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Farhangnia P, Noormohammadi M, Delbandi AA. Vitamin D and reproductive disorders: a comprehensive review with a focus on endometriosis. Reprod Health 2024; 21:61. [PMID: 38698459 PMCID: PMC11064344 DOI: 10.1186/s12978-024-01797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/20/2024] [Indexed: 05/05/2024] Open
Abstract
Vitamin D is a fat-soluble steroid hormone that was initially known only for regulating calcium and phosphorus levels and maintaining bone health. However, it was later discovered that many organs express vitamin D metabolizing enzymes and have a ligand for vitamin D, which regulates the expression of an extensive assortment of genes. As a result, vitamin D is indispensable for the proper function of organs, and its deficiency is believed to be a critical factor in symptoms and disorders such as cardiovascular diseases, autoimmune diseases, and cancers. The significance of vitamin D in reproductive tissues was recognized later, and studies have revealed its crucial role in male and female fertility, as well as proper reproductive function during pregnancy. Vitamin D deficiency has been identified as a risk factor for infertility, gonadal cancers, pregnancy complications, polycystic ovary syndrome, and endometriosis. However, data investigating the association between vitamin D levels and reproductive disorders, including endometriosis, have encountered inconsistencies. Therefore, the present study aims to review existing research on the effect of vitamin D on proper reproductive function, and the role of deficiency in reproductive diseases and specifically focuses on endometriosis.
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Affiliation(s)
- Pooya Farhangnia
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
- Immunology Board for Transplantation and Cell-Based Therapeutics (ImmunoTACT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Reproductive Sciences and Technology Research Center, Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Morvarid Noormohammadi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Akbar Delbandi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
- Immunology Board for Transplantation and Cell-Based Therapeutics (ImmunoTACT), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Reproductive Sciences and Technology Research Center, Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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2
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Wang Z, Wang H, Zheng D, Liu J, Liu Y. Body composition phase angle: A potential predictor of vitamin D status in early pregnancy. Food Sci Nutr 2023; 11:8027-8034. [PMID: 38107136 PMCID: PMC10724638 DOI: 10.1002/fsn3.3722] [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: 05/05/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023] Open
Abstract
Phase angle and vitamin D can reflect the state of the body cells, and the two may interact with each other. Therefore, this study was conducted to find out the relationship between PA and vitamin D. Taking women in early pregnancy as our study subjects, we found that PA had a positive effect on vitamin D levels. Body composition phase angle, as a noninvasive, easy-to-operate, and easy-to-monitor indicator, can be used an early screening index for vitamin D nutrition levels in early pregnancy, and the cutoff value was 4.95°.
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Affiliation(s)
- Ziqin Wang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of EducationGuizhou Medical UniversityGuiyangChina
| | - Huiqun Wang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of EducationGuizhou Medical UniversityGuiyangChina
| | - Dan Zheng
- Department of Maternity HealthGuiyang Maternal and Child Health Care HospitalGuiyangChina
| | - Jing Liu
- Department of ObstetricsGuiqian International General HospitalGuiyangChina
| | - Yanping Liu
- Department of Clinical NutritionPeking Union Medical College HospitalBeijingChina
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3
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Woo J, Guffey T, Dailey R, Misra D, Giurgescu C. Vitamin D Status as an Important Predictor of Preterm Birth in a Cohort of Black Women. Nutrients 2023; 15:4637. [PMID: 37960290 PMCID: PMC10649077 DOI: 10.3390/nu15214637] [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: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Vitamin D deficiency (25 (OH)D < 20 ng/mL) is a modifiable risk factor that has been associated with an increased risk of preterm birth (PTB) (<37 weeks gestation). Black women are at a high risk for vitamin D deficiency due to higher melanin levels. Vitamin D sufficiency may be protective against PTB risk in Black women. Black participants between 8 and 25 weeks of gestation were included in this nested case-control study. The sample consisted of women who had either PTBs (n = 57) or term births, were selected based on maternal age compared to those who had PTBs (n = 118), and had blood samples available between 8 and 25 weeks of gestation. The women completed questionnaires about depressive symptoms and smoking behavior and had blood collected to determine their vitamin D levels. Gestational age at birth, hypertensive disorders, and body mass index (BMI) were collected from the medical records. The odds of PTB were increased by 3.34 times for participants with vitamin D deficiency after adjusting for hypertensive disorders of pregnancy and depressive symptoms. Vitamin D assessment and supplementation may be an important intervention for preventing PTB in pregnant Black women.
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Affiliation(s)
- Jennifer Woo
- College of Nursing, Texas Woman’s University, Dallas, TX 75235, USA
- Greene Center for Reproductive Biology, UT Southwestern, Dallas, TX 75390, USA
| | - Thomas Guffey
- Center for Research Design and Analysis, Texas Woman’s University, Denton, TX 76204, USA;
| | - Rhonda Dailey
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI 48202, USA;
| | - Dawn Misra
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48823, USA;
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL 32816, USA;
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Sunarno RD, Kartasurya MI, Suwondo A, Rahfiludin MZ. Vitamin D Supplementation and Sun Exposure Maintain Blood Pressures of Pregnant Women and Increase Birth Weight in a Randomized Controlled Trial. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2148-2156. [PMID: 37899933 PMCID: PMC10612544 DOI: 10.18502/ijph.v52i10.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/24/2022] [Indexed: 10/31/2023]
Abstract
Background Vitamin D supplementation or sun exposure increase pregnant women's Calcidiol levels, lower the blood pressures and increase birth weight. We aimed to compare the effects between sun exposure and vitamin D supplementation on pregnant women's Calcidiol levels, blood pressures and newborns' anthropometric indices. Methods This randomized clinical trial was conducted on 108 pregnant women at 20 wk of gestation on 2021's dry season in Semarang City, Indonesia. The subjects were randomly and evenly divided into 3 groups of 36 subjects (sunlight exposure, vitamin D supplement, and control). Vitamin D group received 1000 IU daily and sun exposure group was recommended to have 15-30 min for 3 times/week for 17 wk. Compliance was monitored every 2 d through home visits. Calcidiol levels, blood pressures, in all groups were compared before and after intervention. The increments and the newborn anthropometric indices were compared between the groups and controlled for confounding factors. Results At baseline, all groups had vitamin D deficiency, different mean Calcidiol levels, systolic, and diastolic blood pressures. The mean Calcidiol levels increased in the sun exposure and vitamin D group after the intervention. Systolic blood pressure decreased in the vitamin D group only (P=0.019). The mean birth weight was the highest in the vitamin D group (3,172±181.8 g) compared to the sun exposure (3,091±362.5g) and control groups (2,861 ± 208.0 g). Conclusion Vitamin D supplementation and sun exposure increased Calcidiol levels and birth weights. Vitamin D supplementation maintained systolic blood pressure.
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Affiliation(s)
- Rita Dewi Sunarno
- Doctoral Program in Public Health, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Martha Irene Kartasurya
- Public Health Nutrition Department, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Ari Suwondo
- Occupational Health and Safety Department, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Mohammad Zen Rahfiludin
- Public Health Nutrition Department, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
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Moon RJ, D’Angelo S, Crozier SR, Curtis EM, Fernandes M, Kermack AJ, Davies JH, Godfrey KM, Bishop NJ, Kennedy SH, Prentice A, Schoenmakers I, Fraser R, Gandhi SV, Inskip HM, Javaid MK, Papageorghiou AT, Cooper C, Harvey NC. Does antenatal cholecalciferol supplementation affect the mode or timing of delivery? Post hoc analyses of the MAVIDOS randomized controlled trial. J Public Health (Oxf) 2023; 45:738-747. [PMID: 36585903 PMCID: PMC10470377 DOI: 10.1093/pubmed/fdac160] [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: 06/13/2022] [Revised: 11/07/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Observational studies relating maternal 25-hydroxyvitamin D status to timing and mode of delivery have reported inconsistent results. We assessed the effect of antenatal cholecalciferol supplementation on the incidence of preterm birth, delivery mode and post-partum haemorrhage (PPH). METHODS MAVIDOS was a randomized, double-blind, placebo-controlled trial of 1000 IU/day cholecalciferol from 14 weeks' gestation until delivery. Gestational age, mode of delivery [categorized as spontaneous vaginal delivery (SVD), instrumental (including forceps and vacuum extraction) or Caesarean section] and PPH (>500 ml estimated blood loss) were determined from medical records. RESULTS A total of 965 women participated in the study until delivery. Gestation at birth and incidence of preterm birth (cholecalciferol 5.7%, placebo 4.5%, P = 0.43) were similar between the two treatment groups. SVD (versus instrumental or Caesarean delivery) was more likely in women randomized to cholecalciferol [Relative Risk (RR) 1.13, 95% confidence interval (CI) 1.02,1.25] due to lower instrumental (RR 0.68, 95%CI 0.51,0.91) but similar risk of Caesarean delivery (RR 0.94, 95%CI 0.74,1.19). PPH was less common in women randomized to cholecalciferol [32.1% compared with placebo (38.1%, P = 0.054) overall], but similar when stratified by delivery mode. CONCLUSIONS Antenatal cholecalciferol supplementation did not alter timing of birth or prevalence of preterm birth but demonstrated a possible effect on the likelihood of SVD.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Paediatric Endocrinology, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Stefania D’Angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Michelle Fernandes
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Alexandra J Kermack
- Department of Women’s Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Justin H Davies
- Paediatric Endocrinology, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas J Bishop
- Academic Unit of Child Health, Sheffield Children’s Hospital, University of Sheffield, Sheffield, UK
| | - Stephen H Kennedy
- Nuffield Department of Women’s & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Ann Prentice
- MRC Epidemiology Unit, University of Cambridge, previously at MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Inez Schoenmakers
- Faculty of Medicine and Health Sciences, Department of Medicine, University of East Anglia, Norwich, UK
| | - Robert Fraser
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield, Sheffield, UK
| | - Saurabh V Gandhi
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield, Sheffield, UK
| | - Hazel M Inskip
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Muhammad Kassim Javaid
- National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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6
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Liu CC, Huang JP. Potential benefits of vitamin D supplementation on pregnancy. J Formos Med Assoc 2023:S0929-6646(23)00058-X. [PMID: 36925361 DOI: 10.1016/j.jfma.2023.02.004] [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: 07/07/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND The level of vitamin D in pregnant women and the effect of vitamin D supplementation are lack in Taiwan. OBJECTIVE To investigate the vitamin D serum level and the effect of its supplementation on pregnancy. METHODS We included 1048 pregnant women who underwent prenatal exam with known serum 25-hydroxyvitamin D3 [25(OH)D3] levels and delivery at the Mackay Memorial Hospital, Taipei, Taiwan during 2015-2018. A daily dose 2000 IU of vitamin D was given, starting at 12-16 weeks of pregnancy, to reach the level of 20 ng/mL, and then a maintenance dose of 800 IU/day was given. The other 3654 women without vitamin D supplementation delivered in 2018 served as control group. Pregnancy outcomes were recorded for analysis. RESULTS Over 80% of the 1048 pregnant women were vitamin D deficiency. There was an inverse correlation between serum vitamin D levels and maternal body mass index (p = 0.0366). We compared 375 women with serum vitamin D levels increased above 30 ng/mL after supplementation with control group. The rates of preterm birth, low birth weight, and postpartum hemorrhage between these 2 groups were 6.67% vs. 11.19% (p = 0.007), 6.40% vs. 10.0% (p = 0.025), and 1.33% vs. 3.20% (p = 0.04), respectively. CONCLUSIONS Vitamin D deficiency is very prevalent in pregnant women, especially those with high BMI, in Taiwan. It can be corrected by adequate vitamin D supplementation, which may decrease the risk of pregnancy complications and bring benefits to the fetus.
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Affiliation(s)
- Cheng-Chiang Liu
- Division of General Obstetrics and Gynecology, Department of Obstetrics & Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jian-Pei Huang
- Division of General Obstetrics and Gynecology, Department of Obstetrics & Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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Ahi S, Adelpour M, Fereydooni I, Hatami N. Correlation between Maternal Vitamin D and Thyroid Function in Pregnancy with Maternal and Neonatal Outcomes: A Cross-Sectional Study. Int J Endocrinol 2022; 2022:6295775. [PMID: 35132318 PMCID: PMC8817873 DOI: 10.1155/2022/6295775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the prevalence of vitamin D deficiency in pregnant women to investigate the relationship between vitamin D level and thyroid function. METHODS In this cross-sectional descriptive study, a total number of 66 patients during the three trimesters of pregnancy were investigated; 22 pregnant women were studied in each trimester of pregnancy. We evaluated thyroid function tests and thyroid autoantibodies (TPOAb and TGAb), as well as the serum level of 25OHD, to determine the relationship between vitamin D level and autoimmune or non-autoimmune thyroid disease in pregnancy. RESULTS Pearson's correlation in all subjects showed that vitamin D levels did not have a significant relationship with maternal age. Only in the third trimester, there was a significant difference in maternal age based on their vitamin D status. There was no significant difference between the trimesters of pregnancy and vitamin D status (P > 0.05). Also, there were no significant differences between serum levels of vitamin D within three trimesters. Examination of thyroid function tests during pregnancy in relation to vitamin D showed that there was no significant Spearman's correlation between thyroid function status and serum vitamin D level (P > 0.05). There was no significant difference in the mean level of serum 25OH vitamin D in each subgroup of thyroid status (P > 0.05). Regarding the pregnancy outcomes, two newborns were admitted to NICU, meconium aspiration was in one case, and IUFD in another case led to pregnancy termination. These four cases were related to the maternal history of hypothyroidism. CONCLUSION There was no significant relationship between vitamin D and pregnancy trimester. The serum level of vitamin D had no particular effect on the outcome of pregnancy and the thyroid gland function.
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Affiliation(s)
- Salma Ahi
- Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohsen Adelpour
- Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Iman Fereydooni
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Naser Hatami
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
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Lian RH, Qi PA, Yuan T, Yan PJ, Qiu WW, Wei Y, Hu YG, Yang KH, Yi B. Systematic review and meta-analysis of vitamin D deficiency in different pregnancy on preterm birth: Deficiency in middle pregnancy might be at risk. Medicine (Baltimore) 2021; 100:e26303. [PMID: 34128867 PMCID: PMC8213249 DOI: 10.1097/md.0000000000026303] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Current studies suggest that vitamin D deficiency during pregnancy can produce a certain effect for preterm birth (PTB), but there is no research showing whether vitamin D deficiency has a consistent effect in different pregnancies; thus, we conducted a systematic review and meta-analysis of 24 observational studies, grouping them according to the gestational age at the time of serum sampling, to investigate whether vitamin D deficiency in different periods of gestation has different effects on PTB and to provide an evidence-based basis for pregnant women to measure and supplement vitamin D. METHODS The databases PubMed-Medline, EMBASE, the Cochrane Library, Web of Science, EBSCO, CBM, and CNKI were searched until February 2020. Two researchers independently assessed the eligibility and quality of studies, and STATA 12.0 software was used for meta-analysis. RESULT Seven cohort studies, 13 case-control studies, and 4 cross-sectional studies were included from 2500 articles by inclusion and exclusion criteria. After adjusting for age, race, and other confounding factors, meta-analysis results showed that vitamin D deficiency in the first trimester, the second trimester, and the third trimester did not increase the risk of PTB (odds ratio (OR) = 1.01, 95% confidence interval (CI) (0.88, 1.16), P = .867; OR = 1.12, 95%CI (0.92, 1.37), P = .249; OR = 1.05, 95%CI (0.87, 1.27), P = .602). However, there was moderate heterogeneity in the study of vitamin D deficiency in the second trimester, and subgroup analysis suggested that vitamin D deficiency in the second trimester may increase the risk of PTB (OR = 1.33, 95%CI (1.15, 1.54), P = .000). A sensitivity analysis of the second trimester showed that excluding any 1 study did not significantly change the results. CONCLUSIONS Vitamin D deficiency in early and late pregnancy may not be associated with PTB, while vitamin D deficiency in middle pregnancy is likely to have an important effect on PTB. Vitamin D levels should be measured in the second trimester of pregnancy, and vitamin D supplements should be provided if necessary.
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Affiliation(s)
- Rui-Han Lian
- Gansu Provincial Maternity and Child-Care Hospital
- Gansu University of Chinese Medicine
| | - Ping-An Qi
- Gansu Provincial Maternity and Child-Care Hospital
- Gansu University of Chinese Medicine
| | - Tao Yuan
- The First Hospital of Lanzhou University
| | - Pei-Jing Yan
- Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital
| | | | - Ying Wei
- Gansu Provincial Maternity and Child-Care Hospital
- Gansu University of Chinese Medicine
| | - Ya-Guang Hu
- Gansu Provincial Maternity and Child-Care Hospital
| | - Ke-Hu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Bin Yi
- Gansu Provincial Maternity and Child-Care Hospital
- Gansu University of Chinese Medicine
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Asali FF, Tayyem RF, Allehdan SS, Mahfouz IA, Bawadi HA. Use of dietary supplements among pregnant women in the center of Jordan. NFS JOURNAL 2020. [DOI: 10.1016/j.nfs.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Vivanti AJ, Monier I, Salakos E, Elie C, Tsatsaris V, Senat MV, Jani J, Jouannic JM, Winer N, Zeitlin J, Mougneaud C, Souberbielle JC, Courbebaisse M, Benachi A. Vitamin D and pregnancy outcomes: Overall results of the FEPED study. J Gynecol Obstet Hum Reprod 2020; 49:101883. [PMID: 32730862 DOI: 10.1016/j.jogoh.2020.101883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 01/20/2023]
Abstract
Vitamin D insufficiency is highly prevalent in children and adults including pregnant women. During pregnancy, maternal vitamin D insufficiency could increase risks of several pregnancy complications and adverse birth outcomes. The FEPED study was designed to assess the effects of maternal vitamin D status in the first trimester during pregnancy on risks of preeclampsia, gestational diabetes mellitus (GDM), preterm birth and small-for-gestational age (SGA) at birth. This observational prospective cohort included 3129 women with a singleton pregnancy between April 2012 and July 2014 in six maternity units in France and Belgium. The aim of this review is to summarize the results of the FEPED study. At the first trimester the mean 25(OH)D concentration was 21.9 ± 10.4 ng/mL and 25(OH)D concentration was <20 ng/mL in 46.5 % of patients. After matching 83 cases of preeclampsia with 319 controls, a significant decrease in the risk of preeclampsia was associated with maternal vitamin D levels ≥ 30 ng/mL in the third trimesters (OR = 0.34; 95 % CI: 0.13-0.86. P = 0.023). In the first trimester, the risk for preeclampsia was decreased in these patients, but did not achieve statistical significance (OR = 0.57 95 % CI, 0.30-1.01; p = 0.09). For the 250 cases with GDM matched with 941 controls, no linear relationship was found between GDM and 25OHD levels in the first trimester of pregnancy. Finally, 2813 pregnant women were included in analyses of risks of preterm and SGA birth. No association was found between low maternal vitamin D levels in the first trimester and the risks of preterm birth (aOR = 1.53; 95 % CI: 0.97-2.43) or SGA (aOR = 1.07; 95 % CI: 0.75-1.54). Further investigation is needed to understand the mechanisms behind the association between vitamin D and birth outcomes.
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Affiliation(s)
- Alexandre J Vivanti
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, Clamart, France.
| | - Isabelle Monier
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, Clamart, France; Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Eleonora Salakos
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, Clamart, France
| | - Caroline Elie
- URC/CIC Paris Descartes Necker Cochin, Hôpital Necker-Enfants maladies, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Vassilis Tsatsaris
- Service de Gynécologie-Obstétrique, Hôpital Cochin Port Royal, Assistance Publique des Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Marie-Victoire Senat
- Service de Gynécologie-Obstétrique, Hôpital de Bicêtre, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Jacques Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Marie Jouannic
- Département de Médecine Fœtale, Hôpital Armand Trousseau, Assistance Publique des Hôpitaux de Paris, Université UPMC-Sorbonne, Paris, France
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU de Nantes, CIC Mère enfant Nantes, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | | | - Charlotte Mougneaud
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, Clamart, France
| | - Jean-Claude Souberbielle
- Laboratoire d'Explorations Fonctionnelles, Hôpital Necker-Enfants malades, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Marie Courbebaisse
- Service de Physiologie-Explorations Fonctionnelles Rénales, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université de Paris, INSERM U1151, Paris, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, Clamart, France
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11
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Monier I, Baptiste A, Tsatsaris V, Senat MV, Jani J, Jouannic JM, Winer N, Elie C, Souberbielle JC, Zeitlin J, Benachi A. First Trimester Maternal Vitamin D Status and Risks of Preterm Birth and Small-For-Gestational Age. Nutrients 2019; 11:nu11123042. [PMID: 31847068 PMCID: PMC6950733 DOI: 10.3390/nu11123042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022] Open
Abstract
Maternal 25-hydroxyvitamin D (25-OHD) deficiency during pregnancy may increase the risk of preterm and small-for-gestational age (SGA) birth, but studies report conflicting results. We used a multicenter prospective cohort of 2813 pregnant women assessed for 25-OHD levels in the first trimester of pregnancy to investigate the association between maternal 25-OHD concentrations and risks of preterm birth (<37 weeks) and SGA (birthweight <10th percentile). Odds ratios were adjusted (aOR) for potential cofounders overall and among women with light and dark skin separately, based on the Fitzpatrick scale. 25-OHD concentrations were <20 ng/mL for 45.1% of the cohort. A total of 6.7% of women had a preterm birth. The aOR for preterm birth associated with the 1st quartile of 25-OHD concentrations compared to the 4th quartile was 1.53 (95% confidence interval (CI): 0.97–2.43). In stratified analyses, an association was observed for women with darker skin (aOR = 2.89 (95% CI: 1.02–8.18)), and no association with lighter skin. A total of 11.9% of births were SGA and there was no association overall or by skin color. Our results do not provide support for an association between maternal first trimester 25-OHD deficiency and risk of preterm or SGA birth overall; the association with preterm birth risk among women with darker skin requires further investigation.
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Affiliation(s)
- Isabelle Monier
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France;
- Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, University Paris Saclay, F-92140 Clamart, France;
- Correspondence: ; Tel.: +33-(0)1-7172-2992
| | - Amandine Baptiste
- URC/CIC Paris Descartes Necker Cochin, Necker-Enfants Malades Hospital, AP-HP, F-75015 Paris, France
| | - Vassilis Tsatsaris
- Department of Obstetrics, Cochin Hospital, AP-HP, Paris-Descartes University, F-75014 Paris, France
| | - Marie-Victoire Senat
- Department of Obstetrics and Gynecology, Bicêtre Hospital, AP-HP, Université Paris Saclay, F-94270 Kremlin Bicêtre, France
| | - Jacques Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, B-1000 Brussels, Belgium
| | - Jean-Marie Jouannic
- Fetal Medecine Department, Armand Trousseau Hospital, AP-HP, UPMC-Sorbonne Université, F-75012 Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, CIC Mere enfant Nantes, NUN, INRA, UMR 1280, Phan, Nantes University, F-44000 Nantes, France
| | - Caroline Elie
- URC/CIC Paris Descartes Necker Cochin, Necker-Enfants Malades Hospital, AP-HP, F-75015 Paris, France
| | - Jean-Claude Souberbielle
- Laboratoire d’Explorations Fonctionnelles, Necker-Enfants malades Hospital, AP-HP, F-75015 Paris, France
| | - Jennifer Zeitlin
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France;
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, University Paris Saclay, F-92140 Clamart, France;
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12
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Budhwar S, Verma P, Verma R, Gupta S, Rai S, Rajender S, Singh K. Altered cord serum 25-hydroxyvitamin D signaling and placental inflammation is associated with pre-term birth. Am J Reprod Immunol 2019; 83:e13201. [PMID: 31642155 DOI: 10.1111/aji.13201] [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] [Received: 06/20/2019] [Revised: 09/30/2019] [Accepted: 10/18/2019] [Indexed: 12/18/2022] Open
Abstract
PROBLEM Vitamin D is well-known for having anti-inflammatory and immunomodulatory properties. Impaired maternal vitamin D status has been known to increase the risk of adverse pregnancy outcomes like pre-term birth. The present study aims to evaluate the impact of fetal cord serum 25-hydroxyvitamin D-mediated signaling in mediating inflammatory responses in placenta during pre-term birth. METHOD OF STUDY For the above purpose, cord serum 25 hydroxyvitamin D 25(OH)D were measured in term (n = 20) and pre-term (n = 20) born babies using ELISA. Vitamin D downstream signaling has also been checked in placenta (VDR, CYP27B1, cathelicidin LL37) along with expression of inflammatory markers (S100A8, HMGB1, TLR2, p-NF-kappaB) using Western blotting and immunohistochemistry. Pearson correlation model was used to do correlation study. RESULTS Compared with term born babies (59.31 ± 3.476), decline in cord serum 25(OH)D levels is observed in pre-term born babies (22.26 ± 1.083, P = <0.0001) that showed strong positive correlation with gestational age (r = .9368***) and birthweight (r = .9559***). On the other hand, vitamin D signaling markers were found to be downregulated and inflammatory markers were upregulated in placental tissue of pre-term born babies. CONCLUSION Thus, our study demonstrated that insufficient cord 25(OH)D levels may disturb the homeostasis of inflammation in placenta. Altered cord serum 25(OH)D mediated anti-inflammatory signaling may be acting as trigger signals in modulating inflammatory responses in placenta and eliciting premature activation of spontaneous labor in pre-term birth.
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Affiliation(s)
- Snehil Budhwar
- Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Priyanka Verma
- Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Rachna Verma
- Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Shreshtha Gupta
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sangeeta Rai
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Singh Rajender
- Division of Endocrinology, CSIR Central Drug Research Institute, Lucknow, India
| | - Kiran Singh
- Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India
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13
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Savard C, Gagnon C, Morisset AS. Disparities in the timing and measurement methods to assess vitamin D status during pregnancy: A Narrative Review. INT J VITAM NUTR RES 2019; 88:176-189. [PMID: 30747608 DOI: 10.1024/0300-9831/a000507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Studies that examined associations between low circulating 25-hydroxyvitamin D (25(OH)D) and adverse pregnancy outcomes used various designs, assay methods and time points for measurement of 25(OH)D concentrations, which creates some confusion in the current literature. We aimed to investigate the variability in the timing and measurement methods used to evaluate vitamin D status during pregnancy. Analysis of 198 studies published between 1976 and 2017 showed an important variability in the choice of 1) threshold values for 25(OH)D insufficiency or deficiency, 2) 25(OH)D measurement methods, and 3) trimester in which 25(OH)D concentrations were measured. Blood samples were taken once during pregnancy in a large majority of studies, which may not be representative of vitamin D status throughout pregnancy. Most studies reported adjustment for confounding factors including season of blood sampling, but very few studies used the 25(OH)D gold standard assay, the LC-MS/MS. Prospective studies assessing maternal 25(OH)D concentrations 1) by standardized and validated methods, 2) at various time points during pregnancy, and 3) after considering potential confounding factors, are needed.
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Affiliation(s)
- Claudia Savard
- 1 School of Nutrition, Laval University.,2 Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec, Canada.,3 Institute of Nutrition and Functional Foods, Laval University Quebec City, Québec, Canada
| | - Claudia Gagnon
- 2 Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec, Canada.,3 Institute of Nutrition and Functional Foods, Laval University Quebec City, Québec, Canada.,4 Department of Medicine, Laval University, Quebec City, Québec, Canada
| | - Anne-Sophie Morisset
- 1 School of Nutrition, Laval University.,2 Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec, Canada.,3 Institute of Nutrition and Functional Foods, Laval University Quebec City, Québec, Canada
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14
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Ciebiera M, Wojtyła C, Łukaszuk K, Zgliczyńska M, Zaręba K, Rawski W, Jakiel G. The role of vitamin D in perinatology. An up-to-date review. Arch Med Sci 2019; 17:992-1005. [PMID: 34336027 PMCID: PMC8314414 DOI: 10.5114/aoms.2019.81747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023] Open
Abstract
The role of vitamin D in perinatology is a subject of major interest in current medicine. There is growing evidence about the role of maternal vitamin D levels in pregnancy outcomes. The aim of this review is to summarize the current literature about the role of vitamin D in perinatology. Evidence from this review suggests associations between low levels of maternal vitamin D and higher risk of certain obstetrical complications. Vitamin D has been found to be related to preeclampsia, gestational diabetes mellitus, low birth weight, and preterm birth. The current literature supports vitamin D supplementation in pregnant women, but more high-quality data are necessary. The problem that remains is how to achieve an optimal 25-hydroxyvitamin D level. To determine the real benefits of vitamin D supplementation in pregnancy, we need high-quality trials in larger groups.
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Affiliation(s)
- Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Cezary Wojtyła
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
- European Observatory of Health Inequalities, State University of Applied Sciences, Kalisz, Poland
| | - Krzysztof Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Magdalena Zgliczyńska
- Students’ Scientific Association at the First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Kornelia Zaręba
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Wojciech Rawski
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
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15
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Subramanian A, Gernand AD. Vitamin D metabolites across the menstrual cycle: a systematic review. BMC WOMENS HEALTH 2019; 19:19. [PMID: 30691458 PMCID: PMC6348668 DOI: 10.1186/s12905-019-0721-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/18/2019] [Indexed: 01/28/2023]
Abstract
Background Accurate estimation of vitamin D status is important for health research and can impact prevention and treatment of deficiency in women of reproductive age. We aimed to assess if blood concentrations of 25-hydroxyvitamin D [25(OH)D] or 1,25-dihydroxyvitamin D [1,25(OH)2D] change across the menstrual cycle. Methods We conducted a systematic search in PubMed, Web of Science, CAB and BIOSIS of literature published until December 2018 which reported concentrations of vitamin D metabolites at two or more identified points among women with regular menstrual cycles. Results Ten longitudinal studies met the inclusion criteria; nine studies measured 1,25(OH)2D and five studies measured 25(OH)D. Study size ranged from 5 to 47 subjects, with an age range of 18–47 years. One study found a decrease in concentration of 25(OH)D in the periovulatory and luteal phase. Four studies found no changes in concentrations of 25(OH)D. Two studies found a rise in 1,25(OH)2D within the follicular phase, including a 128% increase from day 1 to 15 and a 56% increase from day 0 to 12. Two studies found rises in 1,25(OH)2D concentrations from the follicular to luteal phase of 13 and 26%. Five studies did not find any changes in concentrations of 1,25(OH)2D. Conclusions No conclusion can be drawn on the pattern of 1,25(OH)2D concentrations across the normal menstrual cycle due to inconsistencies in study findings. Evidence is currently insufficient to assess 25(OH)D concentrations across the cycle. Future studies should aim to measure 1,25(OH)2D and 25(OH)D longitudinally, to understand relationships with other hormones and the potential impact on estimates of vitamin D deficiency.
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Affiliation(s)
- Anita Subramanian
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA.
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16
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Wang B, Cruz Ithier M, Parobchak N, Yadava SM, Schulkin J, Rosen T. Vitamin D stimulates multiple microRNAs to inhibit CRH and other pro-labor genes in human placenta. Endocr Connect 2018; 7:1380-1388. [PMID: 30395535 PMCID: PMC6280586 DOI: 10.1530/ec-18-0345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 01/23/2023]
Abstract
Maternal vitamin D deficiency is linked to adverse pregnancy outcomes including spontaneous preterm birth (SPB). Placental corticotropin-releasing hormone (CRH) has been proposed to be part of a clock that governs the length of gestation in humans, with elevated maternal serum levels predicting early delivery. In this study, we test the hypothesis that vitamin D could contribute to the prevention of preterm labor by inhibiting CRH and other pro-labor mediators. The biological activity of vitamin D occurs via two pathways: non-genomic and genomic responses, both of which involve binding of 1,25-dihydroxyvitamin D (1,25(OH)2D), the active metabolite of vitamin D binding to the vitamin D receptor (VDR). By using chromatin immunoprecipitation followed by sequencing (ChIP-seq), we found that 1,25(OH)2D stimulates association of VDR with a number of miRNA genes including MIR181B2 and MIR26B, and their mature products miR-181b-5p and miR-26b-5p are predicted to target CRH and cyclooxygenase-2 (COX-2) mRNA at 3'-untranslated region (UTR), respectively. We performed RT-qPCR analysis to validate that expression of mature miR-181b-5p and miR-26b-5p in term human syncytiotrophoblast increased in response to treatment with 1,25(OH)2D. miR-181b-5p- or miR-26b-5p-mediated inhibition of CRH or COX-2 was further assessed by the use of miRNA mimics/inhibitors and a luciferase reporter assay. Taken together, this study has identified novel mechanisms by which vitamin D downregulates pro-labor genes and could lower the risk of preterm delivery.
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Affiliation(s)
- Bingbing Wang
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Correspondence should be addressed to B Wang or T Rosen: or
| | - Mayra Cruz Ithier
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Nataliya Parobchak
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Stacy M Yadava
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jay Schulkin
- Department of Obstetrics, Gynecology, University of Washington, Seattle, Washington, USA
| | - Todd Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Correspondence should be addressed to B Wang or T Rosen: or
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17
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Dovnik A, Mujezinović F. The Association of Vitamin D Levels with Common Pregnancy Complications. Nutrients 2018; 10:nu10070867. [PMID: 29976852 PMCID: PMC6073751 DOI: 10.3390/nu10070867] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 12/18/2022] Open
Abstract
The association between vitamin D deficiency and various adverse pregnancy outcomes has been extensively investigated in recent years. The pregnant woman is the only source of vitamin D for the foetus. The main sources of vitamin D for pregnant women are sunlight, fortified dairy products, oily fish and dietary supplements. Vitamin D deficiency during pregnancy has been associated with some adverse neonatal outcomes as well as an increased risk of late pregnancy complications. The outcomes of the published studies investigating preeclampsia and gestational diabetes mellitus vary with some large trials suggesting a potential positive effect of vitamin D supplementation during pregnancy on the decreased risk of these complications. Research also suggests a possible connection between lower vitamin D concentrations and increased risk of preterm labour. In our manuscript, we aim to review the existing literature regarding the prevalence of vitamin D deficiency during pregnancy, the factors associated with vitamin D deficiency, and possible pregnancy complications arising from it.
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Affiliation(s)
- Andraž Dovnik
- University Clinic for Gynaecology and Perinatology, Maribor University Medical Centre, Ljubljanska 5, SI-2000 Maribor, Slovenia.
| | - Faris Mujezinović
- University Clinic for Gynaecology and Perinatology, Maribor University Medical Centre, Ljubljanska 5, SI-2000 Maribor, Slovenia.
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18
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Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull 2018; 126:57-77. [PMID: 29684104 PMCID: PMC6003599 DOI: 10.1093/bmb/ldy010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/26/2018] [Indexed: 12/19/2022]
Abstract
Introduction Maternal vitamin D status in pregnancy has been linked to many health outcomes in mother and offspring. A wealth of observational studies have reported on both obstetric outcomes and complications, including pre-eclampsia, gestational diabetes, mode and timing of delivery. Many foetal and childhood outcomes are also linked to vitamin D status, including measures of foetal size, body composition and skeletal mineralization, in addition to later childhood outcomes, such as asthma. Sources of data Synthesis of systematic and narrative reviews. Areas of agreement and controversy The findings are generally inconsistent in most areas, and, at present, there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. In most areas, the evidence tends towards maternal vitamin D being of overall benefit, but often does not reach statistical significance in meta-analyses. Growing points and areas timely for developing research The most conclusive evidence is in the role of maternal vitamin D supplementation in the prevention of neonatal hypocalcaemia; as a consequence the UK department of health recommends that pregnant women take 400 IU vitamin D daily. High-quality randomized placebo-controlled trials, such as the UK-based MAVIDOS trial, will inform the potential efficacy and safety of vitamin D supplementation in pregnancy across a variety of outcomes.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- Paediatric Endocrinology, Southampton University Hospitals NHS
Foundation Trust, Southampton, SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of
Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road,
Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of
Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road,
Southampton, SO16 6YD, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford,
Oxford, OX3 7LD, UK
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19
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Li G, Lin L, Wang YL, Yang H. 1,25(OH)2D3 Protects Trophoblasts Against Insulin Resistance and Inflammation Via Suppressing mTOR Signaling. Reprod Sci 2018; 26:223-232. [PMID: 29575997 DOI: 10.1177/1933719118766253] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is the primary cause of maternal and fetal morbidity and mortality. Insulin resistance (IR) is pivotal to GDM pathogenesis, and mammalian target of rapamycin (mTOR) is a critical regulator of GDM. An increasing amount of evidence indicates that vitamin D deficiency is a risk factor for GDM. However, there are few reports on the effect of IR on GDM placentas. The present study aims to verify that 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) can ameliorate trophoblast IR by suppressing mTOR signaling. An IR BeWo cell model was established in the presence of high insulin and glucose medium. The IR level and mTOR activation with or without 1,25(OH)2D3 treatment were evaluated. The IR cells exhibited excessive mTOR signaling activation, upregulated inflammatory factor levels, and extensive lipid infiltration. However, 1,25(OH)2D3 reversed mTOR activation and reduced the IR level and lipid infiltration. In addition, 1,25(OH)2D3 treatment in GDM placental explants blocked the aberrant, increased levels of leptin, TNF-α, and IL-6. Therefore, 1,25(OH)2D3 treatment protects trophoblasts against high IR mainly through suppressing mTOR signaling, and this mechanism may serve as a potential therapy for patients with GDM.
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Affiliation(s)
- Guanlin Li
- 1 Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People's Republic of China
| | - Li Lin
- 1 Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People's Republic of China
| | - Yan-Ling Wang
- 2 State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Huixia Yang
- 1 Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People's Republic of China
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20
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Influent factors of gestational vitamin D deficiency and its relation to an increased risk of preterm delivery in Chinese population. Sci Rep 2018; 8:3608. [PMID: 29483547 PMCID: PMC5827025 DOI: 10.1038/s41598-018-21944-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/12/2018] [Indexed: 02/06/2023] Open
Abstract
Gestational vitamin D deficiency (VDD) has been linked with adverse pregnant outcomes. To investigate influent factors of gestational VDD and its relation to the incidence of preterm delivery, total 3598 eligible mother-and-singleton-offspring pairs were recruited. For serum 25(OH)D concentration, 941 pregnant women were sufficient, 1260 insufficient, and 1397 deficient. Further analysis showed that VDD was more prevalent in winter than in other seasons. Underweight but not overweight was a risk factor for gestational VDD. Multivitamin use reduced risk of gestational VDD. Interestingly, 8.23% delivered preterm infants among subjects with VDD (adjusted RR: 4.02; 95% CI: 2.33, 6.92) and 3.81% among subjects with gestational vitamin D insufficiency (VDI) (adjusted RR: 2.07; 95% CI: 1.16, 3.71). Moreover, 2.59% delivered early preterm infants among subjects with VDD (adjusted RR: 2.97; 95% CI: 1.41, 6.24) and 0.49% among subjects with VDI (adjusted RR: 0.54; 95% CI: 0.19, 1.51). The incidence of late preterm delivery was 5.64% among subjects with VDD (adjusted RR: 3.90; 95% CI: 2.26, 6.72) and 3.32% among subjects with VDI (adjusted RR: 2.09; 95% CI: 1.17, 3.74). In conclusion, pre-pregnancy BMI, seasonality and multivitamin use are influent factors of gestational vitamin D status. Gestational VDD is associated with an increased risk of preterm delivery in Chinese population.
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21
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Longtine MS, Cvitic S, Colvin BN, Chen B, Desoye G, Nelson DM. Calcitriol regulates immune genes CD14 and CD180 to modulate LPS responses in human trophoblasts. Reproduction 2017; 154:735-744. [DOI: 10.1530/rep-17-0183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/17/2017] [Accepted: 09/04/2017] [Indexed: 11/08/2022]
Abstract
We assessed the response of primary cultures of placental villous mononucleated trophoblasts and multinucleated syncytiotrophoblast to calcitriol, the most biologically active form of vitamin D. Whole-genome microarray data showed that calcitriol modulates the expression of many genes in trophoblasts within 6 hours of exposure and RT-qPCR revealed similar responses in cytotrophoblasts, syncytiotrophoblasts and villous explants. Both cytotrophoblasts and syncytiotrophoblasts expressed genes for the vitamin D receptor, for LRP2 and CUBN that mediate internalization of calcidiol, forCYP27B1that encodes the enzyme that converts calcidiol into active calcitriol, and forCYP24A1that encodes the enzyme that modifies calcitriol and calcidiol to inactive calcitetrol. Notably, we found an inverse effect of calcitriol on expression of CD14 and CD180/RP105, proteins that differentially regulate toll-like receptor 4-mediated immune responses. Supported by gene ontology analysis, we tested the hypothesis that CD14 and CD180 modulate the inflammatory response of syncytiotrophoblast to bacterial lipopolysaccharide (LPS). These cells showed a robust response to a wide range of LPS concentrations, with induction of active NF-κB and increased secretion of IL-6 and IL-8. SiRNA-mediated knockdown ofCD14reduced the secretion of IL-6 and IL-8 in response to LPS. Collectively, our data showed that calcitriol has a rapid and widespread effect on villous trophoblast gene expression in general, and a specific effect on the innate immune response by syncytiotrophoblast.
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22
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Knabl J, Vattai A, Ye Y, Jueckstock J, Hutter S, Kainer F, Mahner S, Jeschke U. Role of Placental VDR Expression and Function in Common Late Pregnancy Disorders. Int J Mol Sci 2017; 18:ijms18112340. [PMID: 29113124 PMCID: PMC5713309 DOI: 10.3390/ijms18112340] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 12/14/2022] Open
Abstract
Vitamin D, besides its classical role in bone metabolism, plays a distinct role in multiple pathways of the feto-maternal unit. Calcitriol is the major active ligand of the nuclear vitamin D receptor (VDR). The vitamin D receptor (VDR) is expressed in different uteroplacental parts and exerts a variety of functions in physiologic pregnancy. It regulates decidualisation and implantation, influences hormone secretion and placental immune modulations. This review highlights the role of the vitamin D receptor in physiologic and disturbed pregnancy, as preeclampsia, fetal growth restriction, gestational diabetes and preterm birth. We discuss the existing literature regarding common VDR polymorphisms in these pregnancy disorders.
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Affiliation(s)
- Julia Knabl
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
- Department of Obstetrics and Gynecology, Klinik Hallerwiese, 90419 Nürnberg, Germany.
| | - Aurelia Vattai
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Yao Ye
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Stefan Hutter
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Franz Kainer
- Department of Obstetrics and Gynecology, Klinik Hallerwiese, 90419 Nürnberg, Germany.
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
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Gernand AD, Simhan HN, Baca KM, Caritis S, Bodnar LM. Vitamin D, pre-eclampsia, and preterm birth among pregnancies at high risk for pre-eclampsia: an analysis of data from a low-dose aspirin trial. BJOG 2017; 124:1874-1882. [PMID: 27704679 PMCID: PMC7845451 DOI: 10.1111/1471-0528.14372] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. DESIGN Analysis of prospectively collected data and blood samples from a trial of prenatal low-dose aspirin. SETTING Thirteen sites across the USA. POPULATION Women at high risk for pre-eclampsia. METHODS We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12-26 weeks' gestation (n = 822). We used mixed effects models to examine the association between 25(OH)D and risk of pre-eclampsia and preterm birth, controlling for confounders including prepregnancy BMI and race. MAIN OUTCOME MEASURES Pre-eclampsia and preterm birth. RESULTS Twelve percent of women were vitamin D deficient [25(OH)D <30 nmol/l]. Women with 25(OH)D <30 versus ≥75 nmol/l had a 2.4-fold (95% CI 1.0-5.6) higher risk of early-onset pre-eclampsia (<35 weeks' gestation) after confounder adjustment. Women with 25(OH)D <50 nmol/l had a 1.8-fold (95% CI 1.0-3.2) increased risk of preterm birth at <35 weeks compared with women who had 25(OH)D ≥75 nmol/l, which was driven by indicated preterm births at <35 weeks' gestation [25(OH)D <50 versus ≥75 nmol/l adjusted RR 2.5 (95% CI 1.1-5.8)]. There was no association between vitamin D status and pre-eclampsia or preterm birth at <37 weeks. CONCLUSION Maternal vitamin D status in the second trimester was inversely associated with risk of early-onset pre-eclampsia and preterm birth at <35 weeks in women at high risk for pre-eclampsia. TWEETABLE ABSTRACT Vitamin D is inversely related to risk of pre-eclampsia and preterm birth at <35 weeks in high-risk pregnancies.
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Affiliation(s)
- AD Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - HN Simhan
- Division of Maternal-Fetal Medicine, Magee-Women’s Hospital and Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - KM Baca
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - S Caritis
- Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - LM Bodnar
- Departments of Epidemiology and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, PA, USA
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Mohamed SA, El Andaloussi A, Al-Hendy A, Menon R, Behnia F, Schulkin J, Power ML. Vitamin D and corticotropin-releasing hormone in term and preterm birth: potential contributions to preterm labor and birth outcome. J Matern Fetal Neonatal Med 2017; 31:2911-2917. [DOI: 10.1080/14767058.2017.1359534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sara A. Mohamed
- Department of Obstetrics and Gynecology, Mansoura Medical School, Mansoura, Egypt
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Abdeljabar El Andaloussi
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Faranak Behnia
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Jay Schulkin
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, Rockefeller University, New York, NY, USA
| | - Michael L. Power
- Department of Research, American College of Obstetricians and Gynecologists, Washington, DC, USA
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25
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Li Z, Mei Z, Zhang L, Li H, Zhang Y, Li N, Ye R, Ren A, Liu JM, Serdula MK. Effects of Prenatal Micronutrient Supplementation on Spontaneous Preterm Birth: A Double-Blind Randomized Controlled Trial in China. Am J Epidemiol 2017; 186:318-325. [PMID: 28472219 DOI: 10.1093/aje/kwx094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/12/2016] [Indexed: 12/17/2022] Open
Abstract
In this secondary analysis of data from a double-blind randomized controlled trial carried out in northern China, we aimed to assess the effect of prenatal supplementation with multiple micronutrients (MMN) or iron + folic acid (IFA), versus folic acid (FA) alone, on risk of spontaneous preterm birth (SPB) and the impact of supplementation timing on SPB. A total of 18,775 nulliparous pregnant women enrolled between 2006 and 2009 were randomly assigned to receive daily FA, IFA, or MMN from the period before 20 weeks' gestation to delivery. The incidences of SPB for women consuming FA, IFA, and MMN were 5.7%, 5.6% and 5.1%, respectively. Compared with women given FA, the relative risks of SPB for those using MMN and IFA were 0.99 (95% confidence interval: 0.85, 1.16) and 0.89 (95% confidence interval: 0.79, 1.05), respectively. SPB incidence in women who started consuming FA, IFA, and MMN before the 12th week of gestation (4.6%, 4.2%, and 3.9%, respectively) was significantly reduced compared with starting supplement use on or after the 12th gestational week (6.9%, 7.2%, and 6.4%, respectively). Starting use of FA, IFA, or MMN supplements before the 12th week of gestation produced a 41%-45% reduction in risk of SPB. Early prenatal enrollment and micronutrient use during the first trimester of pregnancy appeared to be of particular importance for prevention of SPB, regardless of supplement group.
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26
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Zhou SS, Tao YH, Huang K, Zhu BB, Tao FB. Vitamin D and risk of preterm birth: Up-to-date meta-analysis of randomized controlled trials and observational studies. J Obstet Gynaecol Res 2017; 43:247-256. [PMID: 28150405 DOI: 10.1111/jog.13239] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/08/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Abstract
AIM We performed a meta-analysis of randomized controlled trials (RCT) and observational studies to answer the two following questions: (i) whether low maternal circulating 25 hydroxyvitamin D (25-OHD) is associated with an increased risk of preterm birth (PTB) or spontaneous PTB (sPTB); and (ii) whether vitamin D supplementation alone during pregnancy can reduce the risk of PTB. METHODS Literature search was carried out using Pubmed, Web of Science and Embase databases up to June 2016. Pooled OR or relative risk (RR) with 95%CI were computed using fixed or random effects models depending on the size of heterogeneity. Subgroup analysis was used to explore potential sources of between-study heterogeneity. Publication bias was evaluated using Egger's test and Begg's test. RESULTS Twenty-four articles (six RCT and 18 observational studies) were identified. Maternal circulating 25-OHD deficiency (pooled OR, 1.25; 95%CI: 1.13-1.38) rather than insufficiency (pooled OR, 1.09; 95%CI: 0.89-1.35) was associated with an increased risk of PTB, and vitamin D supplementation alone during pregnancy could reduce the risk of PTB (pooled RR, 0.57; 95%CI: 0.36-0.91). This was also the case for the sPTB subgroup (circulating 25-OHD <50 vs >50 nmol/L; pooled OR, 1.45; 95%CI: 1.20-1.75). CONCLUSIONS Maternal circulating 25-OHD deficiency could increase PTB risk and vitamin D supplementation alone during pregnancy could reduce PTB risk. Extrapolation of the results, however, must be done with caution, and there is urgent need for larger, better-designed RCT to confirm this effect.
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Affiliation(s)
- Shan-Shan Zhou
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, China
| | - Yong-Hao Tao
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Kun Huang
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Bei-Bei Zhu
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Fang-Biao Tao
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
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27
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Catov JM, Scifres CM, Caritis SN, Bertolet M, Larkin J, Parks WT. Neonatal outcomes following preterm birth classified according to placental features. Am J Obstet Gynecol 2017; 216:411.e1-411.e14. [PMID: 28065815 DOI: 10.1016/j.ajog.2016.12.022] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Preterm birth has staggering health implications, and yet the causes of most cases are still unknown. Placental features have been understudied as an etiology for preterm birth, and the association between placental pathologic lesions and neonatal outcomes are incompletely understood. OBJECTIVE We sought to characterize births according to placental pathology and relate these to adverse neonatal outcomes. STUDY DESIGN We studied 20,091 births (15,710 term and 4381 preterm) with placental evaluations. Births were classified according to the presence or absence of placental lesions consistent with malperfusion (vasculopathy, infarct, advanced villous maturation, perivillous fibrin, fibrin deposition) and intrauterine inflammation/infection (chorioamnionitis, funisitis, vasculitis). Outcomes were gestational week of delivery, birthweight z-score, neonatal respiratory distress syndrome, and intraventricular hemorrhage. RESULTS Among all preterm births, evidence of placental malperfusion was identified more often than inflammation/infection (50.6% vs 27.3%, P < .0001). Placental malperfusion was associated with reduced fetal growth (adjusted birthweight z-score, -0.83, P < .0001) and lesions of inflammation/infection were associated with earlier delivery (adjusted difference -2.08 weeks, P < .0001) than those with no lesions. When both placental lesions were present, earlier delivery (adjusted difference -2.28 weeks, P < .0001) and reduced fetal growth (adjusted birthweight z-score difference, -0.24, P = .001) were observed more often than when neither lesion was present. Findings were similar when restricted to cases of spontaneous preterm birth. Intraventricular hemorrhage was higher in preterm births with malperfusion lesions than cases with no lesions (7.6% vs 3.4%; odds ratio, 1.98; confidence interval, 1.18-3.32), accounting for gestational age and other covariates. CONCLUSION Placental pathology provides important insight into subtypes of preterm birth with adverse neonatal outcomes. Co-occurrence of malperfusion and inflammation/infection, especially among spontaneous preterm births, may be a novel pattern of placental injury linked to severe adverse outcomes.
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Affiliation(s)
- Janet M Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA.
| | - Christina M Scifres
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Steve N Caritis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
| | - Marnie Bertolet
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Jacob Larkin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
| | - W Tony Parks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA; Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
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28
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Amegah AK, Klevor MK, Wagner CL. Maternal vitamin D insufficiency and risk of adverse pregnancy and birth outcomes: A systematic review and meta-analysis of longitudinal studies. PLoS One 2017; 12:e0173605. [PMID: 28306725 PMCID: PMC5357015 DOI: 10.1371/journal.pone.0173605] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/23/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Three previous reviews on the association of vitamin D insufficiency in pregnancy with preterm birth (PTB) and stillbirth were limited in scope and deemed inconclusive. With important new evidence accumulating, there is the need to update the previous estimates and assess evidence on other clinically important outcomes such as spontaneous abortion and Apgar score. We conducted a systematic review and meta-analysis to evaluate the quality and strength of the available evidence on the relations between vitamin D nutritional status, and pregnancy and birth outcomes. METHODS PubMed and Scopus databases were searched from their inception to June, 2015 with no language restrictions imposed. Eighteen longitudinal studies satisfied the inclusion criteria. Random effects model was applied in computing the summary effect estimates and their corresponding 95% confidence intervals. RESULTS Serum 25(OH)D levels <75 nmol/l was associated with 83% (95% CI: 1.23, 2.74) and 13% (95% CI: 0.94, 1.36) increased risk of PTB measured at <32-34 weeks and <35-37 weeks, respectively. An inverse dose-response relation was observed for both PTB outcome. Serum 25(OH)D levels <75 nmol/l was also associated with 11% increased risk of spontaneous PTB (<35-37 weeks; RR = 1.11; 95% CI: 0.75, 1.65) with a dose-response relation also noted. Vitamin D insufficiency was not associated with risk of spontaneous abortion and stillbirth (RR of 1.04 [95% CI: 0.95, 1.13] and 1.02 [95% CI: 0.96, 1.09], respectively), as well as short gestational length (ES = -0.24, 95% CI: -0.69, 0.22), and low Apgar score. CONCLUSIONS We found vitamin D insufficiency to be associated with risk of PTB. Regarding spontaneous abortion and stillbirth, the available evidence suggest no association with low vitamin D levels. The evidence on vitamin D nutrition and Apgar score is conflicting and controversial. Overall, the experimental evidence uncovered was small and weak. Hence, the benefits of vitamin D supplementation during pregnancy should be further evaluated through rigorous intervention studies.
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Affiliation(s)
- A. Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Moses K. Klevor
- Department of Clinical Nutriton and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Carol L. Wagner
- Medical University of South Carolina Children’s Hospital, Charleston, SC, United States of America
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29
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Chen YY, Powell TL, Jansson T. 1,25-Dihydroxy vitamin D 3 stimulates system A amino acid transport in primary human trophoblast cells. Mol Cell Endocrinol 2017; 442:90-97. [PMID: 27956114 PMCID: PMC5673492 DOI: 10.1016/j.mce.2016.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 12/27/2022]
Abstract
Vitamin D deficiency during pregnancy is linked to adverse perinatal outcomes such as small for gestational age infants. Recent evidence suggests that changes in placental amino acid transport contribute to altered fetal growth. We tested the hypothesis that 1,25-dihydroxy vitamin D3 increases the gene expression of System A and L amino acid transporter isoforms and stimulates placental amino acid transport activity in cultured primary human trophoblast cells mediated by mTOR signaling. Treatment with 1,25-dihydroxy vitamin D3 significantly increased mRNA expression of the System A isoform SNAT2 and System A activity, but had no effect on System L and did not affect mTOR signaling. siRNA silencing of the vitamin D receptor prevented 1,25-dihydroxy vitamin D3-stimulated System A transport. In conclusion, 1,25-dihydroxy vitamin D3 regulates System A activity through increased mRNA expression of SNAT2 transporters. Effects on placental amino acid transport may be the mechanism underlying the association between maternal vitamin D status and fetal growth.
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Affiliation(s)
- Yi-Yung Chen
- Division of Reproductive Science, Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Division of High-risk Pregnancy, Department of Obstetrics & Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
| | - Theresa L Powell
- Division of Reproductive Science, Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas Jansson
- Division of Reproductive Science, Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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30
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Toko EN, Sumba OP, Daud II, Ogolla S, Majiwa M, Krisher JT, Ouma C, Dent AE, Rochford R, Mehta S. Maternal Vitamin D Status and Adverse Birth Outcomes in Children from Rural Western Kenya. Nutrients 2016; 8:nu8120794. [PMID: 27941597 PMCID: PMC5188449 DOI: 10.3390/nu8120794] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 01/04/2023] Open
Abstract
Maternal plasma 25-hydroxyvitamin D (25(OH)D) status and its association with pregnancy outcomes in malaria holoendemic regions of sub-Saharan Africa is poorly defined. We examined this association and any potential interaction with malaria and helminth infections in an ongoing pregnancy cohort study in Kenya. The association of maternal plasma 25(OH)D status with pregnancy outcomes and infant anthropometric measurements at birth was determined in a subset of women (n = 63). Binomial and linear regression analyses were used to examine associations between maternal plasma 25(OH)D and adverse pregnancy outcomes. Fifty-one percent of the women had insufficient (<75 nmol/L) and 21% had deficient (<50 nmol/L) plasma 25(OH)D concentration at enrollment. At birth, 74.4% of the infants had insufficient and 30% had deficient plasma 25(OH)D concentrations, measured in cord blood. Multivariate analysis controlling for maternal age and body mass index (BMI) at enrollment and gestational age at delivery found that deficient plasma 25(OH)D levels were associated with a four-fold higher risk of stunting in neonates (p = 0.04). These findings add to the existing literature about vitamin D and its association with linear growth in resource-limited settings, though randomized clinical trials are needed to establish causation.
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Affiliation(s)
- Eunice N Toko
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Odada P Sumba
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Ibrahim I Daud
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | - Sidney Ogolla
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Maxwel Majiwa
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Jesse T Krisher
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853, USA.
| | - Collins Ouma
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- African Institute for Development Policy, Nairobi, Kenya.
| | - Arlene E Dent
- Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Rosemary Rochford
- SUNY Upstate Medical University, Syracuse, NY 13210, USA.
- Department of Immunology and Microbiology, University of Colorado, Denver, Aurora, CO 80045, USA.
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853, USA.
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Zerofsky MS, Jacoby BN, Pedersen TL, Stephensen CB. Daily Cholecalciferol Supplementation during Pregnancy Alters Markers of Regulatory Immunity, Inflammation, and Clinical Outcomes in a Randomized Controlled Trial. J Nutr 2016; 146:2388-2397. [PMID: 27655755 DOI: 10.3945/jn.116.231480] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/23/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is widespread in pregnancy and has been associated with adverse health conditions in mothers and infants. Vitamin D supplementation in pregnancy may support the maintenance of pregnancy by its effects on innate and adaptive immunity. OBJECTIVE We assessed the effects of vitamin D supplementation during pregnancy on vitamin D status and markers of immune function associated with adverse pregnancy outcomes. METHODS We conducted a randomized, controlled, double-blind intervention of 2 doses of cholecalciferol (400 and 2000 IU/d) from <20 wk to delivery in 57 pregnant women. Vitamin D status, regulatory and inflammatory T cells, markers of innate immunity and systemic inflammation, and clinical outcomes including maternal blood pressure and birth weight were assessed at 26 and 36 wk of pregnancy. RESULTS Supplementation with 2000 IU/d vitamin D had a greater effect on the change in vitamin D status over pregnancy (P < 0.0001) and the final value at 36 wk (P < 0.0001) than 400 IU/d, increasing serum 25-hydroxyvitamin D from 81.1 nmol/L at baseline to 116 nmol/L at 36 wk and from 69.6 nmol/L at baseline to 85.6 nmol/L at 36 wk, respectively. The 2000-IU/d group had 36% more interleukin-10+ regulatory CD4+ T cells at 36 wk than did the 400-IU/d group (P < 0.007). The daily intake of 2000 compared with 400 IU/d tended to dampen the pregnancy-related increase in diastolic blood pressure by 1.3-fold (P = 0.06) and increase birth weight by 8.6% (P = 0.06), but these differences were not statistically significant. CONCLUSIONS Supplementation with 2000 IU/d is more effective at increasing vitamin D status in pregnant women than 400 IU/d and is associated with increased regulatory T cell immunity that may prevent adverse outcomes caused by excess inflammation. This trial was registered at clinicaltrials.gov as NCT01417351.
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Affiliation(s)
- Melissa S Zerofsky
- Graduate Group in Nutritional Biology and .,USDA Western Human Nutrition Research Center, Davis, CA
| | - Bryon N Jacoby
- Division of Maternal/Fetal Medicine, Davis Medical Center, University of California, Davis, Davis, CA; and
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Lykkedegn S, Sorensen GL, Beck-Nielsen SS, Pilecki B, Duelund L, Marcussen N, Christesen HT. Vitamin D Depletion in Pregnancy Decreases Survival Time, Oxygen Saturation, Lung Weight and Body Weight in Preterm Rat Offspring. PLoS One 2016; 11:e0155203. [PMID: 27571350 PMCID: PMC5003352 DOI: 10.1371/journal.pone.0155203] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/28/2016] [Indexed: 01/20/2023] Open
Abstract
Animal studies suggest a role of vitamin D in fetal lung development although not studied in preterm animals. We tested the hypothesis that vitamin D depletion aggravates respiratory insufficiency in preterm rat offspring. Furthermore, the effects of vitamin D depletion on growth and lung surfactant were investigated. Female Sprague-Dawley rats were randomly assigned low vitamin D (VDL) or control diet before mating and followed with serum 25-hydroxyvitamin D (s-25(OH)D) determinations. After cesarean section at gestational day 19 (E19) or day 22 (E22), placental weight, birth weight, crown-rump-length (CRL), oxygenation (SaO2) at 30 min and survival time were recorded. The pup lungs were analyzed for phospholipid levels, surfactant protein A-D mRNA and the expression of the vitamin D receptor (VDR). S-25(OH)D was significantly lower in the VDL group at cesarean section (12 vs. 30nmol/L, p<0.0001). Compared to the controls, E19 VDL pups had lower birth weight (2.13 vs. 2.29g, p<0.001), lung weight (0.09 vs. 0.10g, p = 0.002), SaO2(54% vs. 69%, p = 0.002) as well as reduced survival time (0.50 vs. 1.25h, p<0.0001). At E22, the VDL-induced pulmonary differences were leveled out, but VDL pups had lower CRL (4.0 vs. 4.5cm, p<0.0001). The phospholipid levels and the surfactant protein mRNA expression did not differ between the dietary groups. In conclusion, Vitamin D depletion led to lower oxygenation and reduced survival time in the preterm offspring, associated with reduced lung weight and birth weight. Further studies of vitamin D depletion in respiratory insufficiency in preterm neonates are warranted.
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Affiliation(s)
- Sine Lykkedegn
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Grith Lykke Sorensen
- Institute of Molecular Medicine, Department of Cancer and Inflammation, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Signe Sparre Beck-Nielsen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bartosz Pilecki
- Institute of Molecular Medicine, Department of Cancer and Inflammation, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Duelund
- MEMPHYS, University of Southern Denmark, Odense, Denmark
| | - Niels Marcussen
- Institute of Pathology, Odense University Hospital, Odense, Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- * E-mail:
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Bozoklu Akkar O, Sancakdar E, Karakus S, Yildiz C, Akkar I, Arslan M, Sahin IO, Imir Yenicesu AG, Cetin A. Evaluation of Maternal Serum 25-Hydroxyvitamin D, Paraoxonase 1 Levels, and Neutrophil-to-Lymphocyte Ratio in Spontaneous Preterm Birth. Med Sci Monit 2016; 22:1238-43. [PMID: 27072780 PMCID: PMC4832961 DOI: 10.12659/msm.897983] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to evaluate the association of maternal serum 25-hydroxyvitamin D, paraoxonase 1, and neutrophil-to-lymphocyte ratio in women having early spontaneous preterm birth without clinical chorioamnionitis. Material/Methods This study was prospectively administered in women referred to our obstetrics service with preterm labor that resulted in preterm birth (n=35) and term labor that ended in term birth (n=44). The maternal serum levels of 25-hydroxyvitamin D and paraoxonase 1 were measured and neutrophil-to-lymphocyte ratio was calculated. Results The 25-hydroxyvitamin D and paraoxonase 1 levels of the preterm group were significantly lower than those of the term group (p<0.05). The neutrophil-to-lymphocyte ratio value of the preterm group was significantly higher than that of the term group (p<0.05). There was a significant but small positive correlation between the serum levels of 25-hydroxyvitamin D and paraoxonase 1 in the preterm group (r=0.35; p=0.021). Conclusions Decreased maternal serum 25-hydroxyvitamin D and paraoxonase 1 levels and increased neutrophil-to-lymphocyte ratio may have a role in the etiology of spontaneous preterm birth.
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Affiliation(s)
- Ozlem Bozoklu Akkar
- Department of Obstetrics and Gynecology, Cumhuriyet University, Sivas, Turkey
| | - Enver Sancakdar
- Department of Medical Biochemistry, Cumhuriyet University, Sivas, Turkey
| | - Savas Karakus
- Department of Obstetrics and Gynecology, Cumhuriyet University, Sivas, Turkey
| | - Caglar Yildiz
- Department of Obstetrics and Gynecology, Cumhuriyet University, Sivas, Turkey
| | - Ismail Akkar
- Department of Pediatrics, Sivas State Hospital, Sivas, Turkey
| | - Murat Arslan
- Department of Obstetrics and Gynecology, Sivas State Hospital, Sivas, Turkey
| | | | | | - Ali Cetin
- Department of Obstetrics and Gynecology, Cumhuriyet University, Sivas, Turkey
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Wagner CL, Baggerly C, McDonnell S, Baggerly KA, French CB, Baggerly L, Hamilton SA, Hollis BW. Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009-2011 rates. J Steroid Biochem Mol Biol 2016; 155:245-51. [PMID: 26554936 PMCID: PMC5215876 DOI: 10.1016/j.jsbmb.2015.10.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Two vitamin D pregnancy supplementation trials were recently undertaken in South Carolina: The NICHD (n=346) and Thrasher Research Fund (TRF, n=163) studies. The findings suggest increased dosages of supplemental vitamin D were associated with improved health outcomes of both mother and newborn, including risk of preterm birth (<37 weeks gestation). How that risk was associated with 25(OH)D serum concentration, a better indicator of vitamin D status than dosage, by race/ethnic group and the potential impact in the community was not previously explored. While a recent IOM report suggested a concentration of 20 ng/mL should be targeted, more recent work suggests optimal conversion of 25(OH)D-1,25(OH)2D takes place at 40 ng/mL in pregnant women. OBJECTIVE Post-hoc analysis of the relationship between 25(OH)D concentration and preterm birth rates in the NICHD and TRF studies with comparison to Charleston County, South Carolina March of Dimes (CC-MOD) published rates of preterm birth to assess potential risk reduction in the community. METHODS Using the combined cohort datasets (n=509), preterm birth rates both for the overall population and for the subpopulations achieving 25(OH)D concentrations of ≤20 ng/mL, >20 to <40 ng/mL, and ≥40 ng/mL were calculated; subpopulations broken down by race/ethnicity were also examined. Log-binomial regression was used to test if an association between 25(OH)D serum concentration and preterm birth was present when adjusted for covariates; locally weighted regression (LOESS) was used to explore the relationship between 25(OH)D concentration and gestational age (weeks) at delivery in more detail. These rates were compared with 2009-2011 CC-MOD data to assess potential risk reductions in preterm birth. RESULTS Women with serum 25(OH)D concentrations ≥40 ng/mL (n=233) had a 57% lower risk of preterm birth compared to those with concentrations ≤20 ng/mL [n=82; RR=0.43, 95% confidence interval (CI)=0.22,0.83]; this lower risk was essentially unchanged after adjusting for covariates (RR=0.41, 95% CI=0.20,0.86). The fitted LOESS curve shows gestation week at birth initially rising steadily with increasing 25(OH)D and then plateauing at ∼40 ng/mL. Broken down by race/ethnicity, there was a 79% lower risk of preterm birth among Hispanic women with 25(OH)D concentrations ≥40 ng/mL (n=92) compared to those with 25(OH)D concentrations ≤20 ng/mL (n=29; RR=0.21, 95% CI=0.06,0.69) and a 45% lower risk among Black women (n=52 and n=50; RR=0.55, 95% CI=0.17,1.76). There were too few white women with low 25(OH)D concentrations for assessment (n=3). Differences by race/ethnicity were not statistically significant with 25(OH)D included as a covariate. Compared to the CC-MOD reference group, women with serum concentrations ≥40 ng/mL in the combined cohort had a 46% lower rate of preterm birth overall (n=233, p=0.004) with a 66% lower rate among Hispanic women (n=92, p=0.01) and a 58% lower rate among black women (n=52, p=0.04). CONCLUSIONS In this post-hoc analysis, achieving a 25(OH)D serum concentration ≥40 ng/mL significantly decreased the risk of preterm birth compared to ≤20 ng/mL. These findings suggest the importance of raising 25(OH)D levels substantially above 20 ng/mL; reaching 40 ng/mL during pregnancy would reduce the risk of preterm birth and achieve the maximal production of the active hormone.
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Affiliation(s)
- C L Wagner
- Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
| | | | | | - K A Baggerly
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - S A Hamilton
- Eau Claire Cooperative Health Centers, Columbia, SC, USA
| | - B W Hollis
- Medical University of South Carolina Children's Hospital, Charleston, SC, USA
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Nobles CJ, Markenson G, Chasan-Taber L. Early pregnancy vitamin D status and risk for adverse maternal and infant outcomes in a bi-ethnic cohort: the Behaviors Affecting Baby and You (B.A.B.Y.) Study. Br J Nutr 2015; 114:2116-28. [PMID: 26507186 PMCID: PMC5653966 DOI: 10.1017/s0007114515003980] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Vitamin D deficiency is common during pregnancy and higher in Hispanic as compared with non-Hispanic white women. However, the association between vitamin D deficiency and adverse pregnancy outcomes remains unclear and may vary across ethnic groups, in part because of genetic variation in the metabolism of vitamin D. Few studies have included Hispanic women. Therefore, we investigated this association among 237 participants in the Behaviors Affecting Baby and You Study, a randomised trial of an exercise intervention among ethnically diverse prenatal care patients in Massachusetts. Baseline serum 25-hydroxyvitamin D (25(OH)D) was measured at 15·2 (sd 4·7) weeks' gestation. Information on adverse pregnancy outcomes was abstracted from medical records. Mean 25(OH)D was 30·4 (sd 12·0) ng/ml; 53·2 % of participants had insufficient (<30 ng/ml) and 20·7 % had deficient (<20 ng/ml) 25(OH)D levels. After adjusting for month of blood draw, gestational age at blood draw, gestational age at delivery, age, BMI and Hispanic ethnicity, women with insufficient and deficient vitamin D had infants with birth weights 139·74 (se 69·16) g (P=0·045) and 175·52 (se 89·45) g (P=0·051) lower compared with women with sufficient vitamin D levels (≥30 ng/ml). Each 1 ng/ml increase in 25(OH)D was associated with an increased risk for gestational diabetes mellitus among Hispanic women only (relative risk 1·07; 95 % CI 1·03, 1·11) in multivariable analysis. We did not observe statistically significant associations between maternal vitamin D status and other pregnancy outcomes. Our findings provide further support for an adverse impact of vitamin D deficiency on birth weight in Hispanic women.
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Affiliation(s)
- Carrie J. Nobles
- Department of Biostatistics and Epidemiology, School of Public Health & Health Sciences, Division of Biostatistics & Epidemiology, University of Massachusetts, Amherst, MA 01003-9304, USA
| | - Glenn Markenson
- Baystate Medical Center, Division of Maternal-Fetal Medicine, Springfield, MA 01199, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, School of Public Health & Health Sciences, Division of Biostatistics & Epidemiology, University of Massachusetts, Amherst, MA 01003-9304, USA
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Mirzakhani H, Al-Garawi A, Weiss ST, Litonjua AA. Vitamin D and the development of allergic disease: how important is it? Clin Exp Allergy 2015; 45:114-25. [PMID: 25307157 DOI: 10.1111/cea.12430] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Vitamin D has known effects on lung development and the immune system that may be important in the development, severity, and course of allergic diseases (asthma, eczema, and food allergy). Vitamin D deficiency is prevalent worldwide and may partly explain the increases in asthma and allergic diseases that have occurred over the last 50-60 years. In this review, we explore past and current knowledge on the effect of vitamin D on lung development and immunomodulation and present the evidence of its role in allergic conditions. While there is growing observational and experimental evidence for the role of vitamin D, well-designed and well-powered clinical trials are needed to determine whether supplementation of vitamin D should be recommended in these disorders.
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Affiliation(s)
- H Mirzakhani
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Moon RJ, Harvey NC, Cooper C. ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the fetal skeleton. Eur J Endocrinol 2015; 173:R69-83. [PMID: 25862787 PMCID: PMC4968635 DOI: 10.1530/eje-14-0826] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/10/2015] [Indexed: 12/28/2022]
Abstract
Vitamin D status has been increasingly associated with wide-ranging clinical outcomes. There is now a wealth of observational studies reporting on its associations with obstetric complications, including pre-eclampsia, gestational diabetes and the mode and timing of delivery. The findings are inconsistent, and currently there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. This is similarly true with regards to fetal development, including measures of fetal size and skeletal mineralisation. Overall, there is an indication of possible benefits of vitamin D supplementation during pregnancy for offspring birthweight, calcium concentrations and bone mass as well as for reduced maternal pre-eclampsia. However, for none of these outcomes is the current evidence base conclusive, and the available data justify the instatement of high-quality randomised placebo controlled trials in a range of populations and health care settings to establish the potential efficacy and safety of vitamin D supplementation to improve particular outcomes.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK MRC Lifecourse Epidemiology UnitSouthampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, UKPaediatric EndocrinologyUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UKNIHR Musculoskeletal Biomedical Research UnitUniversity of Oxford, Oxford OX3 7LD, UK
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Pratumvinit B, Wongkrajang P, Wataganara T, Hanyongyuth S, Nimmannit A, Chatsiricharoenkul S, Manonukul K, Reesukumal K. Maternal Vitamin D Status and Its Related Factors in Pregnant Women in Bangkok, Thailand. PLoS One 2015; 10:e0131126. [PMID: 26147381 PMCID: PMC4492949 DOI: 10.1371/journal.pone.0131126] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/27/2015] [Indexed: 12/23/2022] Open
Abstract
Background There are few data focusing on the prevalence of vitamin D deficiency in tropical countries. Objectives We determined the vitamin D status in pregnant women and examined the factors associated with vitamin D deficiency. Design and Methods A cross-sectional study of 147 pregnant Thai women aged 18–45 years at Siriraj Hospital (a university hospital in Bangkok, Thailand) was undertaken. Clinical data and plasma levels of 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone (iPTH), calcium, albumin, phosphate and magnesium were obtained in pregnant women at delivery. Results The prevalence of hypovitaminosis D [defined as 25(OH)D <75 nmol/L] in pregnant women at delivery was 75.5% (95% confidence interval (CI), 67.7–82.2%). Of these, vitamin D insufficiency [defined as 25(OH)D 50–74.9 nmol/L] was found in 41.5% (95% CI, 33.4–49.9%) and vitamin D deficiency [25(OH)D <50 nmol/L] was found in 34.0% (95% CI, 26.4–42.3%) of women. The mean 25(OH)D concentration was 61.6±19.3 nmol/L. The correlation between 25(OH)D and iPTH was weak (r = –0.29, P<0.01). Factors associated with vitamin D deficiency by multiple logistic regression were: pre-pregnancy body mass index (BMI in kg/m2, odds ratio (OR), 0.88, 95% CI 0.80–0.97, P = 0.01) and season of blood collection (winter vs. rainy, OR, 2.62, 95% CI 1.18–5.85, P = 0.02). Conclusions Vitamin D deficiency is common among pregnant Thai women. The prevalence of vitamin D deficiency increased in women who had a lower pre-pregnancy BMI and whose blood was collected in the winter. Vitamin D supplementation may need to be implemented as routine antenatal care.
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Affiliation(s)
- Busadee Pratumvinit
- Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Preechaya Wongkrajang
- Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tuangsit Wataganara
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sithikan Hanyongyuth
- Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Akarin Nimmannit
- Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kotchamol Manonukul
- Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanit Reesukumal
- Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
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Abstract
PURPOSE OF REVIEW This article presents an overview of the most recent scientific evidence of the role of maternal vitamin D on pregnancy outcomes, with a particular emphasis on those articles in the English-language literature published between 1 January 2013 and 1 July 2014 in PubMed. RECENT FINDINGS Low levels of vitamin D status, as measured by 25-hydroxyvitamin D [25(OH)D], are common in pregnant women. Meta-analysis of observational studies has demonstrated positive associations between vitamin D status and adverse pregnancy outcomes such as preeclampsia, gestational diabetes mellitus, preterm birth and small-for-gestational age. There was heterogeneity among studies in terms of design, population, geographic location, definitions of exposure and outcome, gestational age at sampling, confounding factors and approach to analyses. Randomized controlled trials (RCTs) indicate that vitamin D supplementation during pregnancy optimizes maternal and neonatal vitamin D status. SUMMARY Recent evidence supports that low maternal vitamin D status is associated with an increased risk of adverse pregnancy outcomes. Interventional studies demonstrate that vitamin D supplementation during pregnancy optimizes maternal and neonatal vitamin D status. Large, well designed, multicentre RCTs are required to determine whether vitamin D supplementation in pregnant women with low vitamin D status reduces the risk of adverse pregnancy outcomes.
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Weinberg CR, Shi M, DeRoo LA, Basso O, Skjærven R. Season and preterm birth in Norway: A cautionary tale. Int J Epidemiol 2015; 44:1068-78. [PMID: 26045507 DOI: 10.1093/ije/dyv100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preterm birth is a common, costly and dangerous pregnancy complication. Seasonality of risk would suggest modifiable causes. METHODS We examine seasonal effects on preterm birth, using data from the Medical Birth Registry of Norway (2,321,652 births), and show that results based on births are misleading and a fetuses-at-risk approach is essential. In our harmonic-regression Cox proportional hazards model we consider fetal risk of birth between 22 and 37 completed weeks of gestation. We examine effects of both day of year of conception (for early effects) and day of ongoing gestation (for seasonal effects on labour onset) as modifiers of gestational-age-based risk. RESULTS Naïve analysis of preterm rates across days of birth shows compelling evidence for seasonality (P < 10(-152)). However, the reconstructed numbers of conceptions also vary with season (P < 10(-307)), confounding results by inducing seasonal variation in the age distribution of the fetal population at risk. When we instead properly treat fetuses as the individuals at risk, restrict analysis to pregnancies with relatively accurate ultrasound-based assessment of gestational age (available since 1998) and adjust for socio-demographic factors and maternal smoking, we find modest effects of both time of year of conception and time of year at risk, with peaks for early preterm near early January and early July. CONCLUSIONS Analyses of seasonal effects on preterm birth are demonstrably vulnerable to confounding by seasonality of conception, measurement error in conception dating, and socio-demographic factors. The seasonal variation based on fetuses reveals two peaks for early preterm, coinciding with New Year's Day and the early July beginning of Norway's summer break, and may simply reflect a holiday-related pattern of unintended conception.
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Affiliation(s)
- Clarice R Weinberg
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA,
| | - Min Shi
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Lisa A DeRoo
- Department of Global Public Health and Primary Care, University of Bergen, and Medical Birth Registry of Norway, Bergen, Norway and
| | - Olga Basso
- Department of Obstetrics and Gynecology, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Rolv Skjærven
- Department of Global Public Health and Primary Care, University of Bergen, and Medical Birth Registry of Norway, Bergen, Norway and
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Placental pathology measures: Can they be rapidly and reliably integrated into large-scale perinatal studies? Placenta 2015; 36:687-92. [DOI: 10.1016/j.placenta.2015.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 12/17/2022]
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Burris HH, Thomas A, Zera CA, McElrath TF. Prenatal vitamin use and vitamin D status during pregnancy, differences by race and overweight status. J Perinatol 2015; 35:241-5. [PMID: 25357099 PMCID: PMC4380518 DOI: 10.1038/jp.2014.198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We aimed to study whether prenatal vitamin (PNV) use protects against low 25-hydroxyvitamin D (25[OH]D) levels in all women and particularly in obese and black women who are both at risk of vitamin D deficiency and poor pregnancy outcomes. STUDY DESIGN We studied 1019 women enrolled in a prospective study at Brigham and Women's Hospital in Boston, from 2007 to 2009. We used multivariable logistic regression to analyze associations of PNV use and odds of vitamin D deficiency defined as 25[OH]D levels <50 nmol l(-1). RESULT In all, 56% of black and 86% of white women reported pre- and/or postconceptional PNV use. In the first trimester, 75% of black and 19% of white women were vitamin D deficient. Lack of PNV use among black women was not associated with vitamin D deficiency (adjusted odds ratio (OR) 1.0, 95% confidence interval (CI) 0.4, 2.3) but was among white women (OR 3.5, 95% CI 2.1, 5.8) (interaction P<0.01). CONCLUSIONS Ongoing trials of vitamin D supplementation during pregnancy should consider potential effect modification by race/ethnicity.
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Affiliation(s)
- Heather H. Burris
- Department of Neonatology, Beth Israel Deaconess Medical Center and Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Corresponding Author: Heather H. Burris, MD, MPH, BIDMC Neonatology, 330 Brookline Avenue, RO 318, Boston, MA, USA, 02215, Phone 617-667-3276, Fax 617-667-7074,
| | - Ann Thomas
- Division of Maternal Fetal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Chloe A. Zera
- Harvard Medical School, Boston, MA, USA,Division of Maternal Fetal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Thomas F. McElrath
- Harvard Medical School, Boston, MA, USA,Division of Maternal Fetal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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Wagner CL, Baggerly C, McDonnell SL, Baggerly L, Hamilton SA, Winkler J, Warner G, Rodriguez C, Shary JR, Smith PG, Hollis BW. Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery. J Steroid Biochem Mol Biol 2015; 148:256-60. [PMID: 25448734 PMCID: PMC4415820 DOI: 10.1016/j.jsbmb.2014.11.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/02/2014] [Accepted: 11/12/2014] [Indexed: 11/25/2022]
Abstract
There have been observational reports that maternal vitamin D status at baseline and not closest to delivery is a better predictor of pregnancy outcomes, suggesting that a cascade of events is set into motion that is not modifiable by vitamin D supplementation during later pregnancy. To address this issue, in this exploratory post-hoc analysis using correlation and logistic regression, we sought to measure the strength of the association between serum 25(OH)D concentrations at 3 timepoints during pregnancy: baseline, 1st trimester (<16 weeks); 2nd trimester (16-26 weeks); and 3rd trimester (≥27 weeks) and preterm birth. It was hypothesized that the 25(OH)D value closest to delivery would be most significantly associated with preterm birth. To accomplish this objective, the datasets from NICHD (n=333) and Thrasher Research Fund (n=154) vitamin D supplementation pregnancy studies were combined. The results of this analysis were that 25(OH)D values closer to delivery were more strongly correlated with gestational age at delivery than earlier values: 1st trimester: r=0.11 (p=0.02); 2nd trimester: r=0.08 (p=0.09); and 3rd trimester: r=0.15 (p=0.001). When logistic regression was performed with preterm birth (<37 weeks) as the outcome and 25(OH)D quartiles as the predictor variable, adjusting for study and participant race/ethnicity, as with the correlation analysis, the measurements closer to delivery were more significantly associated and had a higher magnitude of effect. That is, at baseline, those who had serum concentrations <50nmol/L (20ng/mL) had 3.3 times of odds of a preterm birth compared to those with serum concentrations ≥100nmol/L (40ng/mL; p=0.27). At 2nd trimester, the odds were 2.0 fold (p=0.21) and at the end of pregnancy, the odds were 3.8 fold (p=0.01). The major findings from this exploratory analysis were: (1) maternal vitamin D status closest to delivery date was more significantly associated with preterm birth, suggesting that later intervention as a rescue treatment may positively impact the risk of preterm delivery, and (2) a serum concentration of 100nmol/L (40ng/mL) in the 3rd trimester was associated with a 47% reduction in preterm births. This article is part of a Special Issue entitled '17th Vitamin D Workshop'.
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Affiliation(s)
- C L Wagner
- Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
| | | | | | | | - S A Hamilton
- Eau Claire Cooperative Health Centers, Columbia, SC, USA
| | - J Winkler
- Eau Claire Cooperative Health Centers, Columbia, SC, USA
| | - G Warner
- Eau Claire Cooperative Health Centers, Columbia, SC, USA
| | - C Rodriguez
- Eau Claire Cooperative Health Centers, Columbia, SC, USA
| | - J R Shary
- Medical University of South Carolina Children's Hospital, Charleston, SC, USA
| | - P G Smith
- Medical University of South Carolina Children's Hospital, Charleston, SC, USA
| | - B W Hollis
- Medical University of South Carolina Children's Hospital, Charleston, SC, USA
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Samsel A, Seneff S. Glyphosate, pathways to modern diseases III: Manganese, neurological diseases, and associated pathologies. Surg Neurol Int 2015; 6:45. [PMID: 25883837 PMCID: PMC4392553 DOI: 10.4103/2152-7806.153876] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/21/2015] [Indexed: 12/20/2022] Open
Abstract
Manganese (Mn) is an often overlooked but important nutrient, required in small amounts for multiple essential functions in the body. A recent study on cows fed genetically modified Roundup(®)-Ready feed revealed a severe depletion of serum Mn. Glyphosate, the active ingredient in Roundup(®), has also been shown to severely deplete Mn levels in plants. Here, we investigate the impact of Mn on physiology, and its association with gut dysbiosis as well as neuropathologies such as autism, Alzheimer's disease (AD), depression, anxiety syndrome, Parkinson's disease (PD), and prion diseases. Glutamate overexpression in the brain in association with autism, AD, and other neurological diseases can be explained by Mn deficiency. Mn superoxide dismutase protects mitochondria from oxidative damage, and mitochondrial dysfunction is a key feature of autism and Alzheimer's. Chondroitin sulfate synthesis depends on Mn, and its deficiency leads to osteoporosis and osteomalacia. Lactobacillus, depleted in autism, depend critically on Mn for antioxidant protection. Lactobacillus probiotics can treat anxiety, which is a comorbidity of autism and chronic fatigue syndrome. Reduced gut Lactobacillus leads to overgrowth of the pathogen, Salmonella, which is resistant to glyphosate toxicity, and Mn plays a role here as well. Sperm motility depends on Mn, and this may partially explain increased rates of infertility and birth defects. We further reason that, under conditions of adequate Mn in the diet, glyphosate, through its disruption of bile acid homeostasis, ironically promotes toxic accumulation of Mn in the brainstem, leading to conditions such as PD and prion diseases.
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Affiliation(s)
- Anthony Samsel
- Research Scientist and Consultant, Deerfield, NH 03037, USA
| | - Stephanie Seneff
- Spoken Language Systems Group, Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge MA 02139, USA
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Bodnar LM, Platt RW, Simhan HN. Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes. Obstet Gynecol 2015; 125:439-447. [PMID: 25569002 PMCID: PMC4304969 DOI: 10.1097/aog.0000000000000621] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the association between maternal 25-hydroxyvitamin D concentrations and risk of preterm birth subtypes. METHODS We performed a case-cohort study using data and banked samples from patients at a teaching hospital in Pittsburgh, Pennsylvania. Eligible participants were women with a prenatal aneuploidy screening serum sample at or before 20 weeks of gestation who subsequently delivered a singleton, liveborn neonate. Of the 12,861 eligible women, we selected 2,327 at random as well as all remaining preterm birth cases for a total of 1,126 cases. Serum 25-hydroxyvitamin D was measured using liquid chromatography-tandem mass spectrometry. Multivariable log-binomial regression models were used to estimate associations between maternal vitamin D status and preterm birth at 37 weeks of gestation (separately by spontaneous or indicated) and preterm birth at less than 34 weeks of gestation. RESULTS The incidence of preterm birth at less than 37 weeks of gestation was 8.6% overall and 11.3%, 8.6%, and 7.3% among mothers with serum 25-hydroxyvitamin D less than 50, 50-74.9, and 75 nmol/L or greater, respectively (P<.01). After adjustment for maternal race and ethnicity, prepregnancy body mass index, season, smoking, and other confounders, the risk of preterm birth at less than 37 weeks of gestation significantly decreased as 25-hydroxyvitamin D increased to approximately 90 nmol/L and then plateaued (test of nonlinearity P<.01). Results were similar when limiting to cases that were medically indicated or occurred spontaneously and cases occurring at less than 34 weeks of gestation. CONCLUSION Our data support a protective association maternal vitamin D sufficiency and preterm birth that combined with extant epidemiologic data may provide justification for a randomized clinical trial of maternal vitamin D replacement or supplementation to prevent preterm birth.
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Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Magee-Womens Research Institute, Pittsburgh, PA
| | - Robert W. Platt
- Departments of Pediatrics and Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Magee-Womens Research Institute, Pittsburgh, PA
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Gernand AD, Klebanoff MA, Simhan HN, Bodnar LM. Maternal vitamin D status, prolonged labor, cesarean delivery and instrumental delivery in an era with a low cesarean rate. J Perinatol 2015; 35:23-8. [PMID: 25102320 PMCID: PMC4281279 DOI: 10.1038/jp.2014.139] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/15/2014] [Accepted: 06/23/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association between maternal 25-hydroxyvitamin D (25(OH)D) and adverse labor and delivery outcomes. STUDY DESIGN We measured serum 25(OH)D at ⩽ 26 weeks gestation in a random subsample of vertex, singleton pregnancies in women who labored (n=2798) from the 12-site Collaborative Perinatal Project (1959 to 1966). We used labor and delivery data to classify cases of adverse outcomes. RESULT Twenty-four percent of women were vitamin D deficient (25(OH)D <30 nmol l(-1)), and 4.5, 3.3, 1.9 and 7.5% of women had prolonged stage 1 labor, prolonged stage 2 labor, primary cesarean delivery or indicated instrumental delivery, respectively. After adjustment for prepregnancy body mass index, race and study site, 25(OH)D concentrations were not associated with risk of prolonged stage 1 or 2, cesarean delivery or instrumental delivery. CONCLUSION Maternal vitamin D status at ⩽ 26 weeks was not associated with risk of prolonged labor or operative delivery in an era with a low cesarean rate.
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Affiliation(s)
- Alison D. Gernand
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA and Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - Mark A. Klebanoff
- Departments of Pediatrics and of Obstetrics and Gynecology, Ohio State University College of Medicine and The Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, School of Medicine, University of Pittsburgh and Division of Maternal-Fetal Medicine, Magee-Womens Hospital, Pittsburgh, PA
| | - Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health and Department of Obstetrics and Gynecology, School of Medicine, University of Pittsburgh, Pittsburgh, PA Pittsburgh, PA
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Lorena Quiroz V, Jorge Andrés Robert S. Problemas médicos habituales relacionados con la paciente embarazada. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Eckhardt CL, Gernand AD, Roth DE, Bodnar LM. Maternal vitamin D status and infant anthropometry in a US multi-centre cohort study. Ann Hum Biol 2014; 42:215-22. [PMID: 25268792 DOI: 10.3109/03014460.2014.954616] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Maternal vitamin D status in pregnancy is linked to foetal growth and may impact infant growth. AIM This study examined the association between maternal vitamin D status and infant anthropometry. SUBJECTS AND METHODS Data came from n = 2473 mother-child pairs from the 12-site US Collaborative Perinatal Project (1959-1965). Maternal serum 25-hydroxyvitamin D (25(OH)D) was measured at ≤ 26 weeks gestation. Multivariate-adjusted linear mixed models were used to relate maternal vitamin D status to infant z-scores for length (LAZ), head circumference (HCZ), weight (WAZ) and BMI (BMIZ), measured at birth and 4, 8 and 12 months. RESULTS Infants with maternal 25(OH)D ≥30 nmol/L vs <30 nmol/L had LAZ and HCZ measures 0.13 (95% CI = 0.03-0.23) and 0.20 (95% CI = 0.11-0.28) units higher, respectively, across the first year of life. Similar differences in WAZ and BMIZ at birth were resolved by 12 months of age due to interactions indicating steeper age slopes in infants with maternal 25(OH)D <30 nmol/L. CONCLUSION Low maternal vitamin D status was associated with deficits at birth in infant weight and BMI that were recouped across the first year of life; associations with reduced measures of linear and skeletal growth were sustained from birth to 12 months.
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Affiliation(s)
- Cara L Eckhardt
- School of Community Health, Portland State University, Portland , USA
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Reichetzeder C, Chen H, Föller M, Slowinski T, Li J, Chen YP, Lang F, Hocher B. Maternal Vitamin D Deficiency and Fetal Programming - Lessons Learned from Humans and Mice. Kidney Blood Press Res 2014; 39:315-29. [DOI: 10.1159/000355809] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
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Hughes MM, Katz J, Mullany LC, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM. Seasonality of birth outcomes in rural Sarlahi District, Nepal: a population-based prospective cohort. BMC Pregnancy Childbirth 2014; 14:310. [PMID: 25195204 PMCID: PMC4162951 DOI: 10.1186/1471-2393-14-310] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 09/01/2014] [Indexed: 02/06/2023] Open
Abstract
Background While seasonality of birth outcomes has been documented in a variety of settings, data from rural South Asia are lacking. We report a descriptive study of the seasonality of prematurity, low birth weight, small for gestational age, neonatal deaths, and stillbirths in the plains of Nepal. Methods Using data collected prospectively during a randomized controlled trial of neonatal skin and umbilical cord cleansing with chlorhexidine, we analyzed a cohort of 23,662 babies born between September 2002 and January 2006. Project workers collected data on birth outcomes at the infant’s household. Supplemental data from other studies conducted at the same field site are presented to provide context. 95% confidence intervals were constructed around monthly estimates to examine statistical significance of findings. Results Month of birth was associated with higher risk for adverse outcomes (neonatal mortality, low birthweight, preterm, and small for gestational age), even when controlling for maternal characteristics. Infants had 87% (95% CI: 27 – 176%) increased risk of neonatal mortality when born in August, the high point, versus March, the low point. Conclusion Seasonality of neonatal deaths, stillbirths, birth weight, gestational age, and small for gestational age were found in Nepal. Maternal factors, meteorological conditions, infectious diseases, and nutritional status may be associated with these adverse birth outcomes. Further research is needed to understand the causal mechanisms that explain the seasonality of adverse birth outcomes. Electronic supplementary material The online version of this article (doi:10.1186/1471-2393-14-310) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Joanne Katz
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, Maryland 21205, USA.
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