSYM.IJPSYM_160_19 pmid: 31997861
[8]	Kraus C, Castren E, Kasper S, et al. Serotonin and neuroplasticity-Links between molecular,functional and structural pathophysiology in depression[J]. Neurosci Biobehav, 2017, 77(6):317-326. doi: 10.1016/j.neubiorev.2017.03.007. doi: 10.1016/j.neubiorev.2017.03.007
[9]	Berridge MJ. Vitamin D and Depression: Cellular and Regulatory Mechanisms[J]. Pharmacol Rev, 2017, 69(2):80-92. doi: 10.1124/pr.116.013227. doi: 10.1124/pr.116.013227 pmid: 28202503
[10]	Geng C, Shaikh AS, Han W, et al. Vitamin D and depression: mechanisms, determination and application[J]. Asia Pac J Clin Nutr, 2019, 28(4):689-694. doi: 10.6133/apjcn.201912_28(4).0003. doi: 10.6133/apjcn.201912_28(4).0003 pmid: 31826364
[11]	Wasserman RH. Vitamin D and the dual processes of intestinal calcium absorption[J]. J Nutr, 2004, 134(11):3137-3139. doi: 10.1093/jn/134.11.3137. doi: 10.1093/jn/134.11.3137 pmid: 15514288
[12]	Benedik E. Sources of vitamin D for humans[J]. Int J Vitam Nutr Res, 2022, 92(2):118-125. doi: 10.1024/0300-9831/a000733. doi: 10.1024/0300-9831/a000733
[13]	Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline[J]. J Clin Endocrinol Metab, 2011, 96(7):1911-1930. doi: 10.1210/jc.2011-0385. doi: 10.1210/jc.2011-0385 pmid: 21646368
[14]	Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem?[J]. J Steroid Biochem Mol Biol, 2014, 144(3):138-145. doi: 10.1016/j.jsbmb.2013.11.003. doi: 10.1016/j.jsbmb.2013.11.003
[15]	Paige V, Jane W, Ewa SG, et al. Associations of Maternal Vitamin D Deficiency with Pregnancy and Neonatal Complications in Developing Countries: A Systematic Review[J]. Nutrients, 2018, 10(5):640. doi: 10.3390/nu10050640. doi: 10.3390/nu10050640
[16]	Accortt EE, Arora C, Mirocha J, et al. Low Prenatal Vitamin D Metabolite Ratio and Subsequent Postpartum Depression Risk[J]. J Womens Health(Larchmt), 2021, 30(1):113-120. doi: 10.1089/jwh.2019.8209. doi: 10.1089/jwh.2019.8209
[17]	敬宏. 二次妊娠孕妇产前抑郁与维生素D缺乏的相关性和对妊娠结局的影响[J]. 中国妇幼保健, 2021, 36(17):3933-3935. doi: 10.19829/j.zgfybj.issn.1001-4411.2021.17.010. doi: 10.19829/j.zgfybj.issn.1001-4411.2021.17.010
[18]	Fariba A, Nicole L, Newsha M, et al. Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review[J]. Nutrients, 2018, 10(4):478-492. Doi: 10.3390/nu10040478. doi: 10.3390/nu10040478
[19]	李响, 吴效科. 维生素D与母体妊娠相关疾病关系的研究进展[J]. 国际妇产科学杂志, 2019, 46(6):632-635. doi: 10.3969/j.issn.1674-1870.2019.06.008. doi: 10.3969/j.issn.1674-1870.2019.06.008
[20]	Brandenbarg J, Vrijkotte TG, Goedhart G, et al. Maternal early-pregnancy vitamin D status is associated with maternal depressive symptoms in the Amsterdam Born Children and Their Development cohort[J]. Psychosom Med, 2012, 74(7):751-757. doi: 10.1097/PSY.0b013e3182639fdb. doi: 10.1097/PSY.0b013e3182639fdb pmid: 22879429
[21]	刘燕婷, 苏卓恒, 刘萍. 维生素D缺乏及抑郁症筛查量表评分与孕期抑郁症的相关性分析[J]. 大医生, 2022, 7(3):72-74.
[22]	陈轶铭, 全宁斌, 吴茵茵. 维生素D水平与孕产妇抑郁关联性的Meta分析[J]. 预防医学, 2021, 33(12):1276-1281. doi: 10.19485/j.cnki.issn2096-5087.2021.12.022. doi: 10.19485/j.cnki.issn2096-5087.2021.12.022
[23]	Wei R, Christakos S. Mechanisms underlying the regulation of Innate and adaptive immunity by vitamin D[J]. Nutrients, 2015, 7(10):8251-8260. doi: 10.3390/nu7105392. doi: 10.3390/nu7105392 pmid: 26404359
[24]	Aghajafari F, Letourneau N, Mahinpey N, et al. Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review[J]. Nutrients, 2018, 10(4):478. doi: 10.3390/nu10040478. doi: 10.3390/nu10040478
[25]	Szpunar MJ. Association of antepartum vitamin D deficiency with postpartum depression: a clinical perspective[J]. Public Health Nutr, 2020, 23(7):1173-1178. doi: 10.1017/S136898001800366X. doi: 10.1017/S136898001800366X pmid: 30657106
[26]	Robinson M, Whitehouse AJ, Newnham JP, et al. Low maternal serum vitamin D during pregnancy and the risk for postpartum depression symptoms[J]. Arch Womens Ment Health, 2014, 17(3):213-219. doi: 10.1007/s00737-014-0422-y. doi: 10.1007/s00737-014-0422-y pmid: 24663685
[27]	Abedi P, Bovayri M, Fakhri A, et al. The Relationship Between Vitamin D and Postpartum Depression in Reproductive-Aged Iranian Women[J]. J Med Life, 2018, 11(4):286-292. doi: 10.25122/jml-2018-0038. doi: 10.25122/jml-2018-0038 pmid: 30894884
[28]	Pillai RR, Premkumar NR, Kattimani S, et al. Reduced Maternal Serum Total, Free and Bioavailable Vitamin D Levels and its Association with the Risk for Postpartum Depressive Symptoms[J]. Arch Med Res, 2021, 52(1):84-92. doi: 10.1016/j.arcmed.2020.10.003. doi: 10.1016/j.arcmed.2020.10.003 pmid: 33067012
[29]	Wang J, Liu N, Sun W, et al. Association between vitamin D deficiency and antepartum and postpartum depression: a systematic review and meta-analysis of longitudinal studies[J]. Arch Gynecol Obstet, 2018, 298(6):1045-1059. doi: 10.1007/s00404-018-4902-6. doi: 10.1007/s00404-018-4902-6 pmid: 30264203
[30]	Gould JF, Anderson AJ, Yelland LN, et al. Association of cord blood vitamin D at delivery with postpartum depression in Australian women[J]. Aust N Z J Obstet Gynaecol, 2015, 55(5):446-452. doi: 10.1111/ajo.12344. doi: 10.1111/ajo.12344 pmid: 26122012
[31]	Strøm M, Halldorsson TI, Hansen S, et al. Vitamin D measured in maternal serum and offspring neurodevelopmental outcomes: a prospective study with long-term follow-up[J]. Ann Nutr Metab, 2014, 64(3/4):254-261. doi: 10.1159/000365030. doi: 10.1159/000365030
[32]	Wilson N, Lee JJ, Bei B. Postpartum fatigue and depression: A systematic review and meta-analysis[J]. J Affect Disord, 2019, 246:224-233. doi: 10.1016/j.jad.2018.12.032. doi: 10.1016/j.jad.2018.12.032
[33]	Opie RS, Uldrich AC, Ball K. Maternal Postpartum Diet and Postpartum Depression: A Systematic Review[J]. Matern Child Health J, 2020, 24(8):966-978. doi: 10.1007/s10995-020-02949-9. doi: 10.1007/s10995-020-02949-9
[34]	Vaziri F, Nasiri S, Tavana Z, et al. A randomized controlled trial of vitamin D supplementation on perinatal depression: in Iranian pregnant mothers[J]. BMC Pregnancy Childbirth, 2016, 16:239. doi: 10.1186/s12884-016-1024-7. doi: 10.1186/s12884-016-1024-7
[35]	Fu CW, Liu JT, Tu WJ, et al. Association between serum 25-hydroxyvitamin D levels measured 24 hours after delivery and postpartum depression[J]. BJOG, 2015, 122(12):1688-1694. doi: 10.1111/1471-0528.13111. doi: 10.1111/1471-0528.13111
[36]	Murphy PK, Mueller M, Hulsey TC, et al. An exploratory study of postpartum depression and vitamin d[J]. J Am Psychiatr Nurses Assoc, 2010, 16(3):170-177. doi: 10.1177/1078390310370476. doi: 10.1177/1078390310370476 pmid: 21659271
[37]	Amini S, Amani R, Jafarirad S, et al. The effect of vitamin D and calcium supplementation on inflammatory biomarkers, estradiol levels and severity of symptoms in women with postpartum depression: a randomized double-blind clinical trial[J]. Nutr Neurosci, 2022, 25(1):22-32. doi: 10.1080/1028415X.2019.1707396. doi: 10.1080/1028415X.2019.1707396