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Taiorazova GB, Alimbayeva AR, Tanatarov SZ, Smailova ZK. A Modern Look at the Development of Intrauterine Pneumonia in Premature Newborns: Literature Review. Respir Physiol Neurobiol 2023; 314:104073. [PMID: 37178744 DOI: 10.1016/j.resp.2023.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Infectious diseases such as malaria, pneumonia, diarrhea and preventable neonatal diseases are common causes of death in children. Globally, neonatal mortality is 44% (2.9 million) annually, with up to 50% of babies dying within the first day of life. Pneumonia kills between 750000 and 1.2 million infants in the neonatal period each year in developing countries. Premature birth, pneumonia, and labor complications are common causes of neonatal mortality. The objective of the study is to present the general characteristics of congenital pneumonia, vitamin D deficiency and micronutrient deficiencies in premature infants. To date, numerous studies confirm the relationship between the inadequate supply of the body with macro- and microelements and the development of diseases of varying severity, including metabolic disorders. Based on this, primary screening, aimed at identifying metabolic disorders of macro- and microelements and further drug correction, should become the main concept for the management of patients in modern times.
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Affiliation(s)
- Gulnara B Taiorazova
- Department of Pediatrics and Medical Rehabilitation named after D.M. Tusupova, Semey Medical University, Semey, Republic of Kazakhstan.
| | - Aliya R Alimbayeva
- Department of Pediatrics and Medical Rehabilitation named after D.M. Tusupova, Semey Medical University, Semey, Republic of Kazakhstan
| | - Sayat Z Tanatarov
- Department of Аnesthesiology, Resuscitation and Narcology, Semey Medical University, Semey, Republic of Kazakhstan
| | - Zhanargul K Smailova
- Department of Biochemistry and Chemical Disciplines named after Doctor of Medical Sciences, Professor S.O. Tapbergenov, Semey Medical University, Semey, Republic of Kazakhstan
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Luo T, Lin Y, Lu J, Lian X, Guo Y, Han L, Guo Y. Effects of vitamin D supplementation during pregnancy on bone health and offspring growth: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0276016. [PMID: 36227906 PMCID: PMC9560143 DOI: 10.1371/journal.pone.0276016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Whether vitamin D supplementation during pregnancy is beneficial to bone health and offspring growth remains controversial. Moreover, there is no universal agreement regarding the appropriate dose and the time of commencement of vitamin D supplementation during pregnancy. OBJECTIVE We aimed to systematically review the effects of vitamin D supplementation during pregnancy on bone development and offspring growth. METHODS A literature search for randomized controlled trials (RCTs) was performed in 7 electronic databases to identify relevant studies about the effects of vitamin D supplementation during pregnancy on bone development and offspring growth from inception to May 22, 2022. A Cochrane Risk Assessment Tool was used for quality assessment. Vitamin D supplementation was compared with placebo or standard supplements. The effects are presented as the mean differences (MDs) with 95% CIs. The outcomes include bone mineral content (BMC), bone mineral density (BMD), bone area (BA), femur length (FL) and humeral length (HL); measurement indicators of growth, including length, weight and head circumference; and secondary outcome measures, including biochemical indicators of bone health, such as the serum 25(OH)D concentration. Additionally, subgroup analyses were carried out to evaluate the impact of different doses and different initiation times of supplementation with vitamin D. RESULTS Twenty-three studies with 5390 participants met our inclusion criteria. Vitamin D supplementation during pregnancy was associated with increased humeral length (HL) (MD 0.13, 95% CI 0.06, 0.21, I2 = 0, P = 0.0007) during the fetal period (third trimester). Vitamin D supplementation during pregnancy was associated with a significantly increased length at birth (MD 0.14, 95% CI 0.04, 0.24, I2 = 24%, P = 0.005) and was associated with a higher cord blood 25(OH)D concentration (MD 48.74, 95% CI 8.47, 89.01, I2 = 100%, P = 0.02). Additionally, subgroup analysis revealed that birth length was significantly higher in the vitamin D intervention groups of ≤1000 IU/day and ≥4001 IU/day compared with the control group. Prenatal (third trimester) vitamin D supplementation was associated with a significant increase in birth length, while prenatal (second trimester) vitamin D supplementation was associated with a significant increase in birth weight. CONCLUSION Vitamin D supplementation during pregnancy may be associated with increased humeral length (HL) in the uterus, increased body length at birth and higher cord blood 25(OH)D concentration. Evidence of its effect on long-term growth in children is lacking. Additional rigorous high-quality, long-term and larger randomized trials are required to more fully investigate the effects of vitamin D supplementation during pregnancy.
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Affiliation(s)
- Ting Luo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, People’s Republic of China
| | - Yunzhu Lin
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, People’s Republic of China
- * E-mail:
| | - Jiayue Lu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, People’s Republic of China
| | - Xianghong Lian
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, People’s Republic of China
| | - Yuanchao Guo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, People’s Republic of China
| | - Lu Han
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, People’s Republic of China
| | - Yixin Guo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, People’s Republic of China
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Razaghi M, Gharibeh N, Vanstone CA, Sotunde OF, Khamessan A, Wei SQ, McNally D, Rauch F, Jones G, Kimmins S, Weiler HA. Correction of neonatal vitamin D status using 1000 IU vitamin D/d increased lean body mass by 12 months of age compared with 400 IU/d: a randomized controlled trial. Am J Clin Nutr 2022; 115:1612-1625. [PMID: 35441210 PMCID: PMC9170472 DOI: 10.1093/ajcn/nqab431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/29/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Intrauterine exposure to maternal vitamin D status <50 nmol/L of serum 25-hydroxyvitamin D [25(OH)D] may adversely affect infant body composition. Whether postnatal interventions can reprogram for a leaner body phenotype is unknown. OBJECTIVES The primary objective was to test whether 1000 IU/d of supplemental vitamin D (compared with 400 IU/d) improves lean mass in infants born with serum 25(OH)D <50 nmol/L. METHODS Healthy, term, breastfed infants (Montréal, Canada, March 2016-2019) were assessed for serum 25(OH)D (immunoassay) 24-36 h postpartum. Infants with serum 25(OH)D <50nmol/L at 24-36 h were eligible for the trial and randomly assigned at baseline (1 mo postpartum) to 400 (29 males, 20 females) or 1000 IU/d (29 males, 20 females) of vitamin D until 12 mo. Infants (23 males, 18 females) with 25(OH)D ≥50 nmol/L (sufficient) formed a nonrandomized reference group provided 400 IU/d. Anthropometry, body composition (DXA), and serum 25(OH)D concentrations were measured at 1, 3, 6, and 12 mo. RESULTS At baseline, mean ± SD serum 25(OH)D concentrations in infants allocated to the 400 and 1000 IU/d vitamin D groups were 45.8 ± 14.1 and 47.6 ± 13.4, respectively; for the reference group it was 69.2 ± 16.4 nmol/L. Serum 25(OH)D concentration increased on average to ≥50 nmol/L in the trial groups at 3-12 mo. Lean mass varied differently between groups over time; at 12 mo it was higher in the 1000 IU/d vitamin D group than in the 400 IU/d group (mean ± SD: 7013 ± 904.6 compared with 6690.4 ± 1121.7 g, P = 0.0428), but not the reference group (mean ± SD: 6715.1 ± 784.6 g, P = 0.19). Whole-body fat mass was not different between the groups over time. CONCLUSIONS Vitamin D supplementation (400 or 1000 IU/d) during infancy readily corrects vitamin D status, whereas 1000 IU/d modestly increases lean mass by 12 mo. The long-term implications require further research. This trial was registered at clinicaltrials.gov as NCT02563015.
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Affiliation(s)
- Maryam Razaghi
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Nathalie Gharibeh
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Catherine A Vanstone
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Olusola F Sotunde
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Ali Khamessan
- Quality & Regulatory Affairs, Europharm International Canada Inc., Montréal, Québec, Canada
| | - Shu Q Wei
- Quebec National Institute of Public Health (INSPQ), Montréal, Québec, Canada
| | - Dayre McNally
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Frank Rauch
- Shriners Hospital for Children, Montréal, Québec, Canada
| | - Glenville Jones
- School of Medicine, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sarah Kimmins
- Animal Sciences, Faculty of Agricultural & Environmental Sciences, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Hope A Weiler
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
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Lorenzon F, Gregorio T, Niebisch F, Stolte RCK, Dos Santos GJ, Rafacho A, Lima FB. Maternal vitamin D administration attenuates metabolic disturbances induced by prenatal exposure to dexamethasone in a sex-dependent manner. J Steroid Biochem Mol Biol 2021; 212:105941. [PMID: 34147644 DOI: 10.1016/j.jsbmb.2021.105941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The overexposure to synthetic glucocorticoids (GC) during pregnancy can predispose to metabolic diseases during adulthood. Vitamin D is not only crucial for fetal development, but also exerts direct effects on the GC sensitivity and down-regulates GC receptors. Given the vitamin D effects on glucocorticoid-related parameters, we aimed to investigate a possible protective role of maternal vitamin D administration on the glucose homeostasis of rats exposed to dexamethasone in utero. METHODS Pregnant rats received dexamethasone (0.1 mg/kg, Dex) daily between the 14th and 19th days of pregnancy. A subgroup of dexamethasone-treated dams received oral administration of vitamin D (500UI, DexVD) during the whole gestation. The corresponding control groups of dams were included (CTL and VD groups, respectively). Male and female offspring were evaluated at 3, 6 and 12 months of age. RESULTS Prenatal exposure to dexamethasone caused metabolic disruption in an age and sex-dependent manner being the older male offspring more susceptible to insulin resistance, fatty liver and beta-cell mass expansion than females. Furthermore, we demonstrated that prenatal GC led to glucose intolerance in male and female offspring in an age-dependent manner. Maternal vitamin D administration did not influence glucose intolerance but attenuated the insulin resistance, liver lipid accumulation and prevented the beta-cell mass expansion caused by prenatal dexamethasone in the male offspring. CONCLUSION Maternal vitamin D administration mitigates metabolic disturbances that occur later in life in male rats exposed to GC in utero. Moreover, our data suggest vitamin D as an important nutritional supplement for pregnant overexposed to GC during gestation.
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Affiliation(s)
- Flaviano Lorenzon
- Departamento de Ciências Fisiológicas, Campus Trindade, 88040-900, Florianópolis, SC, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina - UFSC, Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Tamires Gregorio
- Departamento de Ciências Fisiológicas, Campus Trindade, 88040-900, Florianópolis, SC, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina - UFSC, Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Fernanda Niebisch
- Departamento de Ciências Fisiológicas, Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Rafaela C K Stolte
- Departamento de Ciências Fisiológicas, Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Gustavo J Dos Santos
- Departamento de Ciências Fisiológicas, Campus Trindade, 88040-900, Florianópolis, SC, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina - UFSC, Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Alex Rafacho
- Departamento de Ciências Fisiológicas, Campus Trindade, 88040-900, Florianópolis, SC, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina - UFSC, Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Fernanda B Lima
- Departamento de Ciências Fisiológicas, Campus Trindade, 88040-900, Florianópolis, SC, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina - UFSC, Campus Trindade, 88040-900, Florianópolis, SC, Brazil.
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Treiber M, Mujezinović F, Pečovnik Balon B, Gorenjak M, Maver U, Dovnik A. Association between umbilical cord vitamin D levels and adverse neonatal outcomes. J Int Med Res 2021; 48:300060520955001. [PMID: 33044113 PMCID: PMC7555573 DOI: 10.1177/0300060520955001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective We investigated the associations between cord blood concentration of 25-hydroxyvitamin D [25(OH)D], neonatal outcomes, and the risk of hospitalization during the first year of life. Methods A total of 402 newborn infants and their mothers were prospectively enrolled and divided in four groups according to season of the year. We determined 25(OH)D serum concentrations from maternal–neonatal pairs at delivery by electrochemiluminescence immunoassay. Cut-offs at 25, 50, and 75 nmol/L defined vitamin D status, corresponding to deficiency, insufficiency, and sufficiency, respectively. Crude odds ratio (cOR) and 95% confidence intervals (CI) were estimated using logistic regression. Results Vitamin D severe deficiency (i.e., <25 nmol/L) was present in 18% of newborns. Cord blood severe deficiency was associated with an increased risk of preterm birth (cOR 3.6, 95% CI: 1.1–12.2), neonatal respiratory distress syndrome (cOR 5.9, 95% CI: 1.1–33.2), and increased risk of hospitalization during the first year of life because of acute respiratory infection (cOR 3.9, 95% CI: 1.4–10.6) or acute gastroenterocolitis (cOR 5.2, 95% CI: 1.4–19.1). Conclusion Cord blood vitamin D deficiency is associated with increased risk of preterm birth, neonatal respiratory distress syndrome, and hospitalization during the first year of life.
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Affiliation(s)
- M Treiber
- University Clinic for Gynaecology and Perinatology, Maribor University Medical Centre, Maribor, Slovenia
| | - F Mujezinović
- University Clinic for Gynaecology and Perinatology, Maribor University Medical Centre, Maribor, Slovenia
| | - B Pečovnik Balon
- Department of Internal Medicine, University of Maribor Faculty of Medicine, Maribor, Slovenia
| | - M Gorenjak
- Department of Laboratory Diagnostics, University Medical Centre Maribor, Maribor, Slovenia
| | - U Maver
- Department of Pharmacology and Experimental Toxicology, University of Maribor Faculty of Medicine, Maribor, Slovenia
| | - A Dovnik
- University Clinic for Gynaecology and Perinatology, Maribor University Medical Centre, Maribor, Slovenia
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Associations of Vitamin D Deficiency, Parathyroid hormone, Calcium, and Phosphorus with Perinatal Adverse Outcomes. A Prospective Cohort Study. Nutrients 2020; 12:nu12113279. [PMID: 33114615 PMCID: PMC7692385 DOI: 10.3390/nu12113279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022] Open
Abstract
Vitamin D deficiency during pregnancy has been linked to perinatal adverse outcomes. Studies conducted to date have recommended assessing interactions with other vitamin D-related metabolites to clarify this subject. We aimed to evaluate the association of vitamin D deficiency during early pregnancy with preterm birth. Secondary outcomes included low birth weight and small for gestational age. Additionally, we explored the role that parathyroid hormone, calcium and phosphorus could play in the associations. We conducted a prospective cohort study comprising 289 pregnant women in a hospital in Granada, Spain. Participants were followed-up from weeks 10-12 of gestation to postpartum. Serum 25-hydroxyvitamin D, parathyroid hormone, calcium, and phosphorus were measured within the first week after recruitment. Pearson's χ2 test, Mann-Whitney U test, binary and multivariable logistic regression models were used to explore associations between variables and outcomes. 36.3% of the participants were vitamin D deficient (<20 ng/mL). 25-hydroxyvitamin D concentration was inversely correlated with parathyroid hormone (ρ = -0.146, p = 0.013). Preterm birth was associated with vitamin D deficiency in the multivariable model, being this association stronger amongst women with parathyroid hormone serum levels above the 80th percentile (adjusted odds ratio (aOR) = 6.587, 95% CI (2.049, 21.176), p = 0.002). Calcium and phosphorus were not associated with any studied outcome. Combined measurement of 25-hydroxyvitamin D and parathyroid hormone could be a better estimator of preterm birth than vitamin D in isolation.
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Prevalence of Vitamin D Deficiency in a Large Newborn Cohort from Northern United States and Effect of Intrauterine Drug Exposure. Nutrients 2020; 12:nu12072085. [PMID: 32674386 PMCID: PMC7400905 DOI: 10.3390/nu12072085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022] Open
Abstract
Vitamin D is not only a vital element in bone health but is also a prohormone. Data regarding distribution of vitamin D status among preterm and term neonates in the United States are limited. There are no data on the effect of intrauterine drug exposure on vitamin D status. Our objective was to determine the distribution of vitamin D levels among preterm and term neonates and the effect of intrauterine illicit drug exposure. We did a retrospective chart review of neonates admitted from 2009 to 2016 to our neonatal intensive care unit with serum 25-hydroxycholecalciferol (25[OH]D) levels measured during the hospital stay. Of 1517 neonates, the median 25[OH]D level was 19 ng/mL with 31% deficient and 49% insufficient, even though 75% of mothers took prenatal vitamins. In pregnant women, 38% were vitamin-D-deficient and 44% were vitamin-D-insufficient. Four hundred seventy-one neonates had intrauterine drug exposure, with a median 25[OH]D level of 22.9 ng/mL versus 17.8 ng/mL in nonexposed neonates (p = 0.001). Despite maternal prenatal vitamin intake, neonates are at risk of vitamin D deficiency. Maternal illicit drug use was not related to lower 25[OH]D levels in neonates.
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Aguilar-Cordero MJ, Lasserrot-Cuadrado A, Mur-Villar N, León-Ríos XA, Rivero-Blanco T, Pérez-Castillo IM. Vitamin D, preeclampsia and prematurity: A systematic review and meta-analysis of observational and interventional studies. Midwifery 2020; 87:102707. [PMID: 32438283 DOI: 10.1016/j.midw.2020.102707] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Vitamin D has important functions outside of bone metabolism. Deficiency has been associated with several adverse outcomes during pregnancy such as preeclampsia and prematurity. There is an increasing body of literature on this topic with studies performed to date having produced contradictory results. OBJECTIVE To synthesize the literature about vitamin D deficiency and its association with preeclampsia and prematurity in order to determine if maternal vitamin D insufficiency and/or deficiency during pregnancy is associated with the prevalence of preeclampsia and prematurity. DESIGN A systematic review and meta-analysis of observational and interventional studies. METHODS Two independent researchers reviewed the included studies according to PRISMA reporting guidelines. A protocol for this review was registered in PROSPERO with the registration number: "CRD42019136318". Three electronic databases (PubMed, ScienceDirect and Web of Science); were searched in order to identify eligible studies. Observational and interventional studies were selected which had been published in the last 6 years, and analysed the association between maternal vitamin D concentrations during pregnancy and the development of preeclampsia and/or preterm birth. Data were extracted and presented in tables and figures. Fixed and random-effects meta-analyses were performed on the studies which provided enough sample data to calculate odds ratios. Results from both statistical methods were compared. Meta-analysis cut-off points for vitamin D insufficiency and deficiency were defined as <75nmol/L and <50nmol/L, respectively. RESULTS Fifty-five studies met the inclusion criteria. Fixed-effects meta-analysis of the interventional studies indicated that vitamin D supplementation acts as a prevention factor for preeclampsia and prematurity. Fixed-effects meta-analysis of observational studies concluded that vitamin D insufficiency and deficiency are associated with a higher risk of developing preeclampsia. However, prematurity and vitamin D were only associated when maternal vitamin D concentrations was <75 nmol/L. Random-effects meta-analysis found no significant association between vitamin D, preeclampsia and prematurity in either observational or interventional studies. CONCLUSION Higher vitamin D concentrations during pregnancy could be associated with a decreased risk of preeclampsia and prematurity but statistical significance of associations depends on the study design used. Well-designed clinical trials with vitamin D supplementation are needed in order to better define associations.
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Affiliation(s)
- M J Aguilar-Cordero
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain; Andalusian Research, Development and Innovation Plan. CTS 367, University of Granada. Granada, Spain
| | - A Lasserrot-Cuadrado
- Andalusian Research, Development and Innovation Plan. CTS 367, University of Granada. Granada, Spain
| | - N Mur-Villar
- Andalusian Research, Development and Innovation Plan. CTS 367, University of Granada. Granada, Spain; University of Medical Sciences, Cienfuegos, Cuba
| | - X A León-Ríos
- Andalusian Research, Development and Innovation Plan. CTS 367, University of Granada. Granada, Spain
| | - T Rivero-Blanco
- Andalusian Research, Development and Innovation Plan. CTS 367, University of Granada. Granada, Spain
| | - I M Pérez-Castillo
- Andalusian Research, Development and Innovation Plan. CTS 367, University of Granada. Granada, Spain.
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Yu L, Guo Y, Ke HJ, He YS, Che D, Wu JL. Vitamin D Status in Pregnant Women in Southern China and Risk of Preterm Birth: A Large-Scale Retrospective Cohort Study. Med Sci Monit 2019; 25:7755-7762. [PMID: 31617502 PMCID: PMC6816329 DOI: 10.12659/msm.919307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The influence of maternal vitamin D on pregnancy outcomes, including preterm birth (PTB), is unclear due to different experimental designs and study populations (patient race and sample size) of previous studies. We aimed to investigate the relationship between 25-hydroxyvitamin D (25[OH] D) levels and PTB among pregnant women in southern China. Material/Methods A total of 11 641 pregnant women were retrospectively enrolled between January 2016 and April 2019. Vitamin D concentrations were evaluated by electrochemiluminescence immunoassay. Logistic regression analysis was used to analyze the association between vitamin D and PTB. Results The average 25(OH) D concentration was 59.3±21.5 nmol/L; 34.8% of patients were vitamin D deficient, 43.0% were vitamin D insufficient (25[OH] D <50 nmol/L and 50–74.9 nmol/L, respectively). In total, 3.6% of newborns were born prematurely. Comparing the pre-term and full-term groups, 45.7% versus 42.9% and 29.8% versus 35% were vitamin D deficient and insufficient, respectively These differences were not significant (P>0.05). However, the mean vitamin D status was significantly different between the pre-term and full-term groups (61.3±21.3 and 59.1±21.5 nmol/L, respectively). No association was found between vitamin D deficiency/insufficiency and PTB in unadjusted or adjusted models, compared with vitamin D sufficiency (adjusted odds ratio, 1.016; 95% confidence interval, 0.794–1.301 and 0.842; 0.641–1.106, respectively). Conclusions Low maternal 25(OH) D levels are common in southern China. However, low vitamin D status in pregnant women appears to be unrelated to PTB. Measuring vitamin D level alone is therefore not sufficient to predict PTB.
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Affiliation(s)
- Li Yu
- Department of Children's Health Care, Guangdong Women and Children Hospital, Gangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yong Guo
- Department of Children's Health Care, Guangdong Women and Children Hospital, Gangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Hai-Jin Ke
- Department of Children's Health Care, Guangdong Women and Children Hospital, Gangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yan-Si He
- Department of Children's Health Care, Guangdong Women and Children Hospital, Gangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Di Che
- Department of Children's Health Care, Guangdong Women and Children Hospital, Gangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Jie-Ling Wu
- Department of Children's Health Care, Guangdong Women and Children Hospital, Gangzhou Medical University, Guangzhou, Guangdong, China (mainland)
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Fang K, He Y, Mu M, Liu K. Maternal vitamin D deficiency during pregnancy and low birth weight: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:1167-1173. [PMID: 31122092 DOI: 10.1080/14767058.2019.1623780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The object of the present study was to estimate the relationship between maternal vitamin D deficiency during pregnancy and low birth weight by systematically review prevalence studies. METHODS We collected data from relevant studies published up to April 2019 using predefined inclusion/exclusion criteria. And all the studies were searched in PubMed, Embase, Cochrane Library, and Web of Science. RESULTS A total of 16 studies met the criteria and were included in the meta-analysis. When compared with normal serum levels of vitamin D, the maternal vitamin D deficiency had an increased risk of low birth weight (OR = 2.39; 95%CI 1.25-4.57; p = .008), and same results were found in the comparison of the mean (the total mean birth weight decreased by 0.08 kg; 95%CI -0.10 to -0.06; p < .001). CONCLUSION The evidence from this meta-analysis indicates a consistent association between vitamin D deficiency during pregnancy and an increased risk of low birth weight, and preventing maternal vitamin D deficiency may be an important public health strategy to help decrease the risk of low birth weight.
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Affiliation(s)
- Kehong Fang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Yuna He
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Min Mu
- College of Medicine, Anhui University of Science and Technology Huainan, China
| | - Kai Liu
- Chinese Center for Disease Control and Prevention, National Institute of Occupation Health an Poison Control, Beijing, China
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11
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Tous M, Villalobos M, Iglesias L, Fernández-Barrés S, Arija V. Vitamin D status during pregnancy and offspring outcomes: a systematic review and meta-analysis of observational studies. Eur J Clin Nutr 2019; 74:36-53. [PMID: 30683894 DOI: 10.1038/s41430-018-0373-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/09/2018] [Accepted: 11/26/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES Vitamin D deficiency during pregnancy may influence adverse outcomes in offspring. The aim of this systematic review and meta-analysis of observational studies was to assess the association between low prenatal concentrations of 25(OH)D (by using three different cut-off levels), preterm birth (PTB) and anthropometric and neurodevelopmental outcomes in offspring. SUBJECTS/METHODS Studies reporting data on the association between maternal vitamin D concentrations and offspring outcomes identified through a systematic review of scientific literature published in PubMed/MEDLINE, Scopus and the Cochrane Library databases up to April 2017. RESULTS We included 54 eligible studies. Vitamin D-deficient mothers (<30 nmol/L) had offspring with lower birthweight (MD -87.82 g; 95% CI -119.73, -55.91 g), head circumference (MD -0.19 cm; 95% CI -0.32, -0.06 cm) and a higher risk of small for gestational age (SGA) infants and PTB (OR 1.59; 95% CI 1.24, 2.03) compared to mothers with concentrations ≥30 nmol/L. Vitamin D insufficiency (<50 nmol/L) was associated with a higher risk of SGA and PTB (OR 1.43; 95% CI 1.08, 1.91 and OR 1.28; 95% CI 1.08, 1.52, respectively). Concentrations of 25(OH)D ≥75 nmol/L were not found to be associated with birthweight, SGA or PTB. Offspring of vitamin D-insufficient mothers had lower scores in mental (MD -1.12 points; 95% CI -1.82, -0.42 cm) and language developmental tests (MD -0.35 points; 95% CI -1.00, 0.31 cm). CONCLUSION Maternal vitamin D deficiency is associated with offspring adverse anthropometric outcomes and PTB; insufficiency with a higher risk of SGA, PTB and adverse neurodevelopmental outcomes.
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Affiliation(s)
- Monica Tous
- Research Group in Nutrition and Mental Health (NUTRISAM), Nutrition and Public Health Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain.,Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Marcela Villalobos
- Research Group in Nutrition and Mental Health (NUTRISAM), Nutrition and Public Health Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Lucia Iglesias
- Research Group in Nutrition and Mental Health (NUTRISAM), Nutrition and Public Health Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain.,Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Sílvia Fernández-Barrés
- Research Group in Nutrition and Mental Health (NUTRISAM), Nutrition and Public Health Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain.,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Victoria Arija
- Research Group in Nutrition and Mental Health (NUTRISAM), Nutrition and Public Health Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain. .,Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain. .,Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Tarragona, Spain.
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12
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HU Z, TANG L, XU HL. Maternal Vitamin D Deficiency and the Risk of Small for Gestational Age: A Meta-analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:1785-1795. [PMID: 30788292 PMCID: PMC6379614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inconsistencies among studies still exist in regard to the associations between maternal vitamin D deficiency and the risk of small for gestational age. METHODS We conducted a meta-analysis of observational studies to evaluate these associations. We searched electronic databases for literature published in PubMed, Medline, Web of Science, Embase and the Cochrane Library up to Dec 2016 using the following keywords: "vitamin D" or "cholecalciferol" or "25-OHD" or "25-hydroxyvitamin D" in combination with "small for gestational age" or "SGA" or "fetal outcome" or "pregnancy outcome". RESULTS Twelve studies involving 19,027 participants were included in this meta-analysis. Pregnant women with vitamin D deficiency (25-OHD levels<50 nmol/L) experienced an increased risk of SGA (odds ratio (OR) =1.41, 95% confidence interval (CI): 1.14, 1.75). The vitamin D concentration of the SGA group was lower than that of the non-SGA group (mean difference: -1.75 nmol/L, 95%CI: -3.23, -0.27). CONCLUSION Maternal vitamin D deficiency during pregnancy may be associated with an increased risk of SGA.
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13
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Kim I, Kim SS, Song JI, Yoon SH, Park GY, Lee YW. Association between vitamin D level at birth and respiratory morbidities in very-low-birth-weight infants. KOREAN JOURNAL OF PEDIATRICS 2018; 62:166-172. [PMID: 30360037 PMCID: PMC6528057 DOI: 10.3345/kjp.2018.06632] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/15/2018] [Indexed: 12/31/2022]
Abstract
Purpose This study aimed to evaluate vitamin D status at birth in very-low-birth-weight infants (VLBWIs: <1,500 g) and to determine the association between vitamin D level and respiratory morbidity. Methods A retrospective study was conducted at Soonchunhyang University Bucheon Hospital between November 2013 and November 2017. We collected blood samples and data on respiratory morbidity from 230 VLBWIs on the first day of life. Patients who were transferred to other hospitals (n=19), died before 36 weeks of gestational age (n=18), or whose blood samples were not collected immediately after birth (n=5) were excluded. Finally, 188 patients were enrolled. VLBWIs with different vitamin D levels were compared with respect to demographic features, maternal diseases, respiratory morbidities, and other neonatal diseases. Results The mean serum vitamin D level, as measured by 25-hydroxyvitamin D (25(OH)D), was 13.4± 9.3 ng/mL. The incidence of vitamin D deficiency (<20 ng/mL) was 79.8%, and 44.1% of preterm infants had severe vitamin D deficiency (<10 ng/mL). Logistic analysis shows that a low serum 25(OH)D level (<20 ng/mL) was a risk factor for respiratory distress syndrome (odds ratio [OR], 4.32; P=0.010) and bronchopulmonary dysplasia (OR, 4.11; P=0.035). Conclusion The results showed that 79.8% of preterm infants in this study had vitamin D deficiency at birth. Low vitamin D status was associated with respiratory morbidity, but the exact mechanism was unknown. Additional studies on the association between vitamin D level and neonatal morbidity are required.
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Affiliation(s)
- Ian Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Shin Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jee In Song
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seock Hwa Yoon
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ga Young Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yong-Wha Lee
- Department of Laboratory Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Prenatal vitamin D status and offspring's growth, adiposity and metabolic health: a systematic review and meta-analysis. Br J Nutr 2018; 119:310-319. [PMID: 29321080 DOI: 10.1017/s0007114517003646] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this systematic review and meta-analysis of observational studies, we aimed to estimate the associations between prenatal vitamin D status and offspring growth, adiposity and metabolic health. We searched the literature in human studies on prenatal vitamin D status and offspring growth in PubMed, up to July 2017. Studies were selected according to their methodological quality and outcomes of interest (anthropometry, fat mass and diabetes in offspring). The inverse variance method was used to calculate the pooled mean difference (MD) with 95 % CI for continuous outcomes, and the Mantel-Haenszel method was used to calculate the pooled OR with 95 % CI for dichotomous outcomes. In all, thirty observational studies involving 35 032 mother-offspring pairs were included. Vitamin D status was evaluated by circulating 25-hydroxyvitamin D (25(OH)D) level. Low vitamin D status was based on each study's cut-off for low 25(OH)D levels. Low prenatal vitamin D levels were associated with lower birth weight (g) (MD -100·69; 95 % CI -162·25, -39·13), increased risk of small-for-gestational-age (OR 1·55; 95 % CI 1·16, 2·07) and an elevated weight (g) in infant at the age of 9 months (g) (MD 119·75; 95 % CI 32·97, 206·52). No associations were observed between prenatal vitamin D status and other growth parameters at birth, age 1 year, 4-6 years or 9 years, nor with diabetes type 1. Prenatal vitamin D may play a role in infant adiposity and accelerated postnatal growth. The effects of prenatal vitamin D on long-term metabolic health outcomes in children warrant future studies.
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15
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Vitamin D supplementation, cord 25-hydroxyvitamin D and birth weight: Findings from the Odense Child Cohort. Clin Nutr 2017; 36:1621-1627. [DOI: 10.1016/j.clnu.2016.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 02/01/2023]
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16
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Salcedo-Bellido I, Martínez-Galiano JM, Olmedo-Requena R, Mozas-Moreno J, Bueno-Cavanillas A, Jimenez-Moleon JJ, Delgado-Rodríguez M. Association between Vitamin Intake during Pregnancy and Risk of Small for Gestational Age. Nutrients 2017; 9:E1277. [PMID: 29168736 PMCID: PMC5748728 DOI: 10.3390/nu9121277] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 01/01/2023] Open
Abstract
Pregnancy increases the requirements of certain nutrients, such as vitamins, to provide nutrition for the newborn. The aim was to analyze the association between dietary intake of vitamins during pregnancy and risk of having a small for gestational age (SGA) newborn. A matched case-control study was conducted (518 cases and 518 controls of pregnant women) in Spain. Dietary vitamin intake during pregnancy was assessed using a validated food frequency questionnaire, categorized into quintiles. Odds ratios (ORs) and their 95% confidence intervals (CI) were estimated with conditional regression logistic models. A protective association was observed between maternal dietary intake of vitamins A and D and SGA. For vitamin B3 and B6, the observed protective effect was maintained after adjusting for potential confounding factors. For vitamin B9, we found only an effect in quintiles 3 and 4 (OR = 0.64; 95% CI, 0.41-1.00; OR = 0.58; 95% CI, 0.37-0.91). Protective effect for vitamin B12 was observed in 4th and 5th quintiles (OR = 0.61; 95% CI, 0.39-0.95; OR = 0.68; 95% CI, 0.43-1.04). No associations were detected between dietary intake of vitamins B2, E and C intake and SGA. Our results suggest a positive association between dietary vitamin intake during pregnancy and the weight of the newborn, although more studies are necessary and there could be a ceiling effect for higher intakes of some vitamins cannot be discarded.
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Affiliation(s)
- Inmaculada Salcedo-Bellido
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain.
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Complejo Hospitalario Universitario de Granada/Universidad de Granada, 18012 Granada, Spain.
| | - Juan Miguel Martínez-Galiano
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Department of Nursing, University of Jaen, 23071 Jaen, Spain.
- Public Health System of Andalusia, 23400 Jaen, Spain.
- University of Jaén, Campus de Las Lagunillas s/n, Building B3 Office 413, 23071 Jaén, Spain.
| | - Rocío Olmedo-Requena
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain.
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Complejo Hospitalario Universitario de Granada/Universidad de Granada, 18012 Granada, Spain.
| | - Juan Mozas-Moreno
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Obstetric and Gynecology Unit, Virgen de las Nieves Universitary Hospital, 18014 Granada, Spain.
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain.
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Complejo Hospitalario Universitario de Granada/Universidad de Granada, 18012 Granada, Spain.
| | - Jose J Jimenez-Moleon
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain.
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Complejo Hospitalario Universitario de Granada/Universidad de Granada, 18012 Granada, Spain.
| | - Miguel Delgado-Rodríguez
- Ciber de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain.
- Division of Preventive Medicine, University of Jaen, 23071 Jaen, Spain.
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Agarwal S, Kovilam O, Agrawal DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: A critical review. Crit Rev Food Sci Nutr 2017; 58:755-769. [PMID: 27558700 DOI: 10.1080/10408398.2016.1220915] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The role of vitamin D beyond its classical function in calcium homeostasis has been of significant interest in recent years. There has been expanding research on the pleiotropic role of vitamin D in pregnancy and the implications of its deficiency on maternal-fetal outcomes. Several studies have associated low maternal vitamin D status to adverse outcomes in pregnancy, including preeclampsia, gestational diabetes, preterm births, low birth weight, and others. Several randomized controlled clinical trials of Vitamin D supplementation during pregnancy have also been conducted. Though some of the studies found improvement in pregnancy outcomes with vitamin D supplementation, others have not shown any association. In this article, we have critically reviewed the observational and interventional studies, published primarily within the past two years (January 2014 to February 2016) on the influence of vitamin D deficiency on pregnancy and the impact of its supplementation. The potential underlying mechanisms of vitamin D in regulating each of the outcomes have also been discussed.
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Affiliation(s)
- Shreya Agarwal
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , Nebraska , USA
| | - Oormila Kovilam
- b Department of Obstetrics & Gynecology , Creighton University School of Medicine , Omaha , Nebraska , USA
| | - Devendra K Agrawal
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , Nebraska , USA
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