Insufficient vitamin D intakes among pregnant women

Associations of Dietary Patterns and Vitamin D Levels with Iron Status in Pregnant Women: A Cross-Sectional Study in Taiwan

Vitamin D is involved in the pathophysiology of anemia. This cross-sectional study was conducted using the Nationwide Nutrition and Health Survey in Pregnant Women in Taiwan database. We investigated associations among dietary patterns (DPs), vitamin D, and iron-related biomarkers in pregnant women. The principal component analysis revealed four DPs. Linear and logistic regression analyses were performed to investigate the association of DPs with anemia-related biomarkers. Plant-based, carnivore, and dairy and nondairy alternatives DPs were positively associated with serum vitamin D levels. After adjusting covariates, the pregnant women consuming plant-based DPs at the mid-tertile (T2) were associated with reduced risks of low serum folate and vitamin D levels, and those consuming carnivore DPs at higher tertiles (T2 and/or T3) were correlated with an increased risk of low serum iron levels but decreased risks of low serum transferrin saturation, vitamin B₁₂, and vitamin D levels. The pregnant women consuming dairy and nondairy alternatives DPs at the highest tertile (T3) were associated with reduced risks of low serum folate and vitamin B₁₂ levels. However, the processed food DP was not correlated with anemia-related biomarkers. Thus, plant-based, carnivore, and dairy and nondairy alternatives DPs were associated with the risk of low-serum-anemia-related variables.

Vitamin D supplementation in pregnancy-a survey of compliance with recommendations

BACKGROUND

Vitamin D deficiency in pregnancy has important maternal and fetal implications, with increased risk of developing gestational diabetes, preeclampsia, preterm birth and small for gestational age birthweight. It is recommended that every pregnant woman should take 5 μg (200 IU) of vitamin D per day during pregnancy and lactation.

AIMS

This study aimed to determine the prevalence of women taking vitamin D supplementation and to identify the reasons for patients not taking supplementation within women attending an antenatal clinic in Dublin.

METHODS

Survey of women attending the antenatal clinic of the National Maternity Hospital Dublin during 2 weeks in January 2017. Women were asked to record demographics, medical comorbidities and use of vitamin D supplementation or any other supplements in pregnancy, as well as reasons for non-use if appropriate.

RESULTS

Three hundred women were invited to participate and 175 completed the questionnaire (58%). Overall, 38.9% (n = 68) reported to be taking vitamin D supplementation. Of the women that reported not to be taking vitamin D supplementation, 57.9% (n = 62) were taking a pregnancy multivitamin that contained vitamin D, and 28.0% (n = 30) did not know that it was recommended in pregnancy. Therefore, a total of 45 women (25.7%) in our cohort were taking no vitamin D supplementation during pregnancy. There was no difference in non-use based on maternal age, BMI, parity, or country of origin.

CONCLUSIONS

Of the women surveyed, 74.3% reported supplementation with vitamin D, either knowingly or unknowingly. Public health initiatives need to utilize this relatively safe, low-cost intervention to maximize maternal and fetal health. This could reduce the rates of antenatal conditions with associated high morbidity and healthcare burden such as gestational diabetes and preeclampsia.

Maternal Vitamin D Status and the Relationship with Neonatal Anthropometric and Childhood Neurodevelopmental Outcomes: Results from the Seychelles Child Development Nutrition Study

Vitamin D has an important role in early life; however, the optimal vitamin D status during pregnancy is currently unclear. There have been recent calls for pregnant women to maintain circulating 25-hydroxyvitamin D (25(OH)D) concentrations >100 nmol/L for health, yet little is known about the long-term potential benefits or safety of achieving such high maternal 25(OH)D concentrations for infant or child health outcomes. We examined maternal vitamin D status and its associations with infant anthropometric and later childhood neurocognitive outcomes in a mother-child cohort in a sun-rich country near the equator (4.6° S). This study was conducted in pregnant mothers originally recruited to the Seychelles Child Development Nutrition Study. Blood samples (n = 202) taken at delivery were analysed for serum 25-hydroxyvitamin D (25(OH)D) concentrations. Multiple linear regression models assessed associations between maternal 25(OH)D and birth weight, infant head circumference, and neurocognitive outcomes in the children at age 5 years. Mothers were, on average, 27 years of age, and the children’s average gestational age was 39 weeks. None of the women reported any intake of vitamin D supplements. Maternal 25(OH)D concentrations had a mean of 101 (range 34–218 nmol/L) and none were deficient (<30 nmol/L). Maternal 25(OH)D concentrations were not associated with child anthropometric or neurodevelopmental outcomes. These findings appear to indicate that a higher vitamin D status is not a limiting factor for neonatal growth or neurocognitive development in the first 5 years of life. Larger studies with greater variability in vitamin D status are needed to further explore optimal cut-offs or non-linear associations (including for maternal health) that might exist among populations with sub-optimal exposure.

Maternal vitamin D levels and the risk of perinatal death

OBJECTIVE

To determine the association between maternal vitamin D levels and perinatal death.

METHODS

A retrospective cross-sectional study of all non-anomalous, singleton births (≥24 weeks) with perinatal death compared to a matched control group. Only pregnancies with a recorded vitamin D level at booking (8-19 weeks gestation) were included for analysis. Maternal vitamin D levels were categorized into normal, deficient and insufficient cohorts and variables compared between the three groups.

RESULTS

There were 31 perinatal deaths which were compared to 111 controls. Median vitamin D levels were lower in the perinatal death cohort compared to the control group (55 nmol/L versus 64 nmol/L, p = 0.43). There was no significant increase in deaths between the normal and deficient (p = 0.33) or insufficient (p = 0.09) groups.

CONCLUSIONS

Low maternal vitamin D levels at booking were not associated with an increased risk of perinatal demise.

Dietary contributors to hypertension in adults reviewed

Recent national surveys which measured respondents' blood pressure (BP) levels have shown a high prevalence of hypertension amongst the Irish population, with approximately two-thirds of men and over half of women aged 45 years and over affected. Higher prevalence rates are observed with advancing age. Established diet- and lifestyle-related risk factors for hypertension such as high salt intake, high alcohol consumption and physical inactivity are pervasive in Ireland and are believed to contribute significantly to the high national prevalence of this condition. Additional dietary deficits have been implicated in the development of hypertension, however, including low fruit and vegetable intake, low dairy food consumption and low intake of oily fish. Deficiencies of single micro-nutrients such as folate, riboflavin, vitamin C and vitamin D have also been recently recognised as risk factors for hypertension. For each of these factors, there is evidence that the food and nutrient intakes of many Irish adults fall short of the ideal. These dietary and nutritional deficits, when superimposed on Ireland's existing health-subversive behaviours and escalating rates of obesity, constitute a potent constellation of risk factors for hypertension. However, they also represent viable and potentially effective targets for health promotion initiatives. This review aims to describe the main nutritional, dietary and lifestyle contributors to hypertension in Ireland with a view to informing future interventions aimed at alleviating Ireland's burden of hypertensive disease.

Pregnancy in dark winters: implications for fetal bone growth?

OBJECTIVE

To prospectively examine the prevalence of hypovitaminosis D in pregnancy and to correlate maternal and fetal vitamin D to fetal anthropometry.

DESIGN

A prospective cohort study.

SETTING

Tertiary referral maternity hospital.

PATIENT(S)

Sixty pregnant women.

INTERVENTION(S)

Serum 25-hydroxyvitamin D (25OHD) was measured in early pregnancy, at 28 weeks, and in cord blood at delivery.

MAIN OUTCOME MEASURE(S)

The prevalence of hypovitaminosis D and the relationship between fetal growth and serum 25OHD concentrations.

RESULT(S)

Two subgroups were analyzed to examine results in the context of seasonal variation in 25OHD: a winter and a summer cohort. Fetal anthropometry was assessed at 20 and 34 weeks, and at delivery the neonatal anthropometry was recorded. There was a high prevalence of hypovitaminosis D ranging from 33% to 97%, with a marked seasonal variation. Fetal 25OHD concentrations correlated with all biometry at 20 weeks. In the winter cohort, a correlation was found between early pregnancy 25OHD and femur length at 20 weeks, and between 28-week 25OHD and femur length at 34 weeks. Infant length was shorter in those with early pregnancy 25OHD less than the median (52.1 vs. 53.6 cm).

CONCLUSION(S)

The high prevalence of maternal hypovitaminosis D during winter months in northern latitudes may have detrimental effects on fetal skeletal growth.

The relationship between maternal and fetal vitamin D, insulin resistance, and fetal growth

Evidence for a role of vitamin D in maintaining normal glucose homeostasis is inconclusive. We sought to clarify the relationship between maternal and fetal insulin resistance and vitamin D status. This is a prospective cohort study of 60 caucasian pregnant women. Concentrations of 25-hydroxyvitamin D (25-OHD), glucose, insulin, and leptin were measured in early pregnancy and at 28 weeks. Ultrasound at 34 weeks assessed fetal anthropometry including abdominal wall width, a marker of fetal adiposity. At delivery birth weight was recorded and fetal 25-OHD, glucose, C-peptide, and leptin measured in cord blood. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA) equation. We found that those with lower 25-OHD in early pregnancy had higher HOMA indices at 28 weeks, (r = -.32, P = .02). No significant relationship existed between maternal or fetal leptin and 25-OHD, or between maternal or fetal 25-OHD and fetal anthropometry or birth weight. The incidence of vitamin D deficiency was high at each time point (15%-45%). These findings lend support to routine antenatal supplementation with vitamin D in at risk populations.

Low fish intake is associated with low blood concentrations of vitamin D, choline and n-3 DHA in pregnant women

Several studies have investigated the potential health benefits, including those associated with neurological function, of the n-3 fatty acid DHA. This has arisen in part because of the association between higher intakes of fish, which is a major dietary source of DHA, and reduced disease risk. In addition to DHA, fish also provides choline and vitamin D. The objective of the present study was to assess whether women in the first half of pregnancy with low fish intake also had low blood concentrations of vitamin D, choline and DHA. A total of 222 pregnant women at 16 weeks of gestation were examined for dietary intake, erythrocyte (phosphatidylethanolamine PE) DHA, plasma free choline and 25-hydroxyvitamin D (25(OH)D). Women who consumed ≤ 75 g fish/week (n 56) compared to ≥ 150 g fish/week (n 116) had lower dietary intake of DHA, total choline and vitamin D (P< 0·001), and lower erythrocyte PE DHA (5·25 (sd 1·27), 6·83 (sd 1·62) g/100 g total fatty acid, respectively, P< 0·01), plasma free choline (6·59 (sd 1·65), 7·40 (sd 2·05) μmol/l, respectively, P= 0·023) and 25(OH)D (50·3 (sd 20·0), 62·5 (sd 29·8) nmol/l, respectively, P< 0·01). DHA intake was positively related to the intake of vitamin D from foods (ρ 0·47, P< 0·001) and total choline (ρ 0·32, P< 0·001). Dietary intakes and biomarkers of DHA, choline and vitamin D status were assessed to be linked. This raises the possibility that unidentified concurrent nutrient inadequacies might have an impact on the results of studies addressing the benefits of supplemental DHA.

Maternal dietary patterns and associated nutrient intakes during each trimester of pregnancy

OBJECTIVE

To determine the main dietary patterns of pregnant women during each of the three trimesters of pregnancy and to examine associated nutrient intakes.

DESIGN

Participants completed a 3 d food diary during each trimester of pregnancy. Thirty-six food groups were created and dietary patterns were derived using k-means cluster analysis.

SETTING

National Maternity Hospital, Dublin, Ireland.

SUBJECTS

Two hundred and eighty-five healthy pregnant women aged between 20 and 41 years.

RESULTS

Two dietary patterns were identified at each time point. They were labelled 'Unhealthy' (n =143, 150 and 155 at trimester 1, 2 and 3, respectively) and 'Health Conscious' (n 142, 135 and 130 at trimester 1, 2 and 3, respectively). Women in the 'Health Conscious' cluster were significantly older, had lower BMI and were higher educated than those in the 'Unhealthy' cluster. Of those in the 'Unhealthy' cluster in the first trimester (n =143), 103 (72.0 %) continued in this dietary pattern into trimester 2 and eighty-one (56.6 %) continued into trimester 3. Of those in the 'Health Conscious' cluster in trimester 1 (n =142), ninety-five (66.9 %) continued in this dietary pattern into trimester 2 and sixty-nine (48.6 %) continued into trimester 3.

CONCLUSIONS

Cluster analysis produced two clearly defined dietary patterns at each stage of pregnancy. Knowledge of maternal dietary patterns is important for the development of pregnancy-specific dietary guidelines. Identifying women with an 'Unhealthy' dietary pattern in early pregnancy affords the opportunity for a dietary intervention which may positively impact both maternal and infant health.