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Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull 2018; 126:57-77. [PMID: 29684104 PMCID: PMC6003599 DOI: 10.1093/bmb/ldy010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/26/2018] [Indexed: 12/19/2022]
Abstract
Introduction Maternal vitamin D status in pregnancy has been linked to many health outcomes in mother and offspring. A wealth of observational studies have reported on both obstetric outcomes and complications, including pre-eclampsia, gestational diabetes, mode and timing of delivery. Many foetal and childhood outcomes are also linked to vitamin D status, including measures of foetal size, body composition and skeletal mineralization, in addition to later childhood outcomes, such as asthma. Sources of data Synthesis of systematic and narrative reviews. Areas of agreement and controversy The findings are generally inconsistent in most areas, and, at present, there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. In most areas, the evidence tends towards maternal vitamin D being of overall benefit, but often does not reach statistical significance in meta-analyses. Growing points and areas timely for developing research The most conclusive evidence is in the role of maternal vitamin D supplementation in the prevention of neonatal hypocalcaemia; as a consequence the UK department of health recommends that pregnant women take 400 IU vitamin D daily. High-quality randomized placebo-controlled trials, such as the UK-based MAVIDOS trial, will inform the potential efficacy and safety of vitamin D supplementation in pregnancy across a variety of outcomes.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- Paediatric Endocrinology, Southampton University Hospitals NHS
Foundation Trust, Southampton, SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of
Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road,
Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of
Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road,
Southampton, SO16 6YD, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford,
Oxford, OX3 7LD, UK
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van der Pligt P, Willcox J, Szymlek-Gay EA, Murray E, Worsley A, Daly RM. Associations of Maternal Vitamin D Deficiency with Pregnancy and Neonatal Complications in Developing Countries: A Systematic Review. Nutrients 2018; 10:E640. [PMID: 29783717 PMCID: PMC5986519 DOI: 10.3390/nu10050640] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/16/2018] [Accepted: 05/12/2018] [Indexed: 01/01/2023] Open
Abstract
Pregnant women in Asia, the Middle East, Africa and Latin America are at risk of vitamin D deficiency (VDD) and prevalence throughout these regions are among the highest, globally. Maternal VDD has been associated with increased risk of a number of adverse maternal and neonatal health outcomes, yet research from developing countries is limited. We assessed the associations of maternal VDD during pregnancy with adverse health outcomes by synthesizing the literature from observational studies conducted in developing countries. Six electronic databases were searched for English-language studies published between 2000 and 2017. Thirteen studies from seven countries were included in the review. Prevalence of VDD ranged from 51.3% to 100%. Six studies assessed both maternal and neonatal outcomes, four studies assessed only maternal outcomes and three studies assessed only neonatal outcomes. Ten studies showed at least one significant association between VDD and adverse maternal and/or neonatal health outcomes including pre-eclampsia (n = 3), gestational diabetes mellitus (n = 1), postpartum depression (n = 1), emergency cesarean section delivery (n = 1), low birth weight babies (n = 4), small for gestational age (n = 2), stunting (n = 1). However most of these studies (n = 6) also showed no association with multiple health outcomes. Vitamin D assessment methods, criteria applied to define VDD, season and trimester in which studies were conducted varied considerably across studies. In conclusion, this study highlights the need to improve maternal vitamin D status in developing countries in an effort to support best maternal and child health outcomes across these regions. Future research should focus on more unified approaches to vitamin D assessment and preventative approaches that may be embedded into already existing antenatal care settings.
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Affiliation(s)
- Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Jane Willcox
- School of Exercise and Nutrition Sciences, Deakin University, Burwood 3125, Australia.
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora 3083, Australia.
| | - Ewa A Szymlek-Gay
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Emily Murray
- School of Exercise and Nutrition Sciences, Deakin University, Burwood 3125, Australia.
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
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Li G, Lin L, Wang YL, Yang H. 1,25(OH)2D3 Protects Trophoblasts Against Insulin Resistance and Inflammation Via Suppressing mTOR Signaling. Reprod Sci 2018; 26:223-232. [PMID: 29575997 DOI: 10.1177/1933719118766253] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is the primary cause of maternal and fetal morbidity and mortality. Insulin resistance (IR) is pivotal to GDM pathogenesis, and mammalian target of rapamycin (mTOR) is a critical regulator of GDM. An increasing amount of evidence indicates that vitamin D deficiency is a risk factor for GDM. However, there are few reports on the effect of IR on GDM placentas. The present study aims to verify that 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) can ameliorate trophoblast IR by suppressing mTOR signaling. An IR BeWo cell model was established in the presence of high insulin and glucose medium. The IR level and mTOR activation with or without 1,25(OH)2D3 treatment were evaluated. The IR cells exhibited excessive mTOR signaling activation, upregulated inflammatory factor levels, and extensive lipid infiltration. However, 1,25(OH)2D3 reversed mTOR activation and reduced the IR level and lipid infiltration. In addition, 1,25(OH)2D3 treatment in GDM placental explants blocked the aberrant, increased levels of leptin, TNF-α, and IL-6. Therefore, 1,25(OH)2D3 treatment protects trophoblasts against high IR mainly through suppressing mTOR signaling, and this mechanism may serve as a potential therapy for patients with GDM.
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Affiliation(s)
- Guanlin Li
- 1 Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People's Republic of China
| | - Li Lin
- 1 Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People's Republic of China
| | - Yan-Ling Wang
- 2 State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Huixia Yang
- 1 Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People's Republic of China
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54
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Xu C, Ma HH, Wang Y. Maternal Early Pregnancy Plasma Concentration of 25-Hydroxyvitamin D and Risk of Gestational Diabetes Mellitus. Calcif Tissue Int 2018; 102:280-286. [PMID: 29058058 DOI: 10.1007/s00223-017-0346-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/13/2017] [Indexed: 12/16/2022]
Abstract
We examined whether 25-Hydroxyvitamin D [25(OH) D] concentrations, measured at the first prenatal visit, would be associated with risk of gestational diabetes mellitus (GDM). From July 2015 to June 2016, consecutive women who admitted to the two-obstetrics center in china were included. Relevant data were collected between 24 and 28 weeks of gestation, including fasting plasma glucose (FPG) and 25(OH) D concentrations at the first prenatal visit and the one-step GDM screened with 75-g oral glucose tolerance test (OGTT). Blood from women at first prenatal visit was available for 827 women and 101 of them developed GDM (12.2%). The GDM distribution across the 25(OH) D quartiles ranged between 3.9% (fourth quartile, Q4) and 26.1% (first quartile, Q1). The median plasma concentration of 25(OH) D at first prenatal visit was significantly lower in women who developed GDM compared with those not developed (p < 0.001). In multivariate models comparing the 25(OH) D of Q1, second (Q2) and third quartiles (Q3) against the Q4, it observed that concentrations of 25(OH) D in Q1 and Q2 were associated with later developed GDM, and risk of GDM was increased by 240 and 48%, respectively. The women group with combined vitamin D deficiency and obesity had an OR of 4.66 [95% CI (2.91-8.15); p < 0.001] for GDM compared to those without vitamin D deficiency and obesity. Low 25(OH) D concentrations at the first prenatal visit were associated with increased risk of GDM and might be useful in identifying women at risk of GDM for performing early prevention strategies.
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Affiliation(s)
- Changen Xu
- Department of Obstetrics, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - He-Hong Ma
- Department of Obstetrics, Cangzhou Central Hospital, Cangzhou, China
| | - Yao Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, 200011, Shanghai, China.
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55
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Ganguly A, Tamblyn JA, Finn-Sell S, Chan SY, Westwood M, Gupta J, Kilby MD, Gross SR, Hewison M. Vitamin D, the placenta and early pregnancy: effects on trophoblast function. J Endocrinol 2018; 236:R93-R103. [PMID: 29109081 DOI: 10.1530/joe-17-0491] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 01/01/2023]
Abstract
Pregnancy is associated with significant changes in vitamin D metabolism, notably increased maternal serum levels of active vitamin D, 1,25-dihydroxyvitamin (1,25(OH)2D). This appears to be due primarily to increased renal activity of the enzyme 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1) that catalyzes synthesis of 1,25(OH)2D, but CYP27B1 expression is also prominent in both the maternal decidua and fetal trophoblast components of the placenta. The precise function of placental synthesis of 1,25(OH)2D remains unclear, but is likely to involve localized tissue-specific responses with both decidua and trophoblast also expressing the vitamin D receptor (VDR) for 1,25(OH)2D. We have previously described immunomodulatory responses to 1,25(OH)2D by diverse populations of VDR-expressing cells within the decidua. The aim of the current review is to detail the role of vitamin D in pregnancy from a trophoblast perspective, with particular emphasis on the potential role of 1,25(OH)2D as a regulator of trophoblast invasion in early pregnancy. Vitamin D deficiency is common in pregnant women, and a wide range of studies have linked low vitamin D status to adverse events in pregnancy. To date, most of these studies have focused on adverse events later in pregnancy, but the current review will explore the potential impact of vitamin D on early pregnancy, and how this may influence implantation and miscarriage.
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Affiliation(s)
- Ankana Ganguly
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
| | - Jennifer A Tamblyn
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
- Fetal Medicine CentreBirmingham Women's NHS Foundation Trust, Birmingham, UK
- CEDAMBirmingham Health Partners, The University of Birmingham, Birmingham, UK
| | - Sarah Finn-Sell
- Division of Developmental Biology and MedicineMaternal and Fetal Health Research Centre, School of Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Shiao-Y Chan
- Department of Obstetrics and GynaecologyYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Melissa Westwood
- Division of Developmental Biology and MedicineMaternal and Fetal Health Research Centre, School of Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Janesh Gupta
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
- Fetal Medicine CentreBirmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Mark D Kilby
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
- Fetal Medicine CentreBirmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Stephane R Gross
- School of Life and Health SciencesAston University, Birmingham, UK
| | - Martin Hewison
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
- CEDAMBirmingham Health Partners, The University of Birmingham, Birmingham, UK
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Amraei M, Mohamadpour S, Sayehmiri K, Mousavi SF, Shirzadpour E, Moayeri A. Effects of Vitamin D Deficiency on Incidence Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis. Front Endocrinol (Lausanne) 2018; 9:7. [PMID: 29449829 PMCID: PMC5800395 DOI: 10.3389/fendo.2018.00007] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/05/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Proper nutrition is important for overall health, and it reduces healthcare costs associated with malnutrition. Many studies have investigated vitamin D deficiency and its role in gestational diabetes and controversial data have reported. A comprehensive consideration of articles in this field provides the possibility of a general study of this relationship. This meta-analysis is an evaluation of the relationship between vitamin D deficiency and gestational diabetes. MATERIAL AND METHODS Different databases (such as PubMed, Science Information Institute, EmBase, Scopus, and the Cochrane Library) were searched for studies and eligible English articles published before February 2017 that have reported the risk of gestational diabetes in relation to vitamin D deficiency. This relationship was measured using odds ratios (ORs) with a confidence interval (CI) of 95%. The influence of each study was measured through sensitivity analysis. Funnel plots, Egger regression tests, and the Begg-Mazumdar correlation test were used to determine bias or publication bias. STATA (version 11.2) was used for all analyses. RESULTS Twenty-six studies were selected as eligible for this research and included in the final analysis. In general, vitamin D deficiency among mothers may be related to an increased risk of gestational diabetes (OR = 1.18; 95% CI, 1.01-1.35; p < 0.001). The serum level of 25(OH)D is less meaningful in people with gestational diabetes than in those who have normal glucose tolerance. Subgroup analysis showed that the results concerning this association may vary with study design but do not change with country of origin. CONCLUSION Some evidence has shown that vitamin D deficiency may increase the risk of gestational diabetes.
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Affiliation(s)
- Mansour Amraei
- Biotechnology and Medicinal Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran
- Faculty of Medicine, Department of Physiology, Ilam University of Medical Sciences, Ilam, Iran
| | - Safoura Mohamadpour
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Kourosh Sayehmiri
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Ehsan Shirzadpour
- Biotechnology and Medicinal Plants Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Ardeshir Moayeri
- Faculty of Medicine, Department of Anatomy, Ilam University of Medical Sciences, Ilam, Iran
- *Correspondence: Ardeshir Moayeri,
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Eggemoen ÅR, Waage CW, Sletner L, Gulseth HL, Birkeland KI, Jenum AK. Vitamin D, Gestational Diabetes, and Measures of Glucose Metabolism in a Population-Based Multiethnic Cohort. J Diabetes Res 2018; 2018:8939235. [PMID: 29850611 PMCID: PMC5933024 DOI: 10.1155/2018/8939235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/28/2017] [Accepted: 02/07/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We explored associations between maternal 25-hydroxyvitamin D (25(OH)D) status during pregnancy and gestational diabetes (GDM) and other measures of glucose metabolism. METHODS We analysed 25(OH)D at 15 and 28 gestational weeks (GW) in 745 multiethnic pregnant women attending antenatal care units in Oslo, Norway, between 2008 and 2010. GDM was diagnosed with a 75 g oral glucose tolerance test at 28 GW. Separate regression analyses were performed to investigate associations between 25(OH)D and GDM and measures of glucose metabolism. RESULTS A higher proportion of ethnic minority women had GDM (p < 0.01) and low 25(OH)D (p < 0.01) compared to Europeans. In logistic regression analyses, 25(OH)D < 50 nmol/L was associated with GDM after adjusting for age, parity, education, and season (OR 1.6; 95% CI 1.1-2.2). After additional adjustments for variables reflecting fat mass (skinfolds or BMI) and ethnicity, the association disappeared with ethnicity having a much stronger effect than the adiposity variables. We got similar results exploring effects on other measures of glucose metabolism and when change in 25(OH)D from inclusion to 28 GW was taken into account. CONCLUSIONS Vitamin D deficiency was not associated with GDM or glucose metabolism in a multiethnic population-based study, after adjustments for confounding factors, in particular ethnicity.
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Affiliation(s)
- Åse Ruth Eggemoen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christin Wiegels Waage
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Line Sletner
- Department of Child and Adolescence Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Hanne L. Gulseth
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Kåre I. Birkeland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Ghavam S, Ahmadi MRH, Panah AD, Kazeminezhad B. Evaluation of HbA1C and serum levels of vitamin D in diabetic patients. J Family Med Prim Care 2018; 7:1314-1318. [PMID: 30613518 PMCID: PMC6293952 DOI: 10.4103/jfmpc.jfmpc_73_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Diabetes mellitus is the most common metabolic disease around the world. The present study aims at studying hemoglobin A1C (HbA1C) and vitamin D serum levels in diabetic patients. Materials and Methods A descriptive study was conducted on 102 diabetic patients presenting to the diabetic clinic of a tertiary care hospital in West of Iran in 2016 (Shahid Mostafa Khomeini Hospital of Ilam city). The data collected were inserted into the SPSS-20 software, and it was then analyzed by using the relevant statistical tests. For describing the quantitative variables, mean and standard deviation were used. Moreover, for describing the qualitative variables, number and percentage were applied. The mean serum levels of HbA1C and vitamin D were compared for different variables using the Chi-square and ANOVA. Results There is a positive and statistically significant relationship between the HbA1C and fasting blood sugar (FBS). Moreover, there is a statistically significant relationship between the serum level of vitamin D with smoking and body mass index (BMI). There is also an inverse linear relationship between vitamin D with HbA1C, FBS, BMI, and disease duration. The relationship between HbA1C with FBS and disease duration is a linear direct one. Their relationship between HbA1C and BMI is an inverse linear one, yet not significant. Conclusion Given the role of this vitamin in secretion and the effect of insulin, it seems useful to monitor the serum level of vitamin D in a diabetic patient and prescribe its supplements if necessary.
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Affiliation(s)
- Samiramiss Ghavam
- Department of Cardiology, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Ali Davar Panah
- Medical Student, Ilam University of Medical Sciences, Ilam, Iran
| | - Behrang Kazeminezhad
- Department of Pathology, Clinical Research Development Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
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Tänczer T, Magenheim R, Fürst Á, Domján B, Janicsek Z, Szabó E, Ferencz V, Tabák ÁG. The Relationship between 25-hydroxyvitamin D Levels, Insulin Sensitivity and Insulin Secretion in Women 3 Years after Delivery. Can J Diabetes 2017; 41:621-627. [DOI: 10.1016/j.jcjd.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/02/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
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Ge H, Sun H, Wang T, Liu X, Li X, Yu F, Han H, Wang J, Li W. The association between serum 25-hydroxyvitamin D3 concentration and serum lipids in the rural population of China. Lipids Health Dis 2017; 16:215. [PMID: 29137635 PMCID: PMC5686911 DOI: 10.1186/s12944-017-0603-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/30/2017] [Indexed: 11/11/2022] Open
Abstract
Background Vitamin D deficiency is implicated in some diseases, including cardiovascular. Few studies have assessed the correlation between 25-hydroxyvitamin D3 [25(OH) D3] and serum lipids. In this study, we explored the correlation between serum 25(OH) D3 concentrations and serum lipids with a typical sample of the rural population in China. Methods Face-to-face research was used to gather some basic information. Fasting serum concentrations of 25-(OH) D3, total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C) and, LDL cholesterol (LDL-C) tested in the laboratory. Results The mean of serum 25(OH) D3 level was 28.71 ± 29.29 ng/mL. The results showed that the dyslipidemia was strongly associated with gender (P = 0.031), drinking (P = 0.043), high-fat diet intake (P = 0.017), HDL-C (P<0), TG (P<0), body mass index (BMI) (P<0) and serum 25(OH)D3 levels (P = 0.002). There was a positive correlation between serum 25(OH)D3 and HDL-C (P<0) in all groups. The relationship between 25(OH) D3 and LDL-C (P = 0.024) was discovered only in normal lipid group. The multivariable adjusted odds ratio (95%CI) of hypoalphalipoproteinemia/HDL and dyslipidemia by comparing the sufficiency vs. the deficiency serum 25-(OH) D3 level were 0.31 (0.192, 0.499) (P = 0.001) and 0.52 (0.36, 0.73) (P = 0.005), respectively. Conclusions Serum 25(OH) D3 concentrations were associated with the serum lipids level and the association was different in normal serum lipid group and dyslipidemia group. With the increase of serum 25(OH) D3 levels, the incidence of dyslipidemia decreased.
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Affiliation(s)
- Huina Ge
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China
| | - Hualei Sun
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China
| | - Teng Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China
| | - Xinxin Liu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China
| | - Xing Li
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China
| | - Fei Yu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China
| | - Han Han
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China
| | - Jun Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China
| | - Wenjie Li
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Henan, 450001, China.
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Knabl J, Vattai A, Ye Y, Jueckstock J, Hutter S, Kainer F, Mahner S, Jeschke U. Role of Placental VDR Expression and Function in Common Late Pregnancy Disorders. Int J Mol Sci 2017; 18:ijms18112340. [PMID: 29113124 PMCID: PMC5713309 DOI: 10.3390/ijms18112340] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 12/14/2022] Open
Abstract
Vitamin D, besides its classical role in bone metabolism, plays a distinct role in multiple pathways of the feto-maternal unit. Calcitriol is the major active ligand of the nuclear vitamin D receptor (VDR). The vitamin D receptor (VDR) is expressed in different uteroplacental parts and exerts a variety of functions in physiologic pregnancy. It regulates decidualisation and implantation, influences hormone secretion and placental immune modulations. This review highlights the role of the vitamin D receptor in physiologic and disturbed pregnancy, as preeclampsia, fetal growth restriction, gestational diabetes and preterm birth. We discuss the existing literature regarding common VDR polymorphisms in these pregnancy disorders.
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Affiliation(s)
- Julia Knabl
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
- Department of Obstetrics and Gynecology, Klinik Hallerwiese, 90419 Nürnberg, Germany.
| | - Aurelia Vattai
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Yao Ye
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Stefan Hutter
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Franz Kainer
- Department of Obstetrics and Gynecology, Klinik Hallerwiese, 90419 Nürnberg, Germany.
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
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Vosoughi A, Aliasgarzadeh A, Bahrami A, Abbasalizadeh F, Niafar M, Najafipour F, Aghamohammadzadeh N, Nikniaz Z. Concentration of Maternal Serum 25-Hydroxy Vitamin D and Gestational 2 Diabetes Mellitus Risk. PHARMACEUTICAL SCIENCES 2017. [DOI: 10.15171/ps.2017.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Sofi NY, Jain M, Kapil U, Seenu V, Ramakrishnan L, Yadav CP, Pandey RM. Status of Serum Vitamin D and Calcium Levels in Women of Reproductive Age in National Capital Territory of India. Indian J Endocrinol Metab 2017; 21:731-733. [PMID: 28989883 PMCID: PMC5628545 DOI: 10.4103/ijem.ijem_134_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
CONTEXT In India, Vitamin D deficiency is a major public health problem, associated with lack of sunlight exposure in spite of abundant sunshine usually accompanied by reduced dietary intake. In women of reproductive age, Vitamin D deficiency in pregnancy has been associated with an increased risk of gestational diabetes mellitus, preeclampsia, maternal and perinatal morbidity and mortality. AIMS The aim of the present cross-sectional study was to evaluate the levels of serum Vitamin D 25(OH) D and calcium in women of reproductive age from India. SETTINGS AND DESIGN A cross-sectional study was carried on a total of 224 healthy nonpregnant and nonlactating women in the reproductive age group of 20-49 years. MATERIALS AND METHODS Demographic, socioeconomic class, and biochemical parameters for the estimation of serum 25(OH)D and calcium levels in women of reproductive age were studied. STATISTICAL ANALYSIS Statistical Package for Social Sciences version 20.0 was utilized for conducting the statistical analysis of the data. RESULTS Vitamin D deficiency (<20 ng/ml) was present in 88% of women. Women from middle socioeconomic class had the lowest mean serum 25(OH) D levels (9.6 ± 6 ng/ml) as compared to women from upper middle (11.4 ± 8 ng/ml), lower (11.2 ± 8 ng/ml), and upper (10 ± 8.6 ng/ml) socioeconomic class. Serum calcium levels were found in the normal range of 8.5-10.5 mg/dl for all the study subjects. CONCLUSIONS There is a high prevalence of hypovitaminosis D among women of reproductive age. These women may possibly have a higher risk of development of osteoporosis and pregnancy-related complications in future life.
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Affiliation(s)
- Nighat Yaseen Sofi
- Department of Food Science and Nutrition, Faculty of Home Science, Banasthali University, Newai, Rajasthan, India
- Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Jain
- Department of Food Science and Nutrition, Faculty of Home Science, Banasthali University, Newai, Rajasthan, India
| | - Umesh Kapil
- Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vuthaluru Seenu
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Chander Prakash Yadav
- National Institute of Malaria Research (NIMR), All India Institute of Medical Sciences, New Delhi, India
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Badfar G, Shohani M, Mansouri A, Soleymani A, Azami M. Vitamin D status in Iranian pregnant women and newborns: a systematic review and meta-analysis study. Expert Rev Endocrinol Metab 2017; 12:379-389. [PMID: 30058894 DOI: 10.1080/17446651.2017.1365596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vitamin D deficiency is a common health problem worldwide. The present study was conducted to assess the vitamin D status in Iranian pregnant women and newborns. METHODS A systematic review was conducted following PRISMA guidelines. The Scopus, PubMed, Science Direct, Cochrane, Web of Science, CINAHL, Magiran, Iranmedex, SID, Medlib, IranDoc databases, and Google Scholar were searched until 2017. The data were combined using random effects model. p < 0.05 was considered significant. RESULTS In 23 studies including 6,127 Iranian pregnant women were eligible for inclusion. The prevalence of vitamin D deficiency based on cutoff points of 10, 20, and 30 ng/ml was estimated to be 42.42% (95%CI: 26.90-57.93), 55.84% (95%CI: 31.75-79.93) and 80.82% (95%CI: 71.20-90.45), respectively. The mean 25-hydroxyvitamin D [25(OH)D] concentration was estimated to be 15.69 ng/ml (95%CI: 14.39-17.00) in pregnant women. The mean 25(OH)D concentration was estimated to be 14.97 ng/ml (95% CI: 10.63-19.31) in Iranian newborns. The difference in mean 25(OH)D concentration between pregnant women and their newborns was significant (p = 0.0002). CONCLUSIONS Vitamin D status in Iranian pregnant women and newborns are critical. Therefore, paying attention to the issue of vitamin D deficiency in this group should be a health priority in Iran.
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Affiliation(s)
- Gholamreza Badfar
- a Department of Pediatrics , Behbahan Faculty of Medical Sciences , Behbahan , Iran
| | - Masoumeh Shohani
- b Department of Nursing, Faculty of Allied Medical Sciences , Ilam University of Medical Sciences , Ilam , Iran
| | - Akram Mansouri
- c School of Nursing and Midwifery , Ahvaz jundishapour university of Medical science , Ahvaz , Iran
| | - Ali Soleymani
- d Faculty of Medicine , Dezful University of Medical Sciences , Dezful , Iran
| | - Milad Azami
- e Student Research Committee , Ilam University of Medical Sciences , Ilam , Iran
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Fiscaletti M, Stewart P, Munns CF. The importance of vitamin D in maternal and child health: a global perspective. Public Health Rev 2017; 38:19. [PMID: 29450091 PMCID: PMC5809824 DOI: 10.1186/s40985-017-0066-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/21/2017] [Indexed: 12/12/2022] Open
Abstract
Vitamin D and calcium are important nutrients for skeletal growth and bone health. Children and pregnant women are particularly vulnerable to 25-hydroxy vitamin D deficiency (VDD). VDD, with or without dietary calcium deficiency, can lead to nutritional rickets (NR), osteomalacia, and disturbances in calcium homeostasis. Multiple studies have linked VDD to adverse health outcomes in both children and pregnant women that extend beyond bone health. VDD remains an important global public health concern, and an important differentiation must be made between the impact of VDD on children and adults. Reports of increased incidence of NR continue to emerge. NR is an entirely preventable condition, which could be eradicated in infants and children worldwide with adequate vitamin D and calcium supplementation. The desire and necessity to put in place systems for preventing this potentially devastating pediatric disease should not elicit dispute. VDD and NR are global public health issues that require a collaborative, multi-level approach for the implementation of feasible preventative strategies. This review highlights the history, risk factors, and controversies related to VDD during pregnancy and childhood with a particular focus on global NR prevention.
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Affiliation(s)
- M Fiscaletti
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - P Stewart
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - CF Munns
- Institute of Endocrinology, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Association of vitamin D intake and serum levels with fertility: results from the Lifestyle and Fertility Study. Fertil Steril 2017. [PMID: 28629584 DOI: 10.1016/j.fertnstert.2017.05.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the role of vitamin D intake and serum levels on conception of clinical pregnancy and live birth. DESIGN Prospective cohort study. SETTING Academic medical centers. PATIENT(S) Healthy, nulliparous women, age 18-39 years, and their male partners. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical pregnancy and live birth were compared between those who did or did not meet the vitamin D estimated average requirement (EAR) intake (10 μg/d) and with serum 25-hydroxyvitamin D (25(OH)D) considered at risk for inadequacy or deficiency (<50 nmol/L) or sufficient (≥50 nmol/L). RESULT(S) Among 132 women, 37.1% did not meet the vitamin D EAR and 13.9% had serum levels at risk for inadequacy or deficiency. Clinical pregnancies were significantly higher among women who met the vitamin D EAR (67.5% vs. 49.0%) and with sufficient serum 25(OH)D (64.3% vs. 38.9%) compared with those who did not. Live births were higher among those who met the vitamin D EAR (59.0% vs. 40.0%). The adjusted odds ratio (AOR) of conceiving a clinical pregnancy was significantly higher among those who met the EAR (AOR = 2.26; 95% confidence interval [CI], 1.05-4.86) and had sufficient serum 25(OH)D (AOR = 3.37; 95% CI, 1.06-10.70). The associations were not significant after controlling for selected nutrients and dietary quality. CONCLUSION(S) Women with vitamin D intake below EAR and serum 25(OH)D levels at risk for inadequacy or deficiency may be less likely to conceive and might benefit from increased vitamin D intake to achieve adequacy. CLINICAL TRIAL REGISTRATION NUMBER NCT00642590.
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Siddiqi SS, Borse AG, Pervez A, Anjum S. A study of bone turnover markers in gestational diabetes mellitus. Indian J Endocrinol Metab 2017; 21:38-44. [PMID: 28217496 PMCID: PMC5240078 DOI: 10.4103/2230-8210.196024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Gestational diabetes is defined as carbohydrate intolerance resulting in hyperglycemia of variable severity with the first recognition during pregnancy. Established risk factors for gestational diabetes mellitus (GDM) are maternal age, obesity, family history of diabetes, etc. Vitamin D, parathyroid hormone (PTH), and various other hormones are known for their function in maintaining calcium and phosphorous homeostatic. Furthermore, Vitamin D, PTH serum ionized calcium, and alkaline phosphatase (ALP) have been reported to be altered with glucose homeostasis. The present study compares the bone markers in pregnant women with and without gestational diabetes. MATERIALS AND METHODS This cross-sectional study was conducted at outpatient antenatal check-up clinic and outpatient diabetic clinics at J. N. Medical College and Hospital, Aligarh. One hundred pregnant females, of which fifty with GDM and fifty without GDM, were included in the study from January 2014 to November 2015. Detailed history, physical examination, and anthropometric measurement were done. Bone turnover markers in the form of Vitamin D, parathyroid hormone, serum ionized calcium, and serum ALP were measured in pregnant women who had gestational diabetes which was compared with normal pregnant women. RESULTS In our study, the mean age of participate of GDM group was 28.2 ± 3 years, while the mean age group in non-GDM group was 25.44 ± 2.78 years. Ionized calcium in GDM was found to be 4.606 ± 0.354 mEq/L, while in non-GDM, it was 4.548 ± 0.384 mEq/L, P = 0.430. Vitamin D came out to be 21.80 ± 9.48 ng/ml, while it was 32.346 ± 8.37 ng/ml in non-GDM group. Serum PTH in GDM group was 71.436 ± 36.189 pg/ml and 37.168 ± 8.128 pg/ml in nondiabetic gestational group. Serum ALP in GDM group was 9.1 ± 4.56 KA U/dl and 6.98 ± 2.2 KA U/dl in nondiabetic gestational group, P - 0.0038. In GDM group, there was a significant negative linear correlation between PTH and 25-hydroxyvitamin D with research correlation coefficient r = -0.9073, P = 0; there was a significant positive linear correlation coefficient between PTH and ALP with Persian correlation coefficient r = 0.6597, P = 0; there was no statistically significant correlation between PTH and ionized calcium r = 0.1416, P = 0.3267. CONCLUSION All GDM subjects should ideally be screened for serum calcium, vitamin D, PTH, ALP. If found impaired should immediately be corrected in order to prevent its adverse effects on maternal and fetal outcome. Vitamin D supplementation should ideally be initiated in all GDM females even if the above parameters are not investigated in Indian setup.
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Affiliation(s)
- Sheelu Shafiq Siddiqi
- Rajiv Gandhi Centre for Diabetes and Endocrinology, J. N. Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Abhijit Girish Borse
- Department of Medicine, J. N. Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Anjum Pervez
- Department of Medicine, J. N. Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Shaheen Anjum
- Department of Gynaecology, J. N. Medical College and Hospital, Aligarh, Uttar Pradesh, India
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Zerofsky MS, Jacoby BN, Pedersen TL, Stephensen CB. Daily Cholecalciferol Supplementation during Pregnancy Alters Markers of Regulatory Immunity, Inflammation, and Clinical Outcomes in a Randomized Controlled Trial. J Nutr 2016; 146:2388-2397. [PMID: 27655755 DOI: 10.3945/jn.116.231480] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/23/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is widespread in pregnancy and has been associated with adverse health conditions in mothers and infants. Vitamin D supplementation in pregnancy may support the maintenance of pregnancy by its effects on innate and adaptive immunity. OBJECTIVE We assessed the effects of vitamin D supplementation during pregnancy on vitamin D status and markers of immune function associated with adverse pregnancy outcomes. METHODS We conducted a randomized, controlled, double-blind intervention of 2 doses of cholecalciferol (400 and 2000 IU/d) from <20 wk to delivery in 57 pregnant women. Vitamin D status, regulatory and inflammatory T cells, markers of innate immunity and systemic inflammation, and clinical outcomes including maternal blood pressure and birth weight were assessed at 26 and 36 wk of pregnancy. RESULTS Supplementation with 2000 IU/d vitamin D had a greater effect on the change in vitamin D status over pregnancy (P < 0.0001) and the final value at 36 wk (P < 0.0001) than 400 IU/d, increasing serum 25-hydroxyvitamin D from 81.1 nmol/L at baseline to 116 nmol/L at 36 wk and from 69.6 nmol/L at baseline to 85.6 nmol/L at 36 wk, respectively. The 2000-IU/d group had 36% more interleukin-10+ regulatory CD4+ T cells at 36 wk than did the 400-IU/d group (P < 0.007). The daily intake of 2000 compared with 400 IU/d tended to dampen the pregnancy-related increase in diastolic blood pressure by 1.3-fold (P = 0.06) and increase birth weight by 8.6% (P = 0.06), but these differences were not statistically significant. CONCLUSIONS Supplementation with 2000 IU/d is more effective at increasing vitamin D status in pregnant women than 400 IU/d and is associated with increased regulatory T cell immunity that may prevent adverse outcomes caused by excess inflammation. This trial was registered at clinicaltrials.gov as NCT01417351.
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Affiliation(s)
- Melissa S Zerofsky
- Graduate Group in Nutritional Biology and .,USDA Western Human Nutrition Research Center, Davis, CA
| | - Bryon N Jacoby
- Division of Maternal/Fetal Medicine, Davis Medical Center, University of California, Davis, Davis, CA; and
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Wang Y, Si S, Liu J, Wang Z, Jia H, Feng K, Sun L, Song SJ. The Associations of Serum Lipids with Vitamin D Status. PLoS One 2016; 11:e0165157. [PMID: 27768777 PMCID: PMC5074586 DOI: 10.1371/journal.pone.0165157] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/07/2016] [Indexed: 12/04/2022] Open
Abstract
Aims Vitamin D deficiency has been associated with some disorders including cardiovascular diseases. Dyslipidemia is a major risk factor for cardiovascular diseases. However, data about the relationships between vitamin D and lipids are inconsistent. The relationship of vitamin D and Atherogenic Index of Plasma (AIP), as an excellent predictor of level of small and dense LDL, has not been reported. The objective of this study was to investigate the effects of vitamin D status on serum lipids in Chinese adults. Methods The study was carried out using 1475 participants from the Center for Physical Examination, 306 Hospital of PLA in Beijing, China. Fasting blood samples were collected and serum concentrations of 25(OH)D, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured. AIP was calculated based on the formula: log [TG/HDL-C]. Multiple linear regression analysis was used to estimate the associations between serum 25(OH)D and lipids. The association between the occurrences of dyslipidemias and vitamin D levels was assessed by multiple logistic regression analysis. Confounding factors, age and BMI, were used for the adjustment. Results The median of serum 25(OH)D concentration was 47 (27–92.25) nmol/L in all subjects. The overall percentage of 25(OH)D ≦ 50 nmol/L was 58.5% (males 54.4%, females 63.7%). The serum 25(OH)D levels were inversely associated with TG (β coefficient = -0.24, p < 0.001) and LDL-C (β coefficient = -0.34, p < 0.001) and positively associated with TC (β coefficient = 0.35, p < 0.002) in men. The associations between serum 25(OH)D and LDL-C (β coefficient = -0.25, p = 0.01) and TC (β coefficient = 0.39, p = 0.001) also existed in women. The serum 25(OH)D concentrations were negatively associated with AIP in men (r = -0.111, p < 0.01) but not in women. In addition, vitamin D deficient men had higher AIP values than vitamin D sufficient men. Furthermore, the occurrences of dyslipidemias (reduced HDL-C, elevated TG and elevated AIP) correlated with lower 25(OH)D levels in men, whereas the higher TC and LDL-C associated with higher 25(OH)D levels in women. Conclusion It seems that the serum 25(OH)D levels are closely associated with the serum lipids and AIP. Vitamin D deficiency may be associated with the increased risk of dyslipidemias, especially in men. The association between vitamin D status and serum lipids may differ by genders.
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Affiliation(s)
- Ying Wang
- Center for Special Medicine and Experimental Research, 306th Hospital of PLA, Beijing, P. R. China
| | - Shaoyan Si
- Center for Special Medicine and Experimental Research, 306th Hospital of PLA, Beijing, P. R. China
| | - Junli Liu
- Center for Special Medicine and Experimental Research, 306th Hospital of PLA, Beijing, P. R. China
| | - Zongye Wang
- Center for Special Medicine and Experimental Research, 306th Hospital of PLA, Beijing, P. R. China
| | - Haiying Jia
- Center for Physical Examination, 306th Hospital of PLA Beijing, P. R. China
| | - Kai Feng
- Center for Special Medicine and Experimental Research, 306th Hospital of PLA, Beijing, P. R. China
| | - Lili Sun
- Center for Physical Examination, 306th Hospital of PLA Beijing, P. R. China
| | - Shu Jun Song
- Center for Special Medicine and Experimental Research, 306th Hospital of PLA, Beijing, P. R. China
- * E-mail:
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Gbadegesin A, Sobande A, Adedeji O, Disu E, Korede O, Dosunmu A, Shakunle A. Maternal serum vitamin D levels and pregnancy outcomes: from Lagos, Nigeria. J OBSTET GYNAECOL 2016; 37:25-28. [PMID: 27760474 DOI: 10.1080/01443615.2016.1196483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In an attempt to investigate the effect of vitamin D deficiency on pregnancy complications including caesarean section and foetal outcome in our population, blood samples of 461 pregnant women who attended antenatal booking clinic between 10 and 28 weeks of pregnancy were taken for vitamin D estimation and followed up. Details concerning pregnancy complications, labour and foetal outcome were obtained after delivery. They were divided into three groups according to the serum vitamin D level: group 1 (0-20)ng/ml (deficiency), group 2 (21-30)ng/ml (insufficiency), and group 3 (more than 30 mg/ml) normal. The prevalence of vitamin D deficiency was 29%. There were no differences between the groups regarding complications during pregnancy, including preeclampsia and rate of caesarean section. A multicenter study was advocated to elucidate further the role of vitamin D during pregnancy in our population.
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Affiliation(s)
- Abidoye Gbadegesin
- a Department of Obstetrics & Gynaecology , Lagos State University College of Medicine , Lagos , Nigeria
| | - Adekunle Sobande
- a Department of Obstetrics & Gynaecology , Lagos State University College of Medicine , Lagos , Nigeria
| | - Oluwole Adedeji
- b Department of Chemical Pathology , Lagos State University College of Medicine , Lagos , Nigeria
| | - Elizabeth Disu
- c Department of Paediatrics , Lagos State University College of Medicine , Lagos , Nigeria
| | - Oluwatosin Korede
- d Department of Obstetrics and Gynaecology , Agege General Hospital , Lagos , Nigeria
| | - Adedoyin Dosunmu
- e Department of Haematology , Lagos State University College of Medicine , Lagos , Nigeria
| | - Adebusola Shakunle
- a Department of Obstetrics & Gynaecology , Lagos State University College of Medicine , Lagos , Nigeria
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Chen X, Yin B, Lian RC, Zhang T, Zhang HZ, Diao LH, Li YY, Huang CY, Liang DS, Zeng Y. Modulatory effects of vitamin D on peripheral cellular immunity in patients with recurrent miscarriage. Am J Reprod Immunol 2016; 76:432-438. [PMID: 27696575 DOI: 10.1111/aji.12585] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 01/20/2023] Open
Abstract
PROBLEM We aimed to investigate the modulatory effects of vitamin D on peripheral blood cellular immune response in patients with recurrent miscarriage (RM). METHOD OF STUDY The effect of vitamin D on the number of peripheral blood cells, T helper 1 (Th1) cytokines, and NK cytotoxicity was measured in 99 women with RM. RESULTS The percentage of CD19+ B cells and NK cytotoxicity at an effector-to-target cell (E:T) ratio of 50:1, 25:1, and 12.5:1 were significantly higher in the vitamin D insufficiency group (VDI) than in the vitamin D normal group (VDN) (P<.05 each). The proportion of TNF-α-expressing Th cells was significantly higher in the vitamin D deficiency group (VDD) than in VDN (P<.05). However, there were no significant differences between VDI and VDD. This dysregulation was significantly reduced with 1,25(OH)2 D supplementation. CONCLUSION The data suggest that the abnormalities of cellular immune response were observed in RM patients with a low vitamin D level, which could be regulated to some extent with 1,25(OH)2 D supplementation.
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Affiliation(s)
- Xian Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Biao Yin
- The State Key Laboratory of Medical Genetics of China, Central South University, Changsha, Hunan, China
| | - Ruo-Chun Lian
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Tao Zhang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Hong-Zhan Zhang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Liang-Hui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Yu-Ye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Chun-Yu Huang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - De-Sheng Liang
- The State Key Laboratory of Medical Genetics of China, Central South University, Changsha, Hunan, China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
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Abstract
BACKGROUND A nutrient-rich maternal diet before and during pregnancy is associated with improved fetal health, more appropriate birth weight, and increased rates of maternal and infant survival. Physicians need a better understanding of the role of diet in shaping fetal outcomes. Given this background, we reviewed and summarized articles on maternal nutrition found in MEDLINE since 1981, written in English, and limited to human subjects. FOR THE OFFSPRING Maternal diets high in sugar and fat lead to an increased incidence of metabolic syndrome, diabetes, and cardiovascular disease later in life. Folic acid should be supplemented prior to conception and continued through at least the first 28 days of fetal life to prevent neural tube defects, and vitamin C should be given to women who smoke to lower the incidence of asthma and wheezing in the children. Iodine deficiency is increasing, and iodine should be included in prenatal supplements. If the maternal hemoglobin is 7 g/dL or more, there is no evidence that iron supplementation is needed. Fish intake during pregnancy is protective against atopic outcomes, whereas high-meat diets contribute to elevated adult blood pressure and hypersecretion of cortisol. FOR THE MOTHER Calcium supplementation lowers the risk of preeclampsia and hypertensive disease in pregnancy. CONCLUSIONS Given the limits of our current knowledge, a diet rich in whole grains, fruits, vegetables, and selected fish is desirable for the best outcomes. Diets high in sugar and fat lead to higher rates of diabetes, metabolic syndrome, and cardiovascular disease. Folic acid, iodine, and calcium in all pregnant women and vitamin C in smokers are the only supplements so far shown to be of value for routine use. The physician treating a pregnant woman should be ready to advise a healthy diet for the benefit of the fetus.
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Affiliation(s)
- Richard I. Lowensohn
- *Adjunct Associate Professor, Obstetrics & Gynecology and Medical Informatics & Clinical Epidemiology, †Assistant Professor of Medicine, and ‡Clinical Dietitian Specialist, Center for Women’s Health, Oregon Health & Science University, Portland, OR
| | - Diane D. Stadler
- *Adjunct Associate Professor, Obstetrics & Gynecology and Medical Informatics & Clinical Epidemiology, †Assistant Professor of Medicine, and ‡Clinical Dietitian Specialist, Center for Women’s Health, Oregon Health & Science University, Portland, OR
| | - Christie Naze
- *Adjunct Associate Professor, Obstetrics & Gynecology and Medical Informatics & Clinical Epidemiology, †Assistant Professor of Medicine, and ‡Clinical Dietitian Specialist, Center for Women’s Health, Oregon Health & Science University, Portland, OR
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Bukhary NBI, Isa ZM, Shamsuddin K, Lin KG, Mahdy ZA, Hassan H, Yeop NSH. Risk factors for antenatal hypovitaminosis D in an urban district in Malaysia. BMC Pregnancy Childbirth 2016; 16:156. [PMID: 27411716 PMCID: PMC4944244 DOI: 10.1186/s12884-016-0939-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/23/2016] [Indexed: 12/02/2022] Open
Abstract
Background Pregnant women form one of the high risk groups facing hypovitaminosis D. Low level of vitamin D will affect directly or indirectly both mother and fetus. Screening vitamin D in the first trimester of pregnancy is important to determine the necessary preventive action. Therefore, this study was aimed to determine the prevalence of hypovitaminosis D and its risk factors among pregnant women in the first trimester. Methods A cross sectional study was carried out among first trimester pregnant women during their first antenatal visit. Samples were taken from different ethnicities in an urban district in Malaysia. A total of 396 respondents (99 % response rate) aged 18–40 years completed self–administered and guided questionnaire (characteristics and risk factors), validated semi-quantitative food frequency questionnaire for vitamin D in Malaysia (FFQ vitamin D/My), anthropometric measures (weight and height), blood test for serum 25(OH)D, skin measurement using Mexameter (MX 18) and Fitzpatrick Skin Type Chart Measurement (FSTCM). Data were analyzed to determine the association between risk factors and hypovitaminosis D. Results The prevalence of hypovitaminosis D (serum 25(OH)D < 50 nmol/L) was 90.4 % (358). The mean age of respondents was 28.06 ± 4.09 years old. The independent predictors of hypovitaminosis D were Malay ethnicity (OR 33.68; 95 % CI: 12.81, 88.56), Indian ethnicity (OR 16.86; 95 % CI: 3.78,75.20), secondary education (OR 12.12; 95 % CI: 2.71, 54.16) and tertiary education (OR 14.38; 95 % Cl: 3.31, 62.45). Conclusion Awareness should be raised among Malay and Indian pregnant women with secondary and tertiary education who consumed vitamin D (especially milk) poorly in order to prevent adverse health outcomes. Further studies need to be conducted among health care workers to determine their level of knowledge related to vitamin D, as they are front liner in detecting the hypovitaminosis D.
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Affiliation(s)
- Noriklil Bukhary Ismail Bukhary
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.,Petaling District Health Office, Wisma SAHOCA, No 1, Jalan SS 6/3A Kelana Jaya, 47301, Petaling Jaya, Selangor, Malaysia
| | - Zaleha Md Isa
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Khadijah Shamsuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Khor Geok Lin
- School of Health Sciences, Faculty of Medicine and Health, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Zaleha Abdullah Mahdy
- Faculty of Medicine, Department of Obstetrics and Gynecology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Haslinda Hassan
- Petaling District Health Office, Wisma SAHOCA, No 1, Jalan SS 6/3A Kelana Jaya, 47301, Petaling Jaya, Selangor, Malaysia
| | - Noor Sharifatul Hana Yeop
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
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Al-Shaikh GK, Ibrahim GH, Fayed AA, Al-Mandeel H. Impact of vitamin D deficiency on maternal and birth outcomes in the Saudi population: a cross-sectional study. BMC Pregnancy Childbirth 2016; 16:119. [PMID: 27221615 PMCID: PMC4879737 DOI: 10.1186/s12884-016-0901-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 05/07/2016] [Indexed: 12/11/2022] Open
Abstract
Background Low serum vitamin D [25(OH)D] has been associated with different health problems worldwide. However, its causal role in several diseases remains unclear. We aimed to correlate vitamin D status with maternal and neonatal outcomes in pregnant females. Method One thousand pregnant women were recruited during early labour from the labour ward of King Khaled University Hospital, Riyadh, Saudi Arabia. Detailed medical data of all participants were collected from their records. Delivery events and birth outcomes were also documented. Serum 25(OH)D levels were measured using an enzyme-linked immunosorbent assay. A receiver operating characteristic (ROC) curve was constructed to evaluate the ability of vitamin D levels to predict complicated pregnancies. Regression analysis was used to test the correlation between serum 25(OH)D levels and different variables. Results Most of the participants were Saudis (89.9 %) and housewives (85.1 %) and 86.4 % of them had vitamin D deficiency (mean: 30.46 ± 19.6 nmol/L). Gestational diabetes mellitus (GDM) was the commonest complication detected (11.1 %) while the history of miscarriage was elevated (24.5 %). There was no association between GDM and low 25(OH)D. Yet, there was a significant negative correlation between serum 25(OH)D levels and fasting blood glucose among females older than 35 years (r = −0.2, p = 0.03). Hypertensive disorders of pregnancy and pre-existing hypertension were less than 1.5 % of frequency. Nevertheless, they were only recorded in women with insufficient and deficient vitamin D. ROC curve revealed that 25(OH)D levels were not able to discriminate between normal and adverse pregnancy outcomes (AUROC curve: 0.51; 95 % confidence interval (CI): 0.44–0.58; p = 0.8). Conclusion Hypovitaminosis D, a highly prevalent health problem among pregnant females in Riyadh, has no relation to adverse pregnancy outcomes except for a higher prevalence of miscarriage in women with low 25(OH)D. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0901-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ghadeer K Al-Shaikh
- Obstetrics and Gynecology Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Gehan H Ibrahim
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia. .,Department of Medical Biochemistry, Faculty of Medicine, Suez Canal University, Round Road, Ismailia, 41511, Egypt.
| | - Amel A Fayed
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia.,Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Hazem Al-Mandeel
- Obstetrics and Gynecology Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
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75
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Association between vitamin D receptor ApaI and TaqI gene polymorphisms and gestational diabetes mellitus in an Iranian pregnant women population. Gene 2016; 581:43-7. [DOI: 10.1016/j.gene.2016.01.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/04/2016] [Accepted: 01/15/2016] [Indexed: 12/15/2022]
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76
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Hypovitaminosis D in pregnancy in the Mediterranean region: a systematic review. Eur J Clin Nutr 2016; 70:979-86. [PMID: 26931671 DOI: 10.1038/ejcn.2016.12] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/03/2016] [Accepted: 01/07/2016] [Indexed: 12/12/2022]
Abstract
Despite high levels of sunshine, maternal hypovitaminosis D during pregnancy is prevalent in the Mediterranean region. The aim of this study is to systematically review trials that investigated vitamin D concentrations during pregnancy in this region, in order to determine predictors of hypovitaminosis D and explain this phenomenon. After applying inclusion/exclusion criteria, 15 studies were entered into the systematic review involving 2649 pregnant women and 820 neonates. The main outcome was maternal vitamin D status, assessed by serum 25-hydroxy-vitamin D (25(OH)D) concentrations. Possible predictors of the outcome included maternal age, body mass index (BMI), race, socioeconomic status, skin type, gestational age, sun exposure, calcium and vitamin D intake and supplementation, smoking status, parity and season of delivery. Studies differed widely in vitamin D deficiency criteria, method of measurement and outcomes. The prevalence of vitamin D insufficiency ranges from 9.3 to 41.4%, whereas that of vitamin D deficiency from 22.7 to 90.3%. A positive association with 25(OH)D concentrations exists for light skin color, white race, uncovered dressing pattern, maternal vitamin D supplementation and season of gestation (spring/summer). An inverse association exists for BMI and gestational age, whereas data for smoking and socioeconomic status are controversial. We concluded that vitamin D deficiency in pregnancy seems to be quite common, even in the Mediterranean region. Racial, social and cultural habits, as well as the absence of preventive supplementation/dietary strategies, seem to negate the benefits of sun exposure.
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El-Beshbishy HA, Tawfeek MA, Taha IM, FadulElahi T, Shaheen AY, Bardi FA, Sultan II. Association of vitamin D receptor gene BsmI (A>G) and FokI (C>T) polymorphism in gestational diabetes among Saudi Women. Pak J Med Sci 2016; 31:1328-33. [PMID: 26870091 PMCID: PMC4744276 DOI: 10.12669/pjms.316.7525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Vitamin D receptor (VDR) gene polymorphism have a role in diabetes mellitus pathogenesis. Present study was conducted to determine VDR gene variants among Saudi gestational diabetics (GDM) in Madina, KSA. METHODS This cross sectional study was conducted on 112 GDM patients and 218 normal healthy control. Age, body mass index and blood pressure levels were recorded. Serum triglycerides (mg/dl), total cholesterol, HDL-cholesterol, LDL-cholesterol, fasting blood glucose FBG and post-prandial blood glucose PPBG were estimated. Extracted DNA template was amplified by PCR reaction and genotyped for single nucleotide polymorphism of BsmI and FokI by restriction fragment length polymorphism-PCR (RFLP-PCR) analysis. RESULTS FBG and PPBG levels in GDM patients were significantly elevated by +48.6% and +50%, respectively (P=0.005). Serum triglycerides, total cholesterol and LDL-cholesterol (mg/dl) levels in GDM patients were elevated significantly by +40.5% (P=0.005), +16% (P=0.01) and +30.8% (P=0.005), respectively. Serum HDL-cholesterol (mg/dl) showed significant decline by -10.5%. FokI VDR genotypes showed association with PPBG (P=0.05) among GDM patients. The Ff, FF and ff genotype percentage among GDM patients was 48.2%, 30.4% and 21.4%, respectively. FokI (F and f) and BsmI (B and b) alleles frequency showed no significant difference between GDM patients and control. Percentage BsmI and FokI total homozygous and heterozygous variants among GDM was 45.5% and 81.4%, respectively. CONCLUSION VDR BsmI and FokI polymorphic marker not associated with Saudi GDM.
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Affiliation(s)
- Hesham A El-Beshbishy
- Prof. Hesham A. El-Beshbishy, Ph.D., M.Sc., Pharma B.Sc. Center for Genetics and Inherited Diseases and Medical Laboratories Technology Department, Taibah University, Madina, Saudi Arabia. Biochemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo 11751, Egypt
| | - Manal A Tawfeek
- Prof. Manal A. Tawfeek, Ph.D., MD. Biochemistry and Molecular Medicine Department, College of Medicine, Taibah University, Madina, Saudi Arabia Clinical Pathology Dept., Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Inass M Taha
- Dr. Inass M. Taha, MD., Internal Medicine Department, College of Medicine, Taibah University, Madina, Saudi Arabia
| | - Thoraya FadulElahi
- Dr. Thoraya Fadulelahi, MRCOG., Department of Obstetrics and Gynecology, Ohud Hospital, Madina, Saudi Arabia
| | - Amal Y Shaheen
- Dr. Amal Y. Shaheen, SAB., Department of Obstetrics and Gynecology, Ohud Hospital, Madina, Saudi Arabia
| | - Fouad A Bardi
- Dr. Amal Y. Shaheen, SAB., Department of Obstetrics and Gynecology, Ohud Hospital, Madina, Saudi Arabia
| | - Intessar I Sultan
- Prof. Intessar Sultan, M.D., Internal Medicine Department, College of Medicine, Cairo University, Egypt. Internal Medicine Department, College of Medicine, Taibah University, Madina, Saudi Arabia
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78
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Wallace IR, Wallace HJ, McKinley MC, Bell PM, Hunter SJ. Vitamin D and insulin resistance. Clin Endocrinol (Oxf) 2016; 84:159-171. [PMID: 25727561 DOI: 10.1111/cen.12760] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/06/2014] [Accepted: 02/26/2015] [Indexed: 12/28/2022]
Abstract
Vitamin D is a steroid hormone, which in active form binds to the vitamin D receptor. Expression of the vitamin D receptor in diverse cell types (pancreatic islet cells, myocytes, hepatocytes and adipocytes) raises the suspicion that vitamin D may be involved in multiple cellular processes, including the response to insulin. Insulin resistance is a characteristic feature of type 2 DM, and its attenuation may reduce the incidence of type 2 DM and cardiovascular disease. In observational studies, low serum 25-hydroxyvitamin D (25-OHD) concentrations are associated with an increased risk of type 2 DM. It has been suggested that increasing serum 25-OHD concentrations may have beneficial effects on glucose and insulin homeostasis. However, cross-sectional and interventional studies of vitamin D supplementation provide conflicting results and demonstrate no clear beneficial effect of vitamin D on insulin resistance. These studies are complicated by inclusion of different patient cohorts, different 25-OHD assays and different doses and preparations of vitamin D. Any possible association may be confounded by alterations in PTH, 1,25-dihydroxyvitamin D or tissue vitamin D concentrations. We identified 39 studies via MEDLINE and PUBMED. We review the evidence from 10 studies (seven observational and three interventional) examining vitamin D and type 2 DM incidence, and 29 studies (one prospective observational, 12 cross-sectional and 16 interventional trials) examining vitamin D and insulin resistance. Based on this data, it is not possible to state that vitamin D supplementation has any effect on type 2 DM incidence or on insulin resistance. Data from the multiple ongoing randomized controlled trials of vitamin D supplementation due to report over the next few years should help to clarify this area.
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Affiliation(s)
- Ian R Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
- Nutrition and Metabolism Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Helen J Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
- Nutrition and Metabolism Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Michelle C McKinley
- Nutrition and Metabolism Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Patrick M Bell
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Steven J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
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79
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Association between vitamin D status and the risk of gestational diabetes mellitus: a meta-analysis. Arch Gynecol Obstet 2016; 293:959-66. [PMID: 26825733 DOI: 10.1007/s00404-016-4010-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/05/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Vitamin D is widely used for bone growth and normal insulin secretion; however, the association between vitamin D status and gestational diabetes risk is controversial. This meta-analysis aimed to quantitatively evaluate the association between vitamin status and risk of gestational diabetes. METHODS We performed a systematic search on the PubMed, EmBase, and Cochrane Library databases in January 2015 to obtain observational studies studying gestational diabetes risk in relation to vitamin D status. Odds ratios (ORs) with 95 % confidence intervals (CIs) were used to measure the association between vitamin D status and the risk of gestational diabetes. RESULTS A total of 20 observational studies were included in the final analysis containing 16,515 individuals. Overall, maternal vitamin D insufficiency was found to be associated with a greater risk of gestational diabetes (RR 1.45; 95 % CI 1.15-1.83; P < 0.001). Subgroup analysis indicated that this association might differ based on countries, study design, assessment of vitamin D levels, sample size, age at baseline, adjusted models, and study quality. CONCLUSIONS This meta-analysis revealed that maternal vitamin D insufficiency is associated with increased risk of gestational diabetes.
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Abstract
BACKGROUND Vitamin D deficiency or insufficiency is thought to be common among pregnant women. Vitamin D supplementation during pregnancy has been suggested as an intervention to protect against adverse pregnancy outcomes. OBJECTIVES To examine whether oral supplements with vitamin D alone or in combination with calcium or other vitamins and minerals given to women during pregnancy can safely improve maternal and neonatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 February 2015), the International Clinical Trials Registry Platform (31 January 2015), the Networked Digital Library of Theses and Dissertations (28 January 2015) and also contacted relevant organisations (31 January 2015). SELECTION CRITERIA Randomised and quasi-randomised trials with randomisation at either individual or cluster level, evaluating the effect of supplementation with vitamin D alone or in combination with other micronutrients for women during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently i) assessed the eligibility of studies against the inclusion criteria ii) extracted data from included studies, and iii) assessed the risk of bias of the included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS In this updated review we included 15 trials assessing a total of 2833 women, excluded 27 trials, and 23 trials are still ongoing or unpublished. Nine trials compared the effects of vitamin D alone versus no supplementation or a placebo and six trials compared the effects of vitamin D and calcium with no supplementation. Risk of bias in the majority of trials was unclear and many studies were at high risk of bias for blinding and attrition rates. Vitamin D alone versus no supplementation or a placebo Data from seven trials involving 868 women consistently show that women who received vitamin D supplements alone, particularly on a daily basis, had higher 25-hydroxyvitamin D than those receiving no intervention or placebo, but this response was highly heterogeneous. Also, data from two trials involving 219 women suggest that women who received vitamin D supplements may have a lower risk of pre-eclampsia than those receiving no intervention or placebo (8.9% versus 15.5%; risk ratio (RR) 0.52; 95% CI 0.25 to 1.05, low quality). Data from two trials involving 219 women suggest a similar risk of gestational diabetes among those taking vitamin D supplements or no intervention/placebo (RR 0.43; 95% CI 0.05, 3.45, very low quality). There were no clear differences in adverse effects, with only one reported case of nephritic syndrome in the control group in one study (RR 0.17; 95% CI 0.01 to 4.06; one trial, 135 women, low quality). Given the scarcity of data for this outcome, no firm conclusions can be drawn. No other adverse effects were reported in any of the other studies.With respect to infant outcomes, data from three trials involving 477 women suggest that vitamin D supplementation during pregnancy reduces the risk preterm birth compared to no intervention or placebo (8.9% versus 15.5%; RR 0.36; 95% CI 0.14 to 0.93, moderate quality). Data from three trials involving 493 women also suggest that women who receive vitamin D supplements during pregnancy less frequently had a baby with a birthweight below 2500 g than those receiving no intervention or placebo (RR 0.40; 95% CI 0.24 to 0.67, moderate quality).In terms of other outcomes, there were no clear differences in caesarean section (RR 0.95; 95% CI 0.69 to 1.31; two trials; 312 women); stillbirths (RR 0.35 95% CI 0.06, 1.99; three trials, 540 women); or neonatal deaths (RR 0.27; 95% CI 0.04, 1.67; two trials, 282 women). There was some indication that vitamin D supplementation increases infant length (mean difference (MD) 0.70, 95% CI -0.02 to 1.43; four trials, 638 infants) and head circumference at birth (MD 0.43, 95% CI 0.03 to 0.83; four trials, 638 women). Vitamin D and calcium versus no supplementation or a placeboWomen who received vitamin D with calcium had a lower risk of pre-eclampsia than those not receiving any intervention (RR 0.51; 95% CI 0.32 to 0.80; three trials; 1114 women, moderate quality), but also an increased risk of preterm birth (RR 1.57; 95% CI 1.02 to 2.43, three studies, 798 women, moderate quality). Maternal vitamin D concentration at term, gestational diabetes, adverse effects and low birthweight were not reported in any trial or reported only by one study. AUTHORS' CONCLUSIONS New studies have provided more evidence on the effects of supplementing pregnant women with vitamin D alone or with calcium on pregnancy outcomes. Supplementing pregnant women with vitamin D in a single or continued dose increases serum 25-hydroxyvitamin D at term and may reduce the risk of pre-eclampsia, low birthweight and preterm birth. However, when vitamin D and calcium are combined, the risk of preterm birth is increased. The clinical significance of the increased serum 25-hydroxyvitamin D concentrations is still unclear. In light of this, these results need to be interpreted with caution. Data on adverse effects were lacking in all studies.The evidence on whether vitamin D supplementation should be given as a part of routine antenatal care to all women to improve maternal and infant outcomes remains unclear. While there is some indication that vitamin D supplementation could reduce the risk of pre-eclampsia and increase length and head circumference at birth, further rigorous randomised trials are required to confirm these effects.
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Affiliation(s)
- Luz Maria De-Regil
- Research and Evaluation, Micronutrient Initiative, 180 Elgin Street, Suite 1000, Ottawa, ON, Canada, K2P 2K3
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81
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El-Sagheer GM, Kasem A, Shawky IM, Abdel-Fadeel A. Vitamin D Deficiency and Gestational Diabetes Mellitus in Egyptian Women. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojemd.2016.62015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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82
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Triunfo S, Lanzone A. Potential impact of maternal vitamin D status on obstetric well-being. J Endocrinol Invest 2016; 39:37-44. [PMID: 26062522 DOI: 10.1007/s40618-015-0330-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/01/2015] [Indexed: 01/23/2023]
Abstract
Despite its discovery 100 years ago, vitamin D (VD) has emerged as one of the most controversial nutrients and prohormones of the 21st century. In the past few years, a growing interest in VD has been observed in the biomedical literature due to evidences demonstrating a relevant relationship not only between regulation of calcium and phosphorus homeostasis, but also multiple disease states and low VD status in the population. Indeed, several studies carried out to decipher its role in the body in almost every cell, tissue, and different organs. Recent findings suggested a significant implication of VD in different physiologic processes , such as vascular health, immune function, metabolism, and placental function. In the attempt to focus the attention on effect of VD on female reproductive health, there has been a paucity of data from randomized controlled trials to establish clear beneficial. Human and animal data suggest that low VD status is associated with impaired fertility, endometriosis, and polycystic ovary syndrome. Findings from observational studies show higher rates of preeclampsia, gestational diabetes, preterm birth, and bacterial vaginosis in women with low VD levels. By recent evidences, this review explored the association between maternal VD status and selected effects on maternal, perinatal, and infant health, and the impact of VD supplementation during pregnancy on obstetric well-being.
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Affiliation(s)
- S Triunfo
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Sabino de Arana, 1 08028, Barcelona, Spain.
| | - A Lanzone
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Nobles CJ, Markenson G, Chasan-Taber L. Early pregnancy vitamin D status and risk for adverse maternal and infant outcomes in a bi-ethnic cohort: the Behaviors Affecting Baby and You (B.A.B.Y.) Study. Br J Nutr 2015; 114:2116-28. [PMID: 26507186 PMCID: PMC5653966 DOI: 10.1017/s0007114515003980] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Vitamin D deficiency is common during pregnancy and higher in Hispanic as compared with non-Hispanic white women. However, the association between vitamin D deficiency and adverse pregnancy outcomes remains unclear and may vary across ethnic groups, in part because of genetic variation in the metabolism of vitamin D. Few studies have included Hispanic women. Therefore, we investigated this association among 237 participants in the Behaviors Affecting Baby and You Study, a randomised trial of an exercise intervention among ethnically diverse prenatal care patients in Massachusetts. Baseline serum 25-hydroxyvitamin D (25(OH)D) was measured at 15·2 (sd 4·7) weeks' gestation. Information on adverse pregnancy outcomes was abstracted from medical records. Mean 25(OH)D was 30·4 (sd 12·0) ng/ml; 53·2 % of participants had insufficient (<30 ng/ml) and 20·7 % had deficient (<20 ng/ml) 25(OH)D levels. After adjusting for month of blood draw, gestational age at blood draw, gestational age at delivery, age, BMI and Hispanic ethnicity, women with insufficient and deficient vitamin D had infants with birth weights 139·74 (se 69·16) g (P=0·045) and 175·52 (se 89·45) g (P=0·051) lower compared with women with sufficient vitamin D levels (≥30 ng/ml). Each 1 ng/ml increase in 25(OH)D was associated with an increased risk for gestational diabetes mellitus among Hispanic women only (relative risk 1·07; 95 % CI 1·03, 1·11) in multivariable analysis. We did not observe statistically significant associations between maternal vitamin D status and other pregnancy outcomes. Our findings provide further support for an adverse impact of vitamin D deficiency on birth weight in Hispanic women.
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Affiliation(s)
- Carrie J. Nobles
- Department of Biostatistics and Epidemiology, School of Public Health & Health Sciences, Division of Biostatistics & Epidemiology, University of Massachusetts, Amherst, MA 01003-9304, USA
| | - Glenn Markenson
- Baystate Medical Center, Division of Maternal-Fetal Medicine, Springfield, MA 01199, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, School of Public Health & Health Sciences, Division of Biostatistics & Epidemiology, University of Massachusetts, Amherst, MA 01003-9304, USA
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Jafarzadeh L, Motamedi A, Behradmanesh M, Hashemi R. A COMPARISON OF SERUM LEVELS OF 25-HYDROXY VITAMIN D IN PREGNANT WOMEN AT RISK FOR GESTATIONAL DIABETES MELLITUS AND WOMEN WITHOUT RISK FACTORS. Mater Sociomed 2015; 27:318-22. [PMID: 26622198 PMCID: PMC4639343 DOI: 10.5455/msm.2015.27.318-322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023] Open
Abstract
Background: During pregnancy, Low serum 25-hydroxyvitamin-D [25(OH)D] concentration is even more critical. This deficiency leads to higher incidences of preeclampsia, gestational diabetes, preterm birth, bacterial vaginosis, and also affects the health of the infants. The aim of this study was to evaluate the relationships between serum levels of 25-hydroxyvitamin D (25[OH]D) and gestational diabetes mellitus (GDM) and differences in high-risk pregnant women and women without risk factors for GDM. Methods: This cross sectional study including 155 pregnant women, who are still in the first trimester of pregnancy (less than 12 weeks gestation), were randomized to two groups of high and low risk for GDM. For these people, once at the gestational age less than 12 times a week and once at for 24 to 28 weeks of pregnancy, tests of FBS / BS / HbA1C / 25OHD / insulin / Ca / Albumin was requested. Besides, the OGTT test was performed with 75 g glucose at 24 and 28 weeks of pregnancy to diagnose GDM. Results: Serum levels of 25(OH)D in the second trimester of pregnancy ng / ml (24.1 ± 39.5) was significantly lower than that of the first trimester ng / ml (25.9 ± 45.6) (p <0.001). But serum 25(OH)D levels in the first and second trimester of pregnancy was significantly different in women at high risk for GDM than women who had no risk factors (p =0.584 and p =0.99). Serum levels of 25(OH)D has an inverse and significant relationship with HbA1C at the beginning of pregnancy (p=0.007). In addition, a significant and inverse relationship was shown between serum levels of 25(OH)D in the second trimester with insulin (p=0.047) and blood sugar 2 hours after ingestion of 75 g glucose (p=0.045) at 24-28 weeks of gestation. Conclusion: Regarding to the relationship between serum levels of 25(OH)D and blood sugar and insulin at the second trimester of pregnancy, it is recommended for pregnant women to take vitamin D supplementation.
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Affiliation(s)
- Lobat Jafarzadeh
- Department of Obstetrics and Gynecology, Shahrekord University of Medical Science, Shahrekord, Iran
| | - Akram Motamedi
- Faculty of medicine, Shahrekord University of Medical Science, Shahrekord, Iran
| | | | - Raziyeh Hashemi
- School of medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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85
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Vitamin D Deficiency Increases the Risk of Gestational Diabetes Mellitus: A Meta-Analysis of Observational Studies. Nutrients 2015; 7:8366-75. [PMID: 26437429 PMCID: PMC4632418 DOI: 10.3390/nu7105398] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 02/07/2023] Open
Abstract
The results investigating the relationship between vitamin D levels and gestational diabetes mellitus (GDM) are inconsistent. Thus, we focused on evaluating the association of vitamin D deficiency with GDM by conducting a meta-analysis of observed studies. A systematic literature search was conducted via PubMed, MEDLINE, and Cochrane library to identify eligible studies before August 2015. The meta-analysis of 20 studies including 9209 participants showed that women with vitamin D deficiency experienced a significantly increased risk for developing GDM (odds ratio (OR) = 1.53; 95% confidence intervals (CI), 1.33, 1.75) with a little heterogeneity (I2 = 16.20%, p = 0.252). A noteworthy decrease of 4.93 nmol/L (95% CI, −6.73, −3.14) in serum 25(OH)D was demonstrated in the participants with GDM, and moderate heterogeneity was observed (I2 = 61.40%, p = 0.001). Subgroup analysis with study design showed that there were obvious heterogeneities in nested case–control studies (I2 > 52.5%, p < 0.07). Sensitivity analysis showed that exclusion of any single study did not materially alter the overall combined effect. In summary, the evidence from this meta-analysis indicates a consistent association between vitamin D deficiency and an increased risk of GDM. However, well-designed randomized controlled trials are needed to elicit the clear effect of vitamin D supplementation on prevention of GDM.
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86
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The effects of maternal vitamin D on neonatal growth parameters. Eur J Pediatr 2015; 174:1169-74. [PMID: 25800497 DOI: 10.1007/s00431-015-2517-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/05/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Vitamin D facilitates calcium absorption and bone building. Presence of vitamin D is highly important in pregnant women due to its effect on the development of the fetal skeleton. The study population comprised 208 low-risk pregnant women of a heterogeneous population. Maternal and fetal serum concentrations of vitamin D were measured using the Liaison 25(OH)D Assay (DiaSorin, Italy). CONCLUSION Maternal vitamin D serum concentrations correlate with neonatal vitamin D serum concentrations but do not affect neonatal weight and/or head circumference. WHAT IS KNOWN? • Vitamin D is known to be also involved in immunomodulation and cellular proliferation and differentiation. • Vitamin D is highly important in pregnant women for its effect on fetal musculoskeletal and neurological development. WHAT IS NEW? • No association was detected between maternal or neonatal vitamin D concentration with neonatal growth parameters or obstetrical complications, and no association was found between maternal vitamin D serum concentrations and maternal obstetrical complication rate. • A strong correlation was demonstrated between maternal and neonatal serum vitamin D concentrations.
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87
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Moon RJ, Harvey NC, Cooper C. ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the fetal skeleton. Eur J Endocrinol 2015; 173:R69-83. [PMID: 25862787 PMCID: PMC4968635 DOI: 10.1530/eje-14-0826] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/10/2015] [Indexed: 12/28/2022]
Abstract
Vitamin D status has been increasingly associated with wide-ranging clinical outcomes. There is now a wealth of observational studies reporting on its associations with obstetric complications, including pre-eclampsia, gestational diabetes and the mode and timing of delivery. The findings are inconsistent, and currently there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. This is similarly true with regards to fetal development, including measures of fetal size and skeletal mineralisation. Overall, there is an indication of possible benefits of vitamin D supplementation during pregnancy for offspring birthweight, calcium concentrations and bone mass as well as for reduced maternal pre-eclampsia. However, for none of these outcomes is the current evidence base conclusive, and the available data justify the instatement of high-quality randomised placebo controlled trials in a range of populations and health care settings to establish the potential efficacy and safety of vitamin D supplementation to improve particular outcomes.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
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88
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Yeow TP, Lim SL, Hor CP, Khir AS, Wan Mohamud WN, Pacini G. Impact of Vitamin D Replacement on Markers of Glucose Metabolism and Cardio-Metabolic Risk in Women with Former Gestational Diabetes--A Double-Blind, Randomized Controlled Trial. PLoS One 2015; 10:e0129017. [PMID: 26057782 PMCID: PMC4461258 DOI: 10.1371/journal.pone.0129017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 05/04/2015] [Indexed: 02/01/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) and vitamin D deficiency are related to insulin resistance and impaired beta cell function, with heightened risk for future development of diabetes. We evaluated the impact of vitamin D supplementation on markers of glucose metabolism and cardio metabolic risk in Asian women with former GDM and hypovitaminosis D. In this double blind, randomized controlled trial, 26 participants were randomized to receive either daily 4000 IU vitamin D3 or placebo capsules. 75g Oral Glucose Tolerance Test (OGTT) and biochemistry profiles were performed at baseline and 6 month visits. Mathematical models, using serial glucose, insulin and C peptide measurements from OGTT, were employed to calculate insulin sensitivity and beta cell function. Thirty three (76%) women with former GDM screened had vitamin D level of <50 nmol/L at baseline. Supplementation, when compared with placebo, resulted in increased vitamin D level (+51.1 nmol/L vs 0.2 nmol/L, p<0.001) and increased fasting insulin (+20% vs 18%, p = 0.034). The vitamin D group also demonstrated a 30% improvement in disposition index and an absolute 0.2% (2 mmol/mol) reduction in HbA1c. There was no clear change in insulin sensitivity or markers of cardio metabolic risk. This study highlighted high prevalence of vitamin D deficiency among Asian women with former GDM. Six months supplementation with 4000 IU of vitamin D3 safely restored the vitamin D level, improved basal pancreatic beta-cell function and ameliorated the metabolic state. There was no effect on markers of cardio metabolic risk. Further mechanistic studies exploring the role of vitamin D supplementation on glucose homeostasis among different ethnicities may be needed to better inform future recommendations for these women with former GDM at high risk of both hypovitaminosis D and future diabetes.
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Affiliation(s)
- Toh Peng Yeow
- Department of Medicine, Penang Medical College, Penang, Malaysia
- Steno Diabetes Centre, Gentofte, Denmark
- * E-mail:
| | - Shueh Lin Lim
- Department of Medicine, Penang General Hospital, Penang, Malaysia
| | - Chee Peng Hor
- Clinical Research Centre, Seberang Jaya Hospital, Seberang Jaya, Penang, Malaysia
- Kepala Batas Hospital, Kepala Batas, Penang, Malaysia
| | - Amir S. Khir
- Department of Medicine, Penang Medical College, Penang, Malaysia
- Department of Medicine, Penang General Hospital, Penang, Malaysia
| | - Wan Nazaimoon Wan Mohamud
- Cardiovascular, Diabetes and Nutrition Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Giovanni Pacini
- Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy
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89
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Park S, Yoon HK, Ryu HM, Han YJ, Lee SW, Park BK, Park SY, Yim CH, Kim SH. Maternal vitamin D deficiency in early pregnancy is not associated with gestational diabetes mellitus development or pregnancy outcomes in Korean pregnant women in a prospective study. J Nutr Sci Vitaminol (Tokyo) 2015; 60:269-75. [PMID: 25297616 DOI: 10.3177/jnsv.60.269] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The association between vitamin D deficiency in the first trimester and GDM development remains controversial in various ethnicities. We prospectively assessed whether pregnant women with vitamin D deficiency during early pregnancy had an increased likelihood of GDM development or poor fetal growth or pregnancy outcomes compared to those with sufficient vitamin D levels. Serum 25-OH-D measurements and fetal ultrasonograms were carried out at 12-14, 20-22, and 32-34 wk in 523 pregnant women. Each woman was screened for GDM at 24-28 wk. There were no differences in serum 25-OH-D levels at 12-14 wk or 22-24 wk of pregnancy between GDM and non-GDM women after adjusting for maternal age, BMI at prepregnancy, BMI at first visit, BMI at GDM screening, gestational age at sampling, previous history of GDM, vitamin D intake, and seasonal variation in sampling. The risk of GDM, insulin resistance, and impaired β-cell function had no association with serum 25-OH-D levels in crude or adjusted logistic regression analysis. GDM was not associated with maternal serum 25-OH-D deficiency during the first trimester or fetal growth during the first and second trimesters. Pregnancy outcomes such as miscarriage, Apgar 1, Apgar 5 and birth weight were independent of maternal serum 25-OH-D levels during the first, second and third trimester of pregnancy. In conclusion, neither GDM prevalence nor fetal growth during pregnancy is associated with vitamin D deficiency at the first trimester in Korean women. Pregnancy outcomes are also independent of maternal vitamin D status.
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Affiliation(s)
- Sunmin Park
- Department of Food & Nutrition, Hoseo University
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90
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Mutlu N, Esra H, Begum A, Fatma D, Arzu Y, Yalcin H, Fatih K, Selahattin K. Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome. Afr Health Sci 2015; 15:523-31. [PMID: 26124799 DOI: 10.4314/ahs.v15i2.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the relationship between maternal vitamin D status and glucose intolerance, and its impact on pregnant women and their newborns. METHODS A cohort of pregnant women were divided into three groups: women with gestational diabetes mellitus, ones with normal results both after the 50 gr and 100 gr OGTT (CG-1) and ones having a positive result after the 50 gr OGTT screening but negative results for gestational diabetes mellitus (GDM) after the 100 gr OGTT (CG-2). RESULTS The newborn length in CG-1 was greater than in GDM and CG-2 (p= 0.002 and p= 0.02). Fasting blood glucose and insulin resistance (IR) were negatively correlated with length of the newborns (r=-0.3, p=0.03 and r=-0.3, p=0.01). The newborns of women with GDM had lower APGAR-1 and 5 scores than those of CG-1 and CG-2 (APGAR-1 p= 0.001 and p= 0.004, APGAR-5 p=0.005 and p=0.007, respectively). APGAR scores were correlated negatively with IR (APGAR-1 r=-0.32, p=0.01, APGAR-5 r=-0.3, p=0.03) and positively with 25OHD levels (APGAR-1 r=0.3, p=0.01, APGAR-5 r=0.3, p=0.02). CONCLUSION Vitamin D deficiency, gestational diabetes and insulin resistance are interrelated. Severe vitamin D deficiency during pregnancy is associated with poor pregnancy and neonatal outcome.
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91
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Vitamin D Status in Women with Gestational Diabetes Mellitus during Pregnancy and Postpartum. BIOMED RESEARCH INTERNATIONAL 2015; 2015:260624. [PMID: 26000285 PMCID: PMC4427001 DOI: 10.1155/2015/260624] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/30/2015] [Accepted: 02/11/2015] [Indexed: 02/08/2023]
Abstract
Of many vitamin D extraskeletal functions, its modulatory role in insulin secretion and action is especially relevant for gestational diabetes mellitus (GDM). The aims of the present study were to determine midgestational and early postpartum vitamin D status in pregnant women with and without GDM and to describe the relationship between midgestational and postpartum vitamin D status and parallel changes of glucose tolerance. A total of 76 pregnant women (47 GDM and 29 healthy controls) were included in the study. Plasma levels of 25(OH)D were measured using an enzyme immunoassay. Vitamin D was not significantly decreased in GDM compared to controls during pregnancy; however, both groups of pregnant women exhibited high prevalence of vitamin D deficiency. Prevalence of postpartum 25(OH)D deficiency in post-GDM women remained significantly higher and their postpartum 25(OH)D levels were significantly lower compared to non-GDM counterparts. Finally, based on the oGTT repeated early postpartum persistent glucose abnormality was ascertained in 15% of post-GDM women; however, neither midgestational nor postpartum 25(OH)D levels significantly differed between subjects with GDM history and persistent postpartum glucose intolerance and those with normal glucose tolerance after delivery.
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92
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The pleiotropic effects of vitamin D in gynaecological and obstetric diseases: an overview on a hot topic. BIOMED RESEARCH INTERNATIONAL 2015; 2015:986281. [PMID: 26000308 PMCID: PMC4426767 DOI: 10.1155/2015/986281] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/17/2015] [Accepted: 01/20/2015] [Indexed: 12/31/2022]
Abstract
The traditionally recognized role of vitamin D consists in the regulation of bone metabolism and calcium-phosphorus homeostasis but recently a lot of in vitro and in vivo studies recognized several “noncalcemic” effects of vitamin D metabolites. Accumulating evidence suggests that the metabolic pathways of this vitamin may play a key role in the developing of gynaecological/obstetric diseases. VDR-mediated signalling pathways and vitamin D levels seem to (deeply) affect the risk of several gynaecological diseases, such as polycystic ovary syndrome (PCOS), endometriosis, and ovarian and even breast cancer. On the other hand, since also the maternal-fetal unit is under the influence of vitamin D, a breakdown in its homeostasis may underlie infertility, preeclampsia, and gestational diabetes mellitus (GDM). According to our literature review, the relationship between vitamin D and gynaecological/obstetric diseases must be replicated in future studies which could clarify the molecular machineries behind their development. We suggest that further investigation should take into account the different serum levels of this vitamin, the several actions which arise from the binding between it and its receptor (taking into account its possible polymorphism), and finally the interplay between vitamin D metabolism and other hormonal and metabolic pathways.
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93
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Flood-Nichols SK, Tinnemore D, Huang RR, Napolitano PG, Ippolito DL. Vitamin D deficiency in early pregnancy. PLoS One 2015; 10:e0123763. [PMID: 25898021 PMCID: PMC4405493 DOI: 10.1371/journal.pone.0123763] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/23/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Vitamin D deficiency is a common problem in reproductive-aged women in the United States. The effect of vitamin D deficiency in pregnancy is unknown, but has been associated with adverse pregnancy outcomes. The objective of this study was to analyze the relationship between vitamin D deficiency in the first trimester and subsequent clinical outcomes. Study Design This is a retrospective cohort study. Plasma was collected in the first trimester from 310 nulliparous women with singleton gestations without significant medical problems. Competitive enzymatic vitamin D assays were performed on banked plasma specimens and pregnancy outcomes were collected after delivery. Logistic regression was performed on patients stratified by plasma vitamin D concentration and the following combined clinical outcomes: preeclampsia, preterm delivery, intrauterine growth restriction, gestational diabetes, and spontaneous abortion. Results Vitamin D concentrations were obtained from 235 patients (mean age 24.3 years, range 18-40 years). Seventy percent of our study population was vitamin D insufficient with a serum concentration less than 30 ng/mL (mean serum concentration 27.6 ng/mL, range 13-71.6 ng/mL). Logistic regression was performed adjusting for age, race, body mass index, tobacco use, and time of year. Adverse pregnancy outcomes included preeclampsia, growth restriction, preterm delivery, gestational diabetes, and spontaneous abortion. There was no association between vitamin D deficiency and composite adverse pregnancy outcomes with an adjusted odds ratio of 1.01 (p value 0.738, 95% confidence intervals 0.961-1.057). Conclusion Vitamin D deficiency did not associate with adverse pregnancy outcomes in this study population. However, the high percentage of affected individuals highlights the prevalence of vitamin D deficiency in young, reproductive-aged women.
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Affiliation(s)
- Shannon K. Flood-Nichols
- Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
- * E-mail:
| | - Deborah Tinnemore
- Department of Clinical Investigation, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
| | - Raywin R. Huang
- Department of Clinical Investigation, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
| | - Peter G. Napolitano
- Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
| | - Danielle L. Ippolito
- Department of Clinical Investigation, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, Washington, United States of America
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94
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Jao J, Freimanis L, Mussi-Pinhata MM, Cohen RA, Monteiro JP, Cruz ML, Sperling RS, Branch A, Siberry GK. Low vitamin D status among pregnant Latin American and Caribbean women with HIV Infection. Int J Gynaecol Obstet 2015; 130:54-8. [PMID: 25912414 DOI: 10.1016/j.ijgo.2015.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/08/2015] [Accepted: 03/26/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the prevalence and predictors of low vitamin D status among pregnant women with HIV infection. METHODS The present cross-sectional study analyzed repository specimens collected at 12-34 weeks of pregnancy among women enrolled across 17 sites in Latin America and the Caribbean between 2002 and 2009. Logistic regression modeling was used to identify factors associated with low vitamin D status (25-hydroxyvitamin D <30 ng/mL). RESULTS Among 715 women, 218 (30.5%) were vitamin D deficient (<20 ng/mL) and 252 (35.2%) were insufficient (21- /mL). Factors associated with low vitamin D status included residence in subtropical latitudes (adjusted odds ratio [aOR] 1.97, 95% confidence interval [CI] 1.35-2.88), assessment during non-summer seasons (autumn: aOR 1.85, 95% CI 1.20-2.86; spring: 4.3, 2.65-6.95; winter: 10.82, 5.74-20.41), employment (aOR 1.56, 95% CI 1.06-2.38), and assessment before 20 weeks of pregnancy (aOR 1.89, 95% CI 1.18-3.06). Factors protective against low vitamin D status were CD4 count below 200 cells per mm(3) (aOR 0.45, 95% CI 0.26-0.77) and protease inhibitors (aOR 0.62, 95% CI 0.40-0.95). CONCLUSION Low vitamin D status was prevalent among pregnant women with HIV infection. Further studies are warranted to identify the impact of low maternal vitamin D status.
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Affiliation(s)
- Jennifer Jao
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | | | | | - Maria L Cruz
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Rhoda S Sperling
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Branch
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George K Siberry
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Pediatric Infectious Disease Branch, Bethesda, MD, USA
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95
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Poomalar GK. Changing trends in management of gestational diabetes mellitus. World J Diabetes 2015; 6:284-95. [PMID: 25789109 PMCID: PMC4360421 DOI: 10.4239/wjd.v6.i2.284] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/18/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control than older insulins. Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control. Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes. As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high, regular assessment of these women is required in future. Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome.
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96
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Gui J, Rohrbach A, Borns K, Hillemanns P, Feng L, Hubel CA, von Versen-Höynck F. Vitamin D rescues dysfunction of fetal endothelial colony forming cells from individuals with gestational diabetes. Placenta 2015; 36:410-8. [PMID: 25684656 DOI: 10.1016/j.placenta.2015.01.195] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/20/2015] [Accepted: 01/24/2015] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Gestational diabetes (GDM) is associated with long-term cardiovascular and metabolic diseases in offspring. However, the mechanisms are not well understood. We explored whether fetal exposure to a diabetic environment is associated with fetal endothelial progenitor cell dysfunction, and whether vitamin D can reverse the impairment. METHODS Nineteen women with uncomplicated pregnancies and 18 women with GDM were recruited before delivery. Time to first appearance of endothelial colony forming cell (ECFC) colonies and number of ECFC colonies formed from culture of cord peripheral blood mononuclear cells were determined. Angiogenesis-related functions of ECFCs in vitro were tested in the presence or absence of vitamin D. RESULTS Fetal ECFCs from GDM pregnancies formed fewer colonies in culture (P = 0.04) and displayed reduced proliferation (P = 0.02), migration (P = 0.04) and tubule formation (P = 0.03) compared to uncomplicated pregnancies. Fetal ECFCs exposed to hyperglycemia in vitro exhibited less migration (P < 0.05) and less tubule formation (P < 0.05) than normoglycemic control. Vitamin D significantly improved the dysfunction of fetal ECFCs from pregnancies complicated by GDM or after exposure of healthy ECFCs to hyperglycemia. DISCUSSION Fetal ECFCs from GDM pregnancies or ECFCs exposed to hyperglycemia in vitro exhibit reduced quantity and impaired angiogenesis-related functions. Vitamin D significantly rescues these functions. These findings may have implications for vascular function of infants exposed to a diabetic intrauterine environment.
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Affiliation(s)
- J Gui
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - A Rohrbach
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
| | - K Borns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
| | - P Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
| | - L Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - C A Hubel
- Magee-Womens Research Institute and Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - F von Versen-Höynck
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
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97
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Olmos-Ortiz A, Avila E, Durand-Carbajal M, Díaz L. Regulation of calcitriol biosynthesis and activity: focus on gestational vitamin D deficiency and adverse pregnancy outcomes. Nutrients 2015; 7:443-80. [PMID: 25584965 PMCID: PMC4303849 DOI: 10.3390/nu7010443] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023] Open
Abstract
Vitamin D has garnered a great deal of attention in recent years due to a global prevalence of vitamin D deficiency associated with an increased risk of a variety of human diseases. Specifically, hypovitaminosis D in pregnant women is highly common and has important implications for the mother and lifelong health of the child, since it has been linked to maternal and child infections, small-for-gestational age, preterm delivery, preeclampsia, gestational diabetes, as well as imprinting on the infant for life chronic diseases. Therefore, factors that regulate vitamin D metabolism are of main importance, especially during pregnancy. The hormonal form and most active metabolite of vitamin D is calcitriol. This hormone mediates its biological effects through a specific nuclear receptor, which is found in many tissues including the placenta. Calcitriol synthesis and degradation depend on the expression and activity of CYP27B1 and CYP24A1 cytochromes, respectively, for which regulation is tissue specific. Among the factors that modify these cytochromes expression and/or activity are calcitriol itself, parathyroid hormone, fibroblast growth factor 23, cytokines, calcium and phosphate. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes.
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Affiliation(s)
- Andrea Olmos-Ortiz
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico.
| | - Euclides Avila
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico.
| | - Marta Durand-Carbajal
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico.
| | - Lorenza Díaz
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico.
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. Med J Aust 2015; 199:S1-S46. [PMID: 25370432 DOI: 10.5694/j.1326-5377.2013.tb04225.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/02/2012] [Indexed: 12/14/2022]
Abstract
Osteoporosis imposes a tremendous burden on Australia: 1.2 million Australians have osteoporosis and 6.3 million have osteopenia. In the 2007–08 financial year, 82 000 Australians suffered fragility fractures, of which > 17 000 were hip fractures. In the 2000–01 financial year, direct costs were estimated at $1.9 billion per year and an additional $5.6 billion on indirect costs. Osteoporosis was designated a National Health Priority Area in 2002; however, implementation of national plans has not yet matched the rhetoric in terms of urgency. Building healthy bones throughout life, the Osteoporosis Australia strategy to prevent osteoporosis throughout the life cycle, presents an evidence-informed set of recommendations for consumers, health care professionals and policymakers. The strategy was adopted by consensus at the Osteoporosis Australia Summit in Sydney, 20 October 2011. Primary objectives throughout the life cycle are: to maximise peak bone mass during childhood and adolescence to prevent premature bone loss and improve or maintain muscle mass, strength and functional capacity in healthy adults to prevent and treat osteoporosis in order to minimise the risk of suffering fragility fractures, and reduce falls risk, in older people. The recommendations focus on three affordable and important interventions — to ensure people have adequate calcium intake, vitamin D levels and appropriate physical activity throughout their lives. Recommendations relevant to all stages of life include: daily dietary calcium intakes should be consistent with Australian and New Zealand guidelines serum levels of vitamin D in the general population should be above 50nmol/L in winter or early spring for optimal bone health regular weight-bearing physical activity, muscle strengthening exercises and challenging balance/mobility activities should be conducted in a safe environment.
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Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC, Australia.
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC, Australia
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA, Australia
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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El Lithy A, Abdella RM, El-Faissal YM, Sayed AM, Samie RMA. The relationship between low maternal serum vitamin D levels and glycemic control in gestational diabetes assessed by HbA1c levels: an observational cross-sectional study. BMC Pregnancy Childbirth 2014; 14:362. [PMID: 25308347 PMCID: PMC4287592 DOI: 10.1186/1471-2393-14-362] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 10/06/2014] [Indexed: 12/01/2022] Open
Abstract
Background A great association between vitamin D deficiency and type 2 diabetes mellitus has been suggested in literature. During pregnancy, this deficiency is even more critical. It appears that vitamin D insufficiency during pregnancy may be associated with maternal hazards. The aim of this study was to assess the relation between the levels of 25-hydroxy-cholecalciferol (vitamin D), and the glycemic control in pregnant women. Methods An observational cross-section study including 160 pregnant women between 20-40 years in age, in their third trimester, divided into two equal groups. First group consisted of 80 women with established diagnosis of gestational diabetes and the second group with proved normal blood glucose levels. We assessed vitamin D in serum, fasting blood glucose, serum insulin and glycosylated hemoglobin (HbA1c) levels and we depicted the insulin sensitivity using the Quantitative insulin sensitivity check index (Quicki). The results were collected and statistically correlated. Results The mean vitamin D levels were 46.61 ± 6.087 and 47.25 ± 10.181in controls and women with gestational diabetes mellitus (GDM) respectively. The fasting insulin levels were significantly higher in the group with GDM with a mean of 18.51 ± 6.44 compared to 8.95 ± 2.52 in the control group. The correlation coefficient (r) between HbA1c levels and Vitamin D level was -0.492 with a P value <0.05. Similar associations were also found with the fasting blood sugar levels (r = - 0.386) and with Quicki values (r = -0.250). Vitamin D levels correlated significantly with the fasting blood glucose, the fasting serum insulin and the HbA1c levels, the P value in all these correlations were <0.05. The P value with Quicki results was 0.064. Conclusions There is a statistically significant negative correlation between the glycemic control and vitamin D levels in serum in the whole study population. The effect of adequate vitamin D replacement on glycemic control was not studied in our work correlation. We suggest larger scale studies addressing this issue.
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