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Article(id=1322165014170026745, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322164984558243894, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.01.005, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1738684800000, receivedDateStr=2025-02-05, revisedDate=1763568000000, revisedDateStr=2025-11-20, acceptedDate=null, acceptedDateStr=null, onlineDate=1793158304015, onlineDateStr=2026-10-28, pubDate=1767974400000, pubDateStr=2026-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793158304015, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793158304015, creator=13701087609, updateTime=1793158304015, updator=13701087609, issue=Issue{id=1322164984558243894, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='1', pageStart='1', pageEnd='176', issueExtLink='null', onlineDate='null', pubDate='1767974400000', pubDateStr='2026-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793158296955, creator='13701087609', updateTime=1793158296955, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=35, endPage=45, ext={EN=ArticleExt(id=1322165014413296378, articleId=1322165014170026745, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Causal relation of 11 trace elements, 22 dietary factors with hyperemesis gravidarum based on Mendelian randomization analysis, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the causal relationship between 11 trace elements(calcium,iron,zinc,selenium,magnesium,copper,vitamin A,vitamin C,vitamin D,vitamin E,carotene),22 common dietary factors(alcohol consumption,beef,bread,cereal,cheese,coffee,cooked vegetable,dried fruit,fresh fruit,lamb,non-oily fish,oily fish,pork,poultry,processed meat,raw vegetable,salt added to food,tea,hot drinks,carbonated beverage,garlic intake,Chinese chive) and hyperemesis gravidarum using Mendelian randomization.

Methods

All data were summarized by using Genome-Wide Association Studies(GWAS),with single nucleotide polymorphisms(SNPs) as instrumental variables.Analyses were performed using inverse variance weighting,weighted mode,MR Egger,and weighted median.Cochrane's Q test was used to identify heterogeneity of results.MR Egger intercept test and "leave-one-out" test were applied to evaluate the robustness of the associations between the 11 trace elements,22 dietary factors and hyperemesis gravidarum.

Results

The results showed that vitamin D supplementation could reduce the risk of hyperemesis gravidarum[OR=0.48,95%CI(0.30,0.75)].No significant effects of the other 10 trace elements or 22 dietary factors on the risk of hyperemesis gravidarum were observed(P>0.05).There was no horizontal pleiotropy or heterogeneity(P>0.05),indicating the robustness of the results.

Conclusions

Vitamin D could reduce the risk of hyperemesis gravidarum.No effects of the other 10 trace elements or 22 dietary factors on increasing or decreasing the risk of hyperemesis gravidarum were found temporarily.

, authors=Xiaochuan RUAN1, Mi'na DENG2, Yunyao RUAN2, authorsList=Xiaochuan RUAN, Mi'na DENG, Yunyao RUAN, authorCompany=null, correspAuthors=Yunyao RUAN, authorNote=null, correspAuthorsNote=
RUAN Yunyao, E-mail:
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目的

采用孟德尔随机化方法研究钙、铁、锌、硒、镁、铜、维生素A、维生素C、维生素D、维生素E、胡萝卜素11种微量元素以及饮酒、牛肉摄入量、面包摄入量、谷物摄入量、奶酪摄入量、咖啡摄入量、熟蔬菜摄入量、干果摄入量、新鲜水果摄入量、羊肉摄入量、非油性鱼类摄入量、油性鱼类摄入量、猪肉摄入量、家禽摄入量、加工肉类摄入量、生蔬菜摄入量、添加到食物中的盐、茶摄入量、热饮、碳酸饮料摄入量、大蒜摄入量、韭菜摄入量22种常见饮食食物与妊娠剧吐的因果关系。

方法

利用全基因组关联研究汇总数据（Genome-Wide Association Studies，GWAS），以单核苷酸多态性作为工具变量，利用逆方差加权、加权模式、MR Egger、加权中位数的方法进行分析。采用Cochrane's Q检验识别结果的异质性，MR Egger截距检验及“留一法”检验等方法评估11种微量元素以及22种饮食和妊娠剧吐关联的稳健性。

结果

补充维生素D可以降低妊娠剧吐发病风险［OR=0.48，95%CI（0.30，0.75）］，未发现其余10种微量元素以及22种食物对妊娠剧吐发病风险的影响（P>0.05）；且不存在水平多效性和异质性（P>0.05），提示结果稳健性。

结论

维生素D可以降低妊娠剧吐发病风险，暂未发现其余10种微量元素以及22种饮食对降低或增加妊娠剧吐风险的影响。

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阮晓川，主管护师，本科

, correspAuthorsNote=
阮云瑶，E-mail:
RUAN Yunyao, E-mail:
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（A为铜；B为维生素C；C为钙；D为锌；E为维生素E；F为铁；G为胡萝卜素；H为硒；I为镁；J为维生素A；K为维生素D）

, figureFileSmall=o5pYaBnup298Im7m72/h+w==, figureFileBig=RkbX9rbu97RxHdwIuA6nHQ==, tableContent=null), ArticleFig(id=1322529716104442822, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322165014170026745, language=EN, label=Figure 3, caption=MR analysis results of 22 dietary factors and hyperemesis gravidarum, figureFileSmall=V+MNDWTLDULfoXju9bU43Q==, figureFileBig=tiDRa/UCOW+rMwF4IptkcA==, tableContent=null), ArticleFig(id=1322529716184134599, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322165014170026745, language=CN, label=图3, caption=22种饮食与妊娠剧吐的MR分析结果, figureFileSmall=V+MNDWTLDULfoXju9bU43Q==, figureFileBig=tiDRa/UCOW+rMwF4IptkcA==, tableContent=null), ArticleFig(id=1322529716242854856, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322165014170026745, language=EN, label=Figure 4, caption=Scatter plots of MR analysis for 22 dietary factors and hyperemesis gravidarum, figureFileSmall=ORKvQbxHE0FVIv5WdC/6Lw==, figureFileBig=CXoPcJmbQkW5lN/ioWChRw==, tableContent=null), ArticleFig(id=1322529716318352329, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322165014170026745, language=CN, label=图4, caption=22种饮食与妊娠剧吐MR分析散点图

（A为羊肉摄入量；B为奶酪摄入量；C为生蔬菜摄入量；D为油性鱼类摄入量；E为韭菜摄入量；F为碳酸饮料摄入量；G为牛肉摄入量；H为新鲜水果摄入量；I为咖啡摄入量；J为猪肉摄入量；K为饮酒；L为茶摄入量；M为加工肉类摄入量；N为家禽摄入量；O为熟蔬菜摄入量；P为添加到食物中的盐；Q为面包摄入量；R为热饮；S为谷物摄入量；T为干果摄入量；U为大蒜摄入量；V为非油性鱼类摄入量）

, figureFileSmall=ORKvQbxHE0FVIv5WdC/6Lw==, figureFileBig=CXoPcJmbQkW5lN/ioWChRw==, tableContent=null), ArticleFig(id=1322529716377072586, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322165014170026745, language=EN, label=Table 1, caption=

Information of GWAS data

, figureFileSmall=null, figureFileBig=null, tableContent=
表型数据来源样本量（人）SNP数量（个）表型数据来源样本量（人）SNP数量（个）
钙UKB336 31410 894 596羊肉摄入量UKB64 9429 851 867
铁UKB461 3849 851 867非油性鱼类摄入量UKB460 8809 851 867
锌UKB64 9499 851 867油性鱼类摄入量UKB460 4439 851 867
硒UKB461 3849 851 867猪肉摄入量UKB460 1629 851 867
镁UKB64 9499 851 867家禽摄入量UKB460 1629 851 867
铜PubMed2 6032 543 646加工肉类摄入量UKB461 9819 851 867
维生素AUKB460 3519 851 867生蔬菜摄入量UKB435 4359 851 867
维生素CUKB335 59110 894 596添加到食物中的盐UKB462 6309 851 867
维生素DIEU441 29116 668 957茶摄入量UKB447 4859 851 867
维生素EUKB460 3519 851 867热饮UKB457 8739 851 867
胡萝卜素UKB64 9799 851 867碳酸饮料摄入量UKB64 9499 851 867
饮酒UKB462 3469 851 867大蒜摄入量UKB64 9499 851 867
牛肉摄入量UKB461 0539 851 867韭菜摄入量UKB64 9499 851 867
面包摄入量UKB452 2369 851 867咖啡摄入量UKB428 8609 851 867
谷物摄入量UKB441 6409 851 867熟蔬菜摄入量UKB448 6519 851 867
奶酪摄入量UKB451 4869 851 867新鲜水果摄入量UKB446 4629 851 867
干果摄入量UKB421 7649 851 867妊娠剧吐芬兰数据库111 47816 379 549
), ArticleFig(id=1322529716448375755, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322165014170026745, language=CN, label=表1, caption=

GWAS数据信息

, figureFileSmall=null, figureFileBig=null, tableContent=
表型数据来源样本量（人）SNP数量（个）表型数据来源样本量（人）SNP数量（个）
钙UKB336 31410 894 596羊肉摄入量UKB64 9429 851 867
铁UKB461 3849 851 867非油性鱼类摄入量UKB460 8809 851 867
锌UKB64 9499 851 867油性鱼类摄入量UKB460 4439 851 867
硒UKB461 3849 851 867猪肉摄入量UKB460 1629 851 867
镁UKB64 9499 851 867家禽摄入量UKB460 1629 851 867
铜PubMed2 6032 543 646加工肉类摄入量UKB461 9819 851 867
维生素AUKB460 3519 851 867生蔬菜摄入量UKB435 4359 851 867
维生素CUKB335 59110 894 596添加到食物中的盐UKB462 6309 851 867
维生素DIEU441 29116 668 957茶摄入量UKB447 4859 851 867
维生素EUKB460 3519 851 867热饮UKB457 8739 851 867
胡萝卜素UKB64 9799 851 867碳酸饮料摄入量UKB64 9499 851 867
饮酒UKB462 3469 851 867大蒜摄入量UKB64 9499 851 867
牛肉摄入量UKB461 0539 851 867韭菜摄入量UKB64 9499 851 867
面包摄入量UKB452 2369 851 867咖啡摄入量UKB428 8609 851 867
谷物摄入量UKB441 6409 851 867熟蔬菜摄入量UKB448 6519 851 867
奶酪摄入量UKB451 4869 851 867新鲜水果摄入量UKB446 4629 851 867
干果摄入量UKB421 7649 851 867妊娠剧吐芬兰数据库111 47816 379 549
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基于孟德尔随机化分析11种微量元素和22种饮食与妊娠剧吐的因果关系
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阮晓川 1 , 邓米娜 2 , 阮云瑶 2, *, *
护理研究 | 科研论著 2026,40(1): 35-45
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护理研究 |科研论著 2026 , 40 (1) : 35 -45
基于孟德尔随机化分析11种微量元素和22种饮食与妊娠剧吐的因果关系
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阮晓川，主管护师，本科

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阮晓川1, 邓米娜2, 阮云瑶2, *, *
作者信息
  • 1深圳市宝安区松岗人民医院，广东 518100
  • 2深圳市中西医结合医院
通讯作者:
阮云瑶，E-mail:
RUAN Yunyao, E-mail:
作者简介:

阮晓川，主管护师，本科

Causal relation of 11 trace elements, 22 dietary factors with hyperemesis gravidarum based on Mendelian randomization analysis
Xiaochuan RUAN1, Mi'na DENG2, Yunyao RUAN2
Affiliations
  • 1Songgang People's Hospital of Bao'an District, Shenzhen, Guangdong 518100 China
  • 2Shenzhen Integrated Traditional Chinese and Western Medicine Hospital
    • Corresponding Author:
    RUAN Yunyao, E-mail:
出版时间: 2026-01-10 doi: 10.12102/j.issn.1009-6493.2026.01.005
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摘要
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目的

采用孟德尔随机化方法研究钙、铁、锌、硒、镁、铜、维生素A、维生素C、维生素D、维生素E、胡萝卜素11种微量元素以及饮酒、牛肉摄入量、面包摄入量、谷物摄入量、奶酪摄入量、咖啡摄入量、熟蔬菜摄入量、干果摄入量、新鲜水果摄入量、羊肉摄入量、非油性鱼类摄入量、油性鱼类摄入量、猪肉摄入量、家禽摄入量、加工肉类摄入量、生蔬菜摄入量、添加到食物中的盐、茶摄入量、热饮、碳酸饮料摄入量、大蒜摄入量、韭菜摄入量22种常见饮食食物与妊娠剧吐的因果关系。

方法

利用全基因组关联研究汇总数据（Genome-Wide Association Studies，GWAS），以单核苷酸多态性作为工具变量，利用逆方差加权、加权模式、MR Egger、加权中位数的方法进行分析。采用Cochrane's Q检验识别结果的异质性，MR Egger截距检验及“留一法”检验等方法评估11种微量元素以及22种饮食和妊娠剧吐关联的稳健性。

结果

补充维生素D可以降低妊娠剧吐发病风险［OR=0.48，95%CI（0.30，0.75）］，未发现其余10种微量元素以及22种食物对妊娠剧吐发病风险的影响（P>0.05）；且不存在水平多效性和异质性（P>0.05），提示结果稳健性。

结论

维生素D可以降低妊娠剧吐发病风险，暂未发现其余10种微量元素以及22种饮食对降低或增加妊娠剧吐风险的影响。

微量元素  /  饮食  /  妊娠  /  妊娠剧吐  /  孟德尔随机化  /  因果推断
Objective

To investigate the causal relationship between 11 trace elements(calcium,iron,zinc,selenium,magnesium,copper,vitamin A,vitamin C,vitamin D,vitamin E,carotene),22 common dietary factors(alcohol consumption,beef,bread,cereal,cheese,coffee,cooked vegetable,dried fruit,fresh fruit,lamb,non-oily fish,oily fish,pork,poultry,processed meat,raw vegetable,salt added to food,tea,hot drinks,carbonated beverage,garlic intake,Chinese chive) and hyperemesis gravidarum using Mendelian randomization.

Methods

All data were summarized by using Genome-Wide Association Studies(GWAS),with single nucleotide polymorphisms(SNPs) as instrumental variables.Analyses were performed using inverse variance weighting,weighted mode,MR Egger,and weighted median.Cochrane's Q test was used to identify heterogeneity of results.MR Egger intercept test and "leave-one-out" test were applied to evaluate the robustness of the associations between the 11 trace elements,22 dietary factors and hyperemesis gravidarum.

Results

The results showed that vitamin D supplementation could reduce the risk of hyperemesis gravidarum[OR=0.48,95%CI(0.30,0.75)].No significant effects of the other 10 trace elements or 22 dietary factors on the risk of hyperemesis gravidarum were observed(P>0.05).There was no horizontal pleiotropy or heterogeneity(P>0.05),indicating the robustness of the results.

Conclusions

Vitamin D could reduce the risk of hyperemesis gravidarum.No effects of the other 10 trace elements or 22 dietary factors on increasing or decreasing the risk of hyperemesis gravidarum were found temporarily.

trace elements  /  diet  /  pregnancy  /  hyperemesis gravidarum  /  Mendelian randomization  /  causal inference
阮晓川, 邓米娜, 阮云瑶. 基于孟德尔随机化分析11种微量元素和22种饮食与妊娠剧吐的因果关系. 护理研究, 2026 , 40 (1) : 35 -45 . DOI: 10.12102/j.issn.1009-6493.2026.01.005
Xiaochuan RUAN, Mi'na DENG, Yunyao RUAN. Causal relation of 11 trace elements, 22 dietary factors with hyperemesis gravidarum based on Mendelian randomization analysis[J]. Chinese Nursing Research, 2026 , 40 (1) : 35 -45 . DOI: 10.12102/j.issn.1009-6493.2026.01.005
正文
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妊娠剧吐（hyperemesis gravidarum，HG）是一种妊娠代谢紊乱，表现为严重的恶心和呕吐，其定义为脱水、尿酮体增高和体重减轻5%以上[1]。据统计，0.3%~3.6%的孕妇会发生妊娠剧吐[2]。我国妊娠女性此病的患病率更高，在一项针对我国人群的研究中，患病率高达约10%[3]。临床上，妊娠剧吐是妊娠前20周住院最常见的指征[4]。虽然它通常发生在妊娠第4周~第9周，并在妊娠中期消退，但15%~20%的妇女直到妊娠晚期仍有症状，5%的妇女在分娩时仍有症状[5]。严重的妊娠剧吐会导致维生素B1缺乏出现Wernicke脑病而导致死亡或残疾[6]。因此，关注与妊娠剧吐相关的维生素和微量元素调控及饮食摄入至关重要。
既往研究报道，在怀孕早期或怀孕前服用多种维生素和微量元素可以降低妊娠期恶心、呕吐症状[7]。如维生素B6已被广泛用于控制怀孕期间的恶心和呕吐[8]。但是，对于钙、铁、锌、硒、镁、铜、维生素A、维生素C、维生素D、维生素E、胡萝卜素对妊娠剧吐研究甚少，且缺乏孕期饮食是否会增加妊娠剧吐的风险的相关研究。由于妊娠涉及一系列伦理问题，大规模临床随机对照试验研究受限。在无法进行大规模的随机对照试验的情况下，孟德尔随机化（MR）设计是一种重要的因果推理策略。MR使用遗传变异作为暴露的工具变量来预测其与结局的因果关系，该方法巧妙地利用了遗传变异的分布随机性，同时成功地避免了混杂偏差[9]。因此，本研究使用MR的方法，利用来自全基因组关联研究汇总数据（GWAS），分析11种微量元素和22种饮食与妊娠剧吐的相关性，旨在阐明11种微量元素和22种饮食是否降低或增加妊娠剧吐的风险，为妊娠剧吐的临床护理和治疗提供科学的依据。
1　对象与方法
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1.1　研究设计
选择与11种微量元素（钙、铁、锌、硒、镁、铜、维生素A、维生素C、维生素D、维生素E、胡萝卜素）和22种饮食模式（饮酒、牛肉摄入量、面包摄入量、谷物摄入量、奶酪摄入量、咖啡摄入量、熟蔬菜摄入量、干果摄入量、新鲜水果摄入量、羊肉摄入量、非油性鱼类摄入量、油性鱼类摄入量、猪肉摄入量、家禽摄入量、加工肉类摄入量、生蔬菜摄入量、添加到食物中的盐、茶摄入量、热饮、碳酸饮料摄入量、大蒜摄入量、韭菜摄入量）强相关的单核苷酸多态性(single nucleotide polymorphism，SNP)作为工具变量。MR设计基于3个核心假设：1）11种微量元素和22种饮食模式与工具变量具有很强的关联性；2）混杂因素不应与遗传变异有关；3）选定的工具变量仅通过11种微量元素或22种饮食模式影响妊娠剧吐。
1.2　数据来源
数据主要来源于UKB、IEU、PubMed和芬兰数据库，样本量为2 603~462 630人，SNP数量至少是2 543 646个，人群主要为欧洲人群。具体见表1。
1.3　工具变量的选择
为了避免选择假阳性工具，本研究设定了显著性阈值P<1×10-5作为主要筛选标准，以筛选出独立的SNP，并排除了处于连锁不平衡（r²=0.001，kb=10 000）的SNP[9]。此外，为了防止选取弱阳性的工具变量，本研究计算了工具变量的F值[10]，并选择F值>10的SNP[11]，以确保结果的可靠性。
1.4　统计学分析
本研究采用R4.2.2软件及其R包TwoSample MR进行MR分析。在对11种微量元素和22种饮食模式和妊娠剧吐数据进行GWAS效应等位基因的匹配后，采用逆方差加权（inverse variance weighted，IVW）分析作为主要的MR方法。通过Phenoscanner网站（http：//www.phenoscanner.medschl.cam.ac.uk/）查找与妊娠剧吐相关的混杂SNP。
1.5　敏感性分析
MR-Egger回归的截距用于评估SNP的水平多效性。当P>0.05时，说明MR分析中不存在显著的多效性[12]，结果被认为是稳健的。同时，采用Cochrane's Q检验判断SNP是否存在异质性[13]。通过留一法进行敏感性分析，以评估该变异是否驱动了11种微量元素和22种饮食模式与妊娠剧吐之间的关联。
2　结果
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2.1　11种微量元素与妊娠剧吐的关系
初始有488个SNP达到了全基因组显著性水平的阈值（P<e-5），与妊娠剧吐的GWAS匹配后，剩余345个SNP。通过使用Phenoscanner网站，未发现混杂因素。最终选定345个SNP用于评估11种微量元素与妊娠剧吐风险之间的关系。F值为19.97~96.69，表明工具变量的强度较高。本研究主要采用IVW方法对11种微量元素与妊娠剧吐进行MR分析。研究结果显示，补充维生素D可以降低妊娠剧吐的发病风险[OR=0.48，95%CI(0.30，0.75)，P=0.001]，暂未发现补充微量钙、铁、锌、硒、镁、铜、维生素A、维生素C、维生素E、胡萝卜素会增加或者降低妊娠剧吐发病风险（P>0.05）。具体见图1。采用Cochran's IVW检验评估异质性，Cochran's IVW检验P值>0.05，未发现异质性。采用MR-Egger回归截距法评估水平多效性，MR-Egger回归截距P>0.05，未发现水平多效性。IVW、MR Egger、加权模式（weighted mode）、加权中位数（weighted median）4种方法散点图见图2。留一敏感性分析显示，剔除任意1个SNP对结果没有显著影响，漏斗图基本对称。
2.2　22种饮食模式与妊娠剧吐的关系
初始有3 512个SNP达到了全基因组显著性水平的阈值（P<1e-5），与妊娠剧吐的GWAS匹配后，剩余3 248个SNP。通过使用Phenoscanner网站，未发现混杂因素。最终选定3 248个SNP用于评估22种饮食模式与妊娠剧吐风险之间的关系。所有F值为19.53~811.86，表明工具变量的强度较高。本研究主要采用IVW方法对22种饮食模式与妊娠剧吐进行MR分析。研究结果见图3。暂未发现饮酒、牛肉摄入量、面包摄入量、谷物摄入量、奶酪摄入量、咖啡摄入量、熟蔬菜摄入量、干果摄入量、新鲜水果摄入量、羊肉摄入量、非油性鱼类摄入量、油性鱼类摄入量、猪肉摄入量、家禽摄入量、加工肉类摄入量、生蔬菜摄入量、添加到食物中的盐、茶摄入量、热饮、碳酸饮料摄入量、大蒜摄入量、韭菜摄入量能降低或增加妊娠剧吐的风险（P>0.05）。采用Cochran's IVW检验评估异质性，Cochran's IVW检验P>0.05，未发现异质性。采用MR-Egger回归截距法评估水平多效性，MR-Egger回归截距P>0.05，未发现水平多效性。IVW、MR Egger、加权模式、加权中位数4种方法散点图见图4。留一法敏感性分析显示，剔除任意1个SNP对结果没有显著影响，漏斗图基本对称。
3　讨论
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本研究采用MR方法探讨11种微量元素和22种饮食与妊娠剧吐的因果关系，结果显示，维生素D可降低妊娠剧吐的风险，但暂未发现其他10种微量元素（钙、铁、锌、硒、镁、铜、维生素A、维生素C、维生素E、胡萝卜素）和22种饮食食物（饮酒、牛肉摄入量、面包摄入量、谷物摄入量、奶酪摄入量、咖啡摄入量、熟蔬菜摄入量、干果摄入量、新鲜水果摄入量、羊肉摄入量、非油性鱼类摄入量、油性鱼类摄入量、猪肉摄入量、家禽摄入量、加工肉类摄入量、生蔬菜摄入量、添加到食物中的盐、茶摄入量、热饮、碳酸饮料摄入量、大蒜摄入量、韭菜摄入量）能降低或者增加妊娠剧吐的风险。但是孕期并不能饮酒或喝任何含有乙醇的饮料，怀孕期间酗酒与子女较低的学业成绩和行为障碍有关，而在整个怀孕期间持续饮酒会导致胎儿酒精综合征[14]。对于其他食物，目前尚未检索到有关于妊娠期间的报道。
本研究发现，维生素D可以降低妊娠剧吐的风险。既往研究发现，怀孕和泌乳期间特别重要的关键营养素包括钙和维生素D[15]。维生素D缺乏症在妊娠早期的女性中很常见[16]。怀孕期间维生素D缺乏与围生期不良结局有关[17]。孕妇应在妊娠中期测量维生素D水平，并推荐补充维生素D[18]。决定胎儿和新生儿维生素D水平的最强因素是孕期母体维生素D水平[19]。15.2%的新生儿在出生时表现出严重的维生素D缺乏症，而52.2%的新生儿则存在维生素D缺乏症[20]。怀孕期间预防维生素D缺乏对于中断维生素D缺乏对儿童呼吸系统疾病的影响具有重要意义[21]。这些证据都表明，孕期补充维生素D的重要性。此外，已有研究支持维生素D作为妊娠剧吐保护因素的作用[22]，进一步印证了本研究的发现。
有研究在我国10个城市的303名孕早期孕妇中展开，通过24 h饮食回忆法和半定量食物频率问卷（SFFQ）收集了她们的膳食营养和食物摄入数据，研究发现，255名（84.1%）孕妇在妊娠前3个月经历了妊娠期恶心呕吐（NVP）。与未经历NVP的孕妇相比，患有NVP的女性能量、蛋白质、脂肪、维生素A、硫胺素、核黄素、维生素E、磷、钾、铁和锌的摄入量较低，且更有可能出现蛋白质、核黄素、钙、磷和硒摄入不足的情况[23]。然而，本研究并未发现维生素A、维生素E、铁、锌、钙、硒等微量元素以及牛肉等食物摄入与妊娠剧吐之间存在显著关联，这与上述研究结论不一致，推测这种差异可能与GWAS数据均来自欧洲人群有关。首先，欧洲人群中妊娠剧吐的患病率低于我国；其次，由于饮食结构的差异，营养物质的摄入模式也存在显著差异。因此，未来可能需要更多基于亚洲人群的研究数据，以进一步探讨这些微量元素的摄入是否会影响妊娠剧吐的发生。
尽管常规补充钙、铁、锌、硒、镁、铜、维生素A、维生素C、维生素E及胡萝卜素与妊娠剧吐的缓解或加剧之间未显现出显著的因果关系，但这些营养素对孕妇的健康仍扮演着关键角色。然而，过量摄入这些营养素可能引发呕吐等症状。鉴于我国孕妇维生素E的摄入现状，孕期应谨慎对待维生素E的过量摄入，因为孕期维生素E浓度过高不仅可能导致呕吐，还可能增加流产风险并干扰胎儿正常发育[24]。孕期对多种维生素和微量元素的需求增加，母体营养状况在很大程度上依赖于孕前微量营养素的储备，尤其是铁和钙的储存[25]。世界卫生组织建议孕期应补充铁、叶酸、维生素A、钙和碘[26]。全球范围内，约20%的孕妇在孕期经历缺铁性贫血[27]。孕期铁的需求量显著增加，缺铁与早产、低出生体重及婴儿期缺铁有关[28]。此外，证据表明怀孕期间摄入足够的钙可降低妊娠期高血压的风险[29]。充足的锌摄入对胎儿生长及锌储存至关重要[30]。孕期抗坏血酸水平的变化及哺乳可能导致母体维生素C的大量流失[31]。早孕期间硒、铜水平较低与妊娠相关高血压的发展密切相关，包括单纯性妊娠高血压[32-33]。维生素C治疗缺氧妊娠有助于预防成年后代的高血压[34]。
4　小结
收起
本研究显示，维生素D可以降低妊娠剧吐的风险，暂未发现补充钙、铁、锌、硒、镁、铜、维生素A、维生素C、维生素E、胡萝卜素和22种饮食能增高或降低妊娠剧吐的风险，但是孕期也应该保持营养均衡，如果相应的微量元素和维生素低也需进行补充，避免微量元素的缺失。

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doi: 10.12102/j.issn.1009-6493.2026.01.005
  • 接收时间：2025-02-05
  • 首发时间：2026-10-28
  • 出版时间：2026-01-10
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  • 收稿日期：2025-02-05
  • 修回日期：2025-11-20
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    1深圳市宝安区松岗人民医院，广东 518100
    2深圳市中西医结合医院

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阮云瑶，E-mail:
RUAN Yunyao, E-mail:
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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