Abstract：
This study explores the possible pathogenesis of recurrent spontaneous abortion (RSA) caused by vitamin D (VD), provides evidence-based bases for prevention and treatment of RSA, improves female reproductive health.
This study randomly selected 305 patients without spontaneous abortion (SA0), 216 patients with a spontaneous abortion (SA1) and 200 patients with RSA from 1421 women of childbearing age who visited the RSA specialty clinic of Hangzhou First People\'s Hospital from January 2021 to June 2023 to conduct a prospective clinical study. Then, we collected the data of clinical diagnosis and treatment, conducted intervention and follow-up, and finally executed statistical analysis.
(1) RSA patients were significantly older than the other two groups. (2) The rates of VD deficiency in SA1 and RSA patients were significantly higher than those in SA0. (3) When BMI < 20 or > 24 kg/m2 , there were abnormal increase in VD and increased number of spontaneous abortions. (4) The bilateral S/D of the VD-sufficient, VD-insufficient and VD-deficient groups gradually increased with statistical significance (p ≤ .018). (5) Among the 65 cases undergoing embryo chromosome examinations, chromosomal abnormalities accounted for 55.38% and 69.05% in RSA patients. (6) Among 186 patients with abnormal ACA, there was a certain negative correlation between ACA and VD, which was stronger among RSA patients. Moreover, ACA significantly decreased (p < .001) after effectively supplementing VD, and the miscarriage rate of re-pregnancy also decreased.
The rate of VD deficiency is higher in RSA patients. VD deficiency may be related to the age of women of childbearing age and too low or high BMI, and may cause abnormal plasma antiphospholipid antibodies, increased uterine artery resistance and abnormal chromosomal division during fertilization, leading to spontaneous abortion and even RSA. The improvement of VD deficiency may reduce the risk of RSA occurrence.
This study randomly selected 305 patients without spontaneous abortion (SA0), 216 patients with a spontaneous abortion (SA1) and 200 patients with RSA from 1421 women of childbearing age who visited the RSA specialty clinic of Hangzhou First People\'s Hospital from January 2021 to June 2023 to conduct a prospective clinical study. Then, we collected the data of clinical diagnosis and treatment, conducted intervention and follow-up, and finally executed statistical analysis.
(1) RSA patients were significantly older than the other two groups. (2) The rates of VD deficiency in SA1 and RSA patients were significantly higher than those in SA0. (3) When BMI < 20 or > 24 kg/m2 , there were abnormal increase in VD and increased number of spontaneous abortions. (4) The bilateral S/D of the VD-sufficient, VD-insufficient and VD-deficient groups gradually increased with statistical significance (p ≤ .018). (5) Among the 65 cases undergoing embryo chromosome examinations, chromosomal abnormalities accounted for 55.38% and 69.05% in RSA patients. (6) Among 186 patients with abnormal ACA, there was a certain negative correlation between ACA and VD, which was stronger among RSA patients. Moreover, ACA significantly decreased (p < .001) after effectively supplementing VD, and the miscarriage rate of re-pregnancy also decreased.
The rate of VD deficiency is higher in RSA patients. VD deficiency may be related to the age of women of childbearing age and too low or high BMI, and may cause abnormal plasma antiphospholipid antibodies, increased uterine artery resistance and abnormal chromosomal division during fertilization, leading to spontaneous abortion and even RSA. The improvement of VD deficiency may reduce the risk of RSA occurrence.
摘要：
目的:本研究探讨维生素D(VD)致复发性自然流产(RSA)的可能发病机制,为RSA的预防和治疗提供循证依据，改善女性生殖健康。
方法：本研究随机选取305例无自然流产(SA0)患者,2021年1月至2023年6月,在杭州市第一人民医院RSA专科门诊就诊的1421名育龄妇女中,216例自然流产(SA1)患者和200例RSA患者进行前瞻性临床研究。然后，我们收集了临床诊断和治疗的数据，进行干预和随访，最后进行统计分析。
结果：（1）RSA患者的年龄明显大于其他两组。（2）SA1和RSA患者的VD缺乏率明显高于SA0。（3）当BMI<20或>24kg/m2时，VD异常增加,自然流产数量增加.(4)VD的双边S/D充足，VD不足组和VD缺乏组逐渐增加，有统计学意义（p≤0.018）。(5)65例进行胚胎染色体检查,染色体异常占RSA患者的55.38%和69.05%。(6)186例ACA异常患者中,ACA和VD之间存在一定的负相关,在RSA患者中更强。此外，有效补充VD后，ACA显着降低（p<.001），再次妊娠的流产率也有所下降。
结论：RSA患者的VD缺乏率较高。VD缺乏可能与育龄妇女年龄、BMI过低或过高有关,并可能导致血浆抗磷脂抗体异常，受精过程中子宫动脉阻力增加和染色体分裂异常，导致自然流产甚至RSA。改善VD缺陷可能降低RSA发生的风险。
方法：本研究随机选取305例无自然流产(SA0)患者,2021年1月至2023年6月,在杭州市第一人民医院RSA专科门诊就诊的1421名育龄妇女中,216例自然流产(SA1)患者和200例RSA患者进行前瞻性临床研究。然后，我们收集了临床诊断和治疗的数据，进行干预和随访，最后进行统计分析。
结果：（1）RSA患者的年龄明显大于其他两组。（2）SA1和RSA患者的VD缺乏率明显高于SA0。（3）当BMI<20或>24kg/m2时，VD异常增加,自然流产数量增加.(4)VD的双边S/D充足，VD不足组和VD缺乏组逐渐增加，有统计学意义（p≤0.018）。(5)65例进行胚胎染色体检查,染色体异常占RSA患者的55.38%和69.05%。(6)186例ACA异常患者中,ACA和VD之间存在一定的负相关,在RSA患者中更强。此外，有效补充VD后，ACA显着降低（p<.001），再次妊娠的流产率也有所下降。
结论：RSA患者的VD缺乏率较高。VD缺乏可能与育龄妇女年龄、BMI过低或过高有关,并可能导致血浆抗磷脂抗体异常，受精过程中子宫动脉阻力增加和染色体分裂异常，导致自然流产甚至RSA。改善VD缺陷可能降低RSA发生的风险。
