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Berry SPDG, Honkpèhedji YJ, Ludwig E, Mahmoudou S, Prodjinotho UF, Adamou R, Nouatin OP, Adégbitè BR, Dejon-Agobe JC, Mba RB, Maloum M, Nkoma AMM, Zinsou JF, Luty AJF, Esen M, Adégnika AA, Prazeres da Costa C. Impact of helminth infections during pregnancy on maternal and newborn Vitamin D and on birth outcomes. Sci Rep 2024; 14:14845. [PMID: 38937587 PMCID: PMC11211496 DOI: 10.1038/s41598-024-65232-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
Poor birth outcomes in low- and middle income countries are associated with maternal vitamin D deficiency and chronic helminth infections. Here, we investigated whether maternal Schistosoma haematobium affects maternal or cord vitamin D status as well as birth outcomes. In a prospective cross-sectional study of pregnant women conducted in Lambaréné, Gabon, we diagnosed maternal parasitic infections in blood, urine and stool. At delivery we measured vitamin D in maternal and cord blood. S. haematobium, soil-transmitted helminths, and microfilariae were found at prevalences of 30.2%, 13.0%, and 8.8%, respectively. Insufficient vitamin D and calcium levels were found in 28% and 15% of mothers, and in 11.5% and 1.5% of newborns. Mothers with adequate vitamin D had lower risk of low birthweight babies (aOR = 0.11, 95% CI 0.02-0.52, p = 0.01), whilst offspring of primipars had low cord vitamin D levels, and low vitamin D levels increased the risk of maternal inflammation. Maternal filariasis was associated with low calcium levels, but other helminth infections affected neither vitamin D nor calcium levels in either mothers or newborns. Healthy birth outcomes require maintenance of adequate vitamin D and calcium levels. Chronic maternal helminth infections do not disrupt those levels in a semi-rural setting in sub-Saharan Africa.
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Affiliation(s)
- Sèyigbéna P Déo-Gracias Berry
- Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine and Health, Technical University of Munich (TUM), Trogerstrasse 30, 81675, Munich, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Center for Global Health, TUM School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
| | - Yabo Josiane Honkpèhedji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Fondation Pour La Recherche Scientifique (FORS), Cotonou, Benin
| | - Esther Ludwig
- Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine and Health, Technical University of Munich (TUM), Trogerstrasse 30, 81675, Munich, Germany
- Center for Global Health, TUM School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
| | | | - Ulrich Fabien Prodjinotho
- Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine and Health, Technical University of Munich (TUM), Trogerstrasse 30, 81675, Munich, Germany
- Center for Global Health, TUM School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
| | - Rafiou Adamou
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Odilon P Nouatin
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Bayode R Adégbitè
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Jean Claude Dejon-Agobe
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Romuald Beh Mba
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | | | - Jeannot Fréjus Zinsou
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Fondation Pour La Recherche Scientifique (FORS), Cotonou, Benin
| | | | - Meral Esen
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Partner site Tübingen, Tübingen, Germany
| | - Ayôla Akim Adégnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut Für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Fondation Pour La Recherche Scientifique (FORS), Cotonou, Benin
- German Center for Infection Research (DZIF), Partner site Tübingen, Tübingen, Germany
| | - Clarissa Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine and Health, Technical University of Munich (TUM), Trogerstrasse 30, 81675, Munich, Germany.
- Center for Global Health, TUM School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany.
- German Center for Infection Research (DZIF), Partner site Munich, Munich, Germany.
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Davis S, Lyles E, Shary JR, Ebeling M, Reed SG, Baatz JE, Hollis BW, Wagner CL. Post Hoc Analysis of National Institute of Child Health and Human Development Vitamin-D Pregnancy Cohort and The Role of Functional Vitamin-D Deficiency in Pregnancy. Am J Perinatol 2024; 41:e2098-e2105. [PMID: 37216969 DOI: 10.1055/a-2097-2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Our objective was to conduct a secondary, post hoc analysis of the National Institute of Child Health and Human Development (NICHD) vitamin D (vitD) pregnancy study by Hollis et al, which reported on the effect of vitD supplementation in pregnant women and determine the potential interaction between intact parathyroid hormone (iPTH) concentrations, vitD status, and various comorbidities associated with pregnancy. Women with low 25-hydroxy vitamin D (25(OH)D) concentrations and high iPTH concentrations during pregnancy, known as functional vitamin-D deficiency (FVDD), were more likely to acquire complications also affecting their neonates. STUDY DESIGN This post hoc analysis of data collected from a diverse group of pregnant women participating in the NICHD vitD pregnancy study was applied to investigate the applicability of the concept of FVDD in pregnancy (Hemmingway, 2018) in identifying potential risks for certain comorbidities of pregnancy. This analysis defines FVDD as maternal serum 25(OH)D concentrations below 20 ng/mL and iPTH concentrations above 65 pg/mL creating a definitive ratio number, 0.308, to classify mothers as having FVDD prior to delivery (PTD). Statistical analyses were performed using SAS 9.4 (Cary, NC). RESULTS In total, 281 women (85 African American, 115 Hispanic, and 81 Caucasian) with 25(OH)D and iPTH concentrations measured at monthly visits were included in this analysis. No statistically significant association was found between mothers classified as having FVDD at baseline or 1-month PTD and hypertensive disorders of pregnancy, infection, or admittance to the neonatal intensive care unit. When combining all comorbidities of pregnancy in this cohort, results showed those with FVDD at baseline, 24 weeks' gestation, and 1-month PTD were more likely to experience a comorbidity (p = 0.001; p = 0.001; p = 0.004, respectively). Those with FVDD 1-month PTD were 7.1 times (confidence interval [CI]: 1.71-29.81) more likely to have preterm birth (<37 weeks) than women without FVDD. CONCLUSION Participants were more likely to have experienced preterm birth if they met the criteria for FVDD. This study supports the importance of FVDD during pregnancy. KEY POINTS · Functional vitamin D deficiency (FVDD) is defined as the ratio of 25(OH)D divided by iPTH concentration ≤0.308.. · At a minimum, it is recommended that vitamin D status be kept in the healthy range based on current recommendations for pregnant individuals.. · FVDD is a more sensitive predictor of pregnancy risk than 25(OH)D alone.. · FVDD identified those with greater risk of preterm birth in this cohort..
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Affiliation(s)
- Shellie Davis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Elliott Lyles
- College of Osteopathic Medicine, Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg, South Carolina
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Myla Ebeling
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Susan G Reed
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - John E Baatz
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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Berky AJ, Weinhouse C, Vissoci J, Rivera N, Ortiz EJ, Navio S, Miranda JJ, Mallipudi A, Fixen E, Hsu-Kim H, Pan WK. In Utero Exposure to Metals and Birth Outcomes in an Artisanal and Small-Scale Gold Mining Birth Cohort in Madre de Dios, Peru. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:97008. [PMID: 37747404 PMCID: PMC10519195 DOI: 10.1289/ehp10557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Few birth cohorts in South America evaluate the joint effect of minerals and toxic metals on neonatal health. In Madre de Dios, Peru, mercury exposure is prevalent owing to artisanal gold mining, yet its effect on neonatal health is unknown. OBJECTIVES We aimed to determine whether toxic metals are associated with lower birth weight and shorter gestational age independently of antenatal care and other maternal well-being factors. METHODS Data are from the COhorte de NAcimiento de MAdre de Dios (CONAMAD) birth cohort, which enrolled pregnant women in Madre de Dios prior to their third trimester and obtained maternal and cord blood samples at birth. We use structural equation models (SEMs) to construct latent variables for the maternal metals environment (ME) and the fetal environment (FE) using concentrations of calcium, iron, selenium, zinc, magnesium, mercury, lead, and arsenic measured in maternal and cord blood, respectively. We then assessed the relationship between the latent variables ME and FE, toxic metals, prenatal visits, hypertension, and their effect on gestational age and birth weight. RESULTS Among 198 mothers successfully enrolled and followed at birth, 29% had blood mercury levels that exceeded the U.S. Centers for Disease Control and Prevention threshold of 5.8 μ g / L and 2 mothers surpassed the former 5 - μ g / dL threshold for blood lead. The current threshold value is 3.5 μ g / dL . Minerals and toxic metals loaded onto ME and FE latent variables. ME was associated with FE (β = 0.24; 95% CI: 0.05, 0.45). FE was associated with longer gestational age (β = 2.31; 95% CI: - 0.3 , 4.51) and heavier birth weight. Mercury exposure was not directly associated with health outcomes. A 1% increase in maternal blood lead shortened gestational age by 0.05 d (β = - 0.75 ; 95% CI: - 1.51 , - 0.13 ), which at the 5 - μ g / dL threshold resulted in a loss of 3.6 gestational days and 76.5 g in birth weight for newborns. Prenatal care visits were associated with improved birth outcomes, with a doubling of visits from 6 to 12 associated with 5.5 more gestational days (95% CI: 1.6, 9.4) and 319 g of birth weight (95% CI: 287.6, 350.7). DISCUSSION Maternal lead, even at low exposures, was associated with shorter gestation and lower birth weight. Studies that focus only on harmful exposures or nutrition may mischaracterize the dynamic maternal ME and FE. SEMs provide a framework to evaluate these complex relationships during pregnancy and reduce overcontrolling that can occur with linear regression. https://doi.org/10.1289/EHP10557.
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Affiliation(s)
- Axel J Berky
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Caren Weinhouse
- Oregon Institute of Occupational Health Sciences, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Joao Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nelson Rivera
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - Ernesto J Ortiz
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Susy Navio
- Dirección Regional de Salud, Ministerio de Salud del Perú, Madre de Dios, Perú
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andres Mallipudi
- Bellevue Hospital Center/Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Emma Fixen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heileen Hsu-Kim
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - William K Pan
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Meija L, Piskurjova A, Nikolajeva K, Aizbalte O, Rezgale R, Lejnieks A, Cauce V. Vitamin D Intake and Serum Levels in Pregnant and Postpartum Women. Nutrients 2023; 15:3493. [PMID: 37571431 PMCID: PMC10421266 DOI: 10.3390/nu15153493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Maternal vitamin D deficiency, which is highly prevalent in pregnant women in Europe, is linked to adverse health effects for both the mother and child. The objective was to assess vitamin D status in pregnant women by evaluating their dietary and supplemental vitamin D intake, serum vitamin D levels, parathyroid hormone levels, and lifestyle factors. This cross-sectional study, with a total of 735 participants (145 pregnant and 590 up to the seventh day postpartum), took place in Latvia. Blood samples, a food frequency questionnaire, and medical documentation were used for data collection. The median serum vitamin D concentration was 34.0 ng/mL, with pregnant women having higher levels (42.9 ng/mL) than postpartum women (31.8 ng/mL). There was no association between vitamin D serum concentration and dietary intake of vitamin D (p > 0.05), whereas there was a significant correlation with use of vitamin D supplements (r = 0.41; p < 0.001 in pregnant women and r = 0.35; p < 0.001 in postpartum women). This study demonstrated that a minority of pregnant women (21.9%) had optimal serum vitamin D concentration (>45 ng/mL), and diet had no significant impact on vitamin D levels. Thus, our proposed recommendation for vitamin D intake during pregnancy was 63 mcg (2500 IU) year-round for optimal levels in pregnant women in Northeastern Europe.
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Affiliation(s)
- Laila Meija
- Department of Sports and Nutrition, Rīga Stradiņš University, 26a Anniņmuižas bulvāris, LV-1067 Riga, Latvia
- Riga East Clinical University Hospital, 2 Hipokrata Street, LV-1038 Riga, Latvia; (K.N.); (A.L.)
| | - Anna Piskurjova
- Department of Public Health and Epidemiology, Rīga Stradiņš University, 9 Kronvalda bulvāris, LV-1010 Riga, Latvia; (A.P.); (O.A.); (V.C.)
| | - Ksenija Nikolajeva
- Riga East Clinical University Hospital, 2 Hipokrata Street, LV-1038 Riga, Latvia; (K.N.); (A.L.)
- Doctoral Department, Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Riga, Latvia
| | - Olga Aizbalte
- Department of Public Health and Epidemiology, Rīga Stradiņš University, 9 Kronvalda bulvāris, LV-1010 Riga, Latvia; (A.P.); (O.A.); (V.C.)
| | - Roberta Rezgale
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Riga, Latvia;
| | - Aivars Lejnieks
- Riga East Clinical University Hospital, 2 Hipokrata Street, LV-1038 Riga, Latvia; (K.N.); (A.L.)
- Department of Internal Diseases, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Riga, Latvia
| | - Vinita Cauce
- Department of Public Health and Epidemiology, Rīga Stradiņš University, 9 Kronvalda bulvāris, LV-1010 Riga, Latvia; (A.P.); (O.A.); (V.C.)
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Li Y, Pan K, McRitchie SL, Harville EW, Sumner SCJ. Untargeted metabolomics on first trimester serum implicates metabolic perturbations associated with BMI in development of hypertensive disorders: a discovery study. Front Nutr 2023; 10:1144131. [PMID: 37528997 PMCID: PMC10388370 DOI: 10.3389/fnut.2023.1144131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Goal Body mass index (BMI) in early pregnancy is a critical risk factor for hypertensive disorders of pregnancy (HDP). The pathobiology of the interplay between BMI and HDP is not fully understood and represents the focus of this investigation. Methods BMI and 1st-trimester serum samples were obtained from the Global Alliance to Prevent Prematurity and Stillbirth repository for 154 women (105 without HDP and 49 with HDP). Metabotyping was conducted using ultra-high-performance liquid-chromatography high-resolution mass spectrometry (UHPLC HR-MS). Multivariable linear regression and logistic models were used to determine metabolites and pathway perturbations associated with BMI in women with and without HDP, and to determine metabolites and pathway perturbations associated with HDP for women in categories of obese, overweight, and normal weight based on the 1st trimester BMI. These outcome-associated signals were identified or annotated by matching against an in-house physical standards library and public database. Pathway analysis was conducted by the Mummichog algorithm in MetaboAnalyst. Result Vitamin D3 and lysine metabolism were enriched to associate with BMI for women with and without HDP. Tryptophan metabolism enrichment was associated with HDP in all the BMI categories. Pregnant women who developed HDP showed more metabolic perturbations with BMI (continuous) than those without HDP in their 1st-trimester serum. The HDP-associated pathways for women with normal weight indicated inflammation and immune responses. In contrast, the HDP-associated pathways for women of overweight and obese BMI indicated metabolic syndromes with disorders in glucose, protein, and amino acid, lipid and bile acid metabolism, and oxidative and inflammatory stress. Conclusion High first-trimester BMI indicates underlying metabolic syndromes, which play critical roles in HDP development. Vitamin D3 and tryptophan metabolism may be the targets to guide nutritional interventions to mitigate metabolic and inflammatory stress in pregnancy and reduce the onset of HDP.
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Affiliation(s)
- Yuanyuan Li
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, United States
| | - Ke Pan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Susan L. McRitchie
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, United States
| | - Emily W. Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Susan C. J. Sumner
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, United States
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Dahma G, Craina M, Dumitru C, Neamtu R, Popa ZL, Gluhovschi A, Citu C, Bratosin F, Bloanca V, Alambaram S, Willie A, Kodimala SC, Negrean RA, Bernad E. A Prospective Analysis of Vitamin D Levels in Pregnant Women Diagnosed with Gestational Hypertension after SARS-CoV-2 Infection. J Pers Med 2023; 13:jpm13020317. [PMID: 36836551 PMCID: PMC9963707 DOI: 10.3390/jpm13020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
The great majority of existing studies suggests that the prognosis and outcomes of SARS-CoV-2 infections are improved with adequate vitamin D levels, with or without supplementation. Simultaneously, whether vitamin D supplementation during pregnancy lessens the chance of developing gestational hypertension is controversial. The objective of the present research was to evaluate whether vitamin D levels during pregnancy differ substantially among pregnant women who develop gestational hypertension following SARS-CoV-2 infection. The current research was designed as a prospective cohort following the pregnant women admitted to our clinic with COVID-19 until 36 weeks of gestation. Total vitamin D (25(OH)D) levels were measured in the three study groups in which pregnant women with COVID-19 during pregnancy and a diagnosis of hypertension after 20 weeks of gestation were considered the group of cases (GH-CoV). The second group (CoV) included those with COVID-19 and no hypertension, while the third group (GH) included those with hypertension and no COVID-19. It was observed that 64.4% of SARS-CoV-2 infections in the group of cases occurred during the first trimester, compared to 29.2% in the first trimester among the controls who did not develop GH. Normal vitamin D levels were measured at admission in a significantly higher proportion of pregnant women without GH (68.8% in the CoV group vs. 47.9% in the GH-CoV group and 45.8% in the GH group). At 36 weeks of gestation, the median values of 25(OH)D in the CoV group was 34.4 (26.9-39.7) ng/mL compared to 27.9 (16.2-32.4) ng/mL in the GH-CoV group and 29.5 ng/mL (18.4-33.2) in the GH group, while the blood pressure measurements remained over 140 mmHg among the groups who developed GH. There was a statistically significant negative association between serum 25(OH)D levels and systolic blood pressure (rho = -0.295; p-value = 0.031); however, the risk of developing GH was not significantly higher among pregnant women with COVID-19 if the vitamin D levels were insufficient (OR = 1.19; p-value = 0.092) or deficient (OR = 1.26; p-value = 0.057). Although insufficient or deficient vitamin D among pregnant women with COVID-19 was not an independent risk factor for the development of GH, it is likely that an association between first-trimester SARS-CoV-2 infection and low vitamin D plays a key role in developing gestational hypertension.
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Affiliation(s)
- George Dahma
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Marius Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Catalin Dumitru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Radu Neamtu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Zoran Laurentiu Popa
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Adrian Gluhovschi
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Cosmin Citu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Vlad Bloanca
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Correspondence:
| | - Satish Alambaram
- Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, India
| | - Anthony Willie
- Igbinedion University, Faculty of General Medicine, Main Campus Mission Road 1090, Okada 302111, Nigeria
| | - Shiva Charana Kodimala
- MediCiti Institute of Medical Sciences, NTR University of Health Sciences, Hyderabad 501401, Telangana, India
| | | | - Elena Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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van Gelder MMHJ, Beekers P, van Rijt-Weetink YRJ, van Drongelen J, Roeleveld N, Smits LJM. Associations Between Late-Onset Preeclampsia and the Use of Calcium-Based Antacids and Proton Pump Inhibitors During Pregnancy: A Prospective Cohort Study. Clin Epidemiol 2022; 14:1229-1240. [PMID: 36325201 PMCID: PMC9621001 DOI: 10.2147/clep.s382303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Preeclampsia is a leading cause of maternal morbidity and mortality. Calcium-based antacids and proton pump inhibitors (PPIs) are commonly used during pregnancy to treat symptoms of gastroesophageal reflux disease. Both have been hypothesized to reduce the risk of preeclampsia. We determined associations of calcium-based antacid and PPI use during pregnancy with late-onset preeclampsia (≥34 weeks of gestation), taking into account dosage and timing of use. Patients and Methods We included 9058 pregnant women participating in the PRIDE Study (2012–2019) or The Dutch Pregnancy Drug Register (2014–2019), two prospective cohorts in The Netherlands. Data were collected through web-based questionnaires and obstetric records. We estimated risk ratios (RRs) for late-onset preeclampsia for any use and trajectories of calcium-based antacid and PPI use before gestational day 238, and hazard ratios (HRs) for time-varying exposures after gestational day 237. Results Late-onset preeclampsia was diagnosed in 2.6% of pregnancies. Any use of calcium-based antacids (RR 1.2 [95% CI 0.9–1.6]) or PPIs (RR 1.4 [95% CI 0.8–2.4]) before gestational day 238 was not associated with late-onset preeclampsia. Use of low-dose calcium-based antacids in gestational weeks 0–16 (<1 g/day; RR 1.8 [95% CI 1.1–2.9]) and any use of PPIs in gestational weeks 17–33 (RR 1.6 [95% CI 1.0–2.8]) seemed to increase risks of late-onset preeclampsia. We did not observe associations between late-onset preeclampsia and use of calcium-based antacids (HR 1.0 [95% CI 0.6–1.5]) and PPIs (HR 1.4 [95% CI 0.7–2.9]) after gestational day 237. Conclusion In this prospective cohort study, use of calcium-based antacids and PPIs during pregnancy was not found to reduce the risk of late-onset preeclampsia.
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Affiliation(s)
- Marleen M H J van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands,Correspondence: Marleen MHJ van Gelder, Department for Health Evidence (HP 133), Radboud University Medical Center, P.O. Box 9101, Nijmegen, 6500 HB, the Netherlands, Tel +31 24 3615305, Fax +31 24 3613505, Email
| | - Pim Beekers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands,National Health Care Institute, Diemen, the Netherlands
| | | | - Joris van Drongelen
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luc J M Smits
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Arshad R, Sameen A, Murtaza MA, Sharif HR, Iahtisham‐Ul‐Haq, Dawood S, Ahmed Z, Nemat A, Manzoor MF. Impact of vitamin D on maternal and fetal health: A review. Food Sci Nutr 2022; 10:3230-3240. [PMID: 36249984 PMCID: PMC9548347 DOI: 10.1002/fsn3.2948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/26/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
The role of vitamin D in improving maternal health and reducing the risk of developmental disorders in fetus has been an important domain of research since the past few years. Vitamin D, owing to its immunomodulatory, anti‐inflammatory, developmental roles, and regulating calcium homeostasis, is predicted to have a significant influence on maternal and fetal health status. Several observational studies and clinical trials, determining the impact of vitamin D on gestational diabetes, C‐section, postpartum depression, pre‐eclampsia, miscarriages, and preterm delivery, have been elaborated in this review. In addition, fetal birth defects including neurological development, reduced birth weight, respiratory infections, bone development, and altered anthropometrics have also been summarized with available evidences. Other important mechanisms related to the roles of vitamin D in the body are also explained. Furthermore, recent studies determining the effect of vitamin D at genetic level will also help in understanding and future design of research in the area of maternal and fetal health.
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Affiliation(s)
- Rizwan Arshad
- University Institute of Diet and Nutritional Sciences The University of Lahore Gujrat Campus Gujrat Pakistan
| | - Aysha Sameen
- National Institute of Food Science and Technology University of Agriculture Faisalabad Faisalabad Pakistan
| | - Mian Anjum Murtaza
- Institute of Food Science and Nutrition University of Sargodha Sargodha Pakistan
| | - Hafiz Rizwan Sharif
- University Institute of Diet and Nutritional Sciences The University of Lahore Gujrat Campus Gujrat Pakistan
| | - Iahtisham‐Ul‐Haq
- Kausar Abdullah Malik School of Life Sciences Forman Christian College University Lahore Pakistan
| | - Sahifa Dawood
- University Institute of Diet and Nutritional Sciences The University of Lahore Gujrat Campus Gujrat Pakistan
| | - Zahoor Ahmed
- Human Nutrition and Dietetics School of Food and Agricultural Sciences, University of Management and Technology Lahore Pakistan
| | - Arash Nemat
- Department of Microbiology Kabul University of Medical Sciences Afghanistan
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9
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Pérez ÍM. Dear Editor. Midwifery 2021; 105:103220. [PMID: 34952725 DOI: 10.1016/j.midw.2021.103220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Íñigo M Pérez
- Department of Nursing. CTS 367, Avenida de la Ilustración s/n, 18002, Granada, Spain.
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10
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Aguilar-Cordero MJ, Pérez-Castillo IM. Response to the Letter to the Editor of Midwifery. Midwifery 2021; 105:103221. [PMID: 34895781 DOI: 10.1016/j.midw.2021.103221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M J Aguilar-Cordero
- Development and Innovation Plan. CTS 367, University of Granada. Granada, Spain
| | - I M Pérez-Castillo
- Development and Innovation Plan. CTS 367, University of Granada. Granada, Spain
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11
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Mokhtari E, Rouhani P, Saneei P. Comments on: "Vitamin D, preeclampsia and prematurity: A systematic review and meta-analysis of observational and interventional studies". Midwifery 2021; 103:103168. [PMID: 34711433 DOI: 10.1016/j.midw.2021.103168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Elahe Mokhtari
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Rouhani
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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12
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Xiaomang J, Yanling W. Effect of vitamin D3 supplementation during pregnancy on high risk factors - a randomized controlled trial. J Perinat Med 2021; 49:480-484. [PMID: 33554587 DOI: 10.1515/jpm-2020-0318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/03/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Vitamin D plays an important role in the release of the placenta and implantation, and low levels are a risk factor for pre-eclampsia. Studies have also shown that symptomatic treatment of vitamin D3 deficiency can effectively reduce the risk of pre-eclampsia. In this study, vitamin D3 supplementation was performed on the risk of pre-eclampsia to observe its effect. METHODS From January 2016 to December 2018, 450 women with maternal treatment and delivery in our hospital underwent an open-label randomized study. The pregnant women were divided into low-dose, medium-dose, and high-dose groups. Compare the incidence of pre-eclampsia and the dose effect of vitamin D levels. RESULTS In the maternal and perinatal periods of the 450 maternal women, the 25[OH] index of the three groups of pregnant women was significantly increased, while the high-dose increase index was more obvious. The relative risk reduction rate was significantly lower. Compared with the low-dose and middle-dose groups, the high-dose group had a significantly lower incidence of pre-eclampsia, while the IUGR index was lower, and other obstetric indicators were comparable. CONCLUSION Vitamin D supplementation can effectively reduce the incidence of pre-eclampsia, while reducing the IUGR index, which has important value and significance in its clinical application.
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Affiliation(s)
- Jiang Xiaomang
- Department of Obstetrics and Gynecology, Chang'an Hospital, Xi'an, Shaanxi Province, P.R. China
| | - Wei Yanling
- Department of Obstetrics and Gynecology, Xijing Hospital of the Air Force Military Medical University, Xi'an, Shaanxi Province, P.R. China
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13
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Subramanian A, Korsiak J, Murphy KE, Al Mahmud A, Roth DE, Gernand AD. Effect of vitamin D supplementation during pregnancy on mid-to-late gestational blood pressure in a randomized controlled trial in Bangladesh. J Hypertens 2021; 39:135-142. [PMID: 32773651 PMCID: PMC7752208 DOI: 10.1097/hjh.0000000000002609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/19/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the dose-dependent effect of maternal vitamin D during pregnancy on blood pressure from mid-to-late gestation within the context of a randomized, placebo-controlled trial of vitamin D supplementation in Bangladesh (n = 1298). METHODS Healthy women without hypertension were enrolled at 17-24 weeks gestation and randomized to one of four vitamin D doses during pregnancy: placebo, 4200, 16 800 or 28 000 IU/week. This substudy examined 1257 women with blood pressure measured at enrollment with at least one other timepoint (measurements included at 24 weeks, 30 weeks, and weekly from 36 weeks until delivery). Effects of vitamin D on SBP or DBP were analyzed using mixed-effects models. RESULTS Vitamin D did not have an effect on SBP or DBP at 24 or 30 weeks; blood pressure was higher at 36 weeks for the highest dose versus placebo [mean difference (95% CI) mmHg: SBP = 2.3 (0.9-3.7); DBP = 1.9 (0.7-3.0)]. The differences in changes in SBP and DBP between vitamin D groups and placebo across intervals were small (P > 0.10), but the difference for 28 000 IU/week versus placebo was the highest from 30 to 36 weeks [SBP 0.2 (-0.1 to 0.5) and DBP 0.2 (-0.0 to 0.4) mmHg]. CONCLUSION Vitamin D supplementation starting mid-pregnancy did not affect SBP or DBP until late gestation, and then only at the highest dose. These results do not support the clinical use of vitamin D in pregnancy to lower maternal blood pressure.
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Affiliation(s)
- Anita Subramanian
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jill Korsiak
- Centre for Global Child Health, Hospital for Sick Children
- Department of Pediatrics, University of Toronto
| | - Kellie E. Murphy
- Department of Obstetrics and Gynecology, Mt. Sinai Hospital, Toronto, Canada
| | | | - Daniel E. Roth
- Centre for Global Child Health, Hospital for Sick Children
- Department of Pediatrics, University of Toronto
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
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14
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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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Fleet JC, Bernal-Mizrachi C, Hewison M, Jorde R, White J, Cantorna M, Schoenmakers I, Erben R. Highlights from the 22nd workshop on vitamin D in New York City, May 2019. J Steroid Biochem Mol Biol 2020; 203:105747. [PMID: 32858157 DOI: 10.1016/j.jsbmb.2020.105747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- James C Fleet
- Department of Nutrition Science, College of Health and Human Sciences, Purdue University, 700 West State St., West Lafayette, IN 47906-2059, USA.
| | - Carlos Bernal-Mizrachi
- Division of Endocrinology, Metabolism & Lipid Research, School of Medicine, Washington University, 660 S. Euclid Ave. Campus Box 8127, St. Louis, MO 63110, USA.
| | - Martin Hewison
- Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Level 2, IBR, Rom 225, The University of Birmingham, Birmingham, B15 2TT, UK.
| | - Rolf Jorde
- Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway.
| | - John White
- Department of Physiology, Department of Medicine, McGill University, 3655 Drummond St. Room 1112, Montreal, QC H3G 1Y6, Canada.
| | - Margherita Cantorna
- Department of Veterinary and Biomedical Sciences, College of Agricultural Sciences, 125 Henning Building, University Park, PA 16802, USA.
| | - Inez Schoenmakers
- Department of Medicine, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4, 7TJ, UK.
| | - Reinhold Erben
- Institute of Physiology, Pathophysiology, and Biophysics, Unit of Physiology, Pathophysiology, and Experimental Endocrinology, Veterinärplatz 1, 1210 Wien, Vienna, Austria.
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16
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Schoenmakers I, Piec I, Baban S, Bärebring L, Green D, Washbourne CJ, Tang JCY, Fraser WD, Augustin H. Gestational hypercalcemia: Prevalence and biochemical profile. J Steroid Biochem Mol Biol 2020; 199:105611. [PMID: 32007562 DOI: 10.1016/j.jsbmb.2020.105611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 01/29/2020] [Indexed: 11/25/2022]
Abstract
Gestational hypercalcemia is associated with an increased risk of maternal, fetal and neonatal morbidity and mortality. Hypercalcemia may develop during pregnancy in individuals who were previously asymptomatic. The increased sensitivity during pregnancy may be related to physiological, gestational alterations in vitamin D and calcium metabolism and may be influenced by gene variants. The prevalence is unknown. We investigated the prevalence of hypercalcemia in trimester 3 (T3) in a population representative prospective cohort study (n = 1832) in South-West Sweden. Women with serum albumin (Alb) adjusted calcium (CaAlb) ≥ 2.65 mmol/L in T3 (n = 30) were matched to normo-calcemic controls, and markers of calcium and vitamin D metabolism were investigated in trimester 1 (T1) and T3. Serum concentrations of Ca, phosphate (P), Magnesium (Mg), Alb and creatinine (Cr), parathyroid hormone (PTH; T3 only), vitamin D metabolites (total 25(OH)D, 1,25(OH)2D, 24,25(OH)2D, and free 25(OH)D) were analysed in T1 and T3. CaAlb (Payne; inter-laboratory difference: UEA = 0.15 + 0.9*UGOT; UEA 2.54 = UGOT 2.65) and estimated glomerular filtration rate (eGFR; modified 4-variable MDRD) and vitamin D metabolites ratios (VMR) were calculated. Normally and non-normally distributed data were presented as mean (SD) or median (95 %CI). Group differences in relationships between vitamin D metabolites and with PTH were investigated with multiple regression analyses. Hypercalcemia in T3 was found in 1.7 % of women. PTH concentrations suggestive of primary hyperparathyroidism was found in 1 woman and none had 25(OH)D or 24,25(OH)2D concentrations in the toxicity range or suggestive of mutations in the CYP24A1 gene. CaAlb was significantly higher in hypercalcemic cases compared to controls in T1 (2.44 (2.30-2.80) vs 2.37 (2.25-2.49) mmol/L) and T3 (2.63 (2.52-2.78) vs 2.46 (2.31-2.58) mmol/L). Serum P was higher among cases than controls in T3 (1.12 (0.16) vs 1.07 (0.18) mmol/L) but not in T1 (1.12 (0.18) and 1.12 (0.16) mmol/L). PTH in T3 was lower in cases (1.6 (1.6-2.8) vs 2.3 (2.1-2.8) pmol/L) but 1,25(OH)2D concentrations were similar. There were no significant group differences in serum 25(OH)D, free 25(OH)D, 24,25(OH)2D, Mg, Alb, Cr and eGFR. Regression analyses did not show significant differences between cases and controls in relationships between vitamin D metabolites and with PTH, except for the free 25(OH)D-PTH relationship and a higher free:total 25(OH)D ratio in cases at T1. In conclusion, most common causes of hypercalcemia were excluded in the majority of women. Hypercalcemic women had a relatively high serum 1,25(OH)2D concentration despite an appropriately suppressed PTH, suggestive of abnormal gestational adaptions.
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Affiliation(s)
- I Schoenmakers
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK.
| | - I Piec
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - S Baban
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - L Bärebring
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - D Green
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - C J Washbourne
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - J C Y Tang
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - W D Fraser
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - H Augustin
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden
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Armanini D, Andrisani A, Ambrosini G, Donà G, Bordin L, Sabbadin C. Hypertension in pregnancy: Role of body mass index, insulin resistance, aldosterone, and calcium homeostasis. J Clin Hypertens (Greenwich) 2019; 21:624-626. [PMID: 30990242 DOI: 10.1111/jch.13538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Decio Armanini
- Department of Medicine-Endocrinology, University of Padova, Padova, Italy
| | - Alessandra Andrisani
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Guido Ambrosini
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gabriella Donà
- Department of Molecular Medicine-Biological Chemistry, University of Padova, Padova, Italy
| | - Luciana Bordin
- Department of Molecular Medicine-Biological Chemistry, University of Padova, Padova, Italy
| | - Chiara Sabbadin
- Department of Medicine-Endocrinology, University of Padova, Padova, Italy
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