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Fondjo LA, Mensah JB, Awuah EO, Sakyi SA. Interplay between vitamin D status, vitamin D receptor gene variants and preeclampsia risk in Ghanaian women: A case-control study. PLoS One 2024; 19:e0303778. [PMID: 38814968 PMCID: PMC11139312 DOI: 10.1371/journal.pone.0303778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND AIM Preeclampsia (PE) is characterized by hypertension and proteinuria mostly after 20 weeks of gestation. It affects 2-8% of pregnancies worldwide, with detrimental consequences for both mother and foetus. Evidence, suggests that genetic factors, including vitamin D receptor (VDR) gene polymorphisms, could contribute to PE complexity. However, their role in the Ghanaian population remains underexplored. We assessed the interplay between Vitamin D, VDR gene variants and preeclampsia risk in Ghanaian women. METHODS This unmatched case-control study was conducted at Kumasi South Hospital, Ghana, from June to November 2022. A total of 162 participants consisting of 62 PE cases and 100 normotensive controls were enrolled. Clinical and obstetric data were collected. Blood samples were also collected for DNA extraction and vitamin D assay. Genotyping of VDR Fok1 and Bsm1 gene variants was performed using Polymerase Chain Reaction (PCR) and Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) analysis whereas Vitamin D levels were estimated using sandwich ELISA. Statistical analyses were computed with SPSS version 25 and GraphPad prism version 8.0. A p-value of < 0.05 was considered statistically significant. RESULTS Vitamin D concentration were significantly lower in the PE group (p < 0.0001). Vitamin D deficiency (aOR = 3.311, 95% CI: 1.584-6.921, p = 0.0010) was significantly associated with a three-fold increase in preeclampsia risk, whilst VDR gene variants, particularly the "bb" genotype (cOR = 0.227, 95% CI: 0.055-0.944, p = 0.0410) was associated with reduced risk of PE. There was no association between the distribution of Fok1 genotypes and PE. CONCLUSION This study highlights a significant association between vitamin D deficiency and an increased risk of PE among Ghanaian women. However, the VDR gene variant, "bb", genotype, for Bsm1 reduces the risk of PE.
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Sörsjö Stevenazzi A, Pihl S, Blomberg M, Axelsson D. The association between maternal vitamin D deficiency and postpartum hemorrhage and uterine atony. Acta Obstet Gynecol Scand 2024; 103:286-293. [PMID: 37960966 PMCID: PMC10823403 DOI: 10.1111/aogs.14719] [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: 07/25/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to pregnancy and delivery, but less evidence of predisposing factors. Recent research has shown that vitamin D deficiency may increase the risk of cesarean section due to dystocia, based on its effect on striated muscle as well as possible effect on the myometrium. Whether vitamin D deficiency increases the risk for postpartum hemorrhage and especially atonic hemorrhage is unknown. MATERIAL AND METHODS This was a retrospective translational study. The study population included 1367 women in Sweden and the main exposure was the serum concentration of 25-hydroxylated vitamin D at time of delivery. The LIASON® 25 OH vitamin D total assay method was used for analyzing 25-hydroxylated vitamin D. Vitamin D insufficiency was defined as serum concentration <50 nmol/L and vitamin D deficiency as serum concentrations <25 nmol/L. Primary outcomes were postpartum hemorrhage and severe postpartum hemorrhage defined as bleeding ≥500 mL and ≥ 1000 mL, respectively 2 h after delivery. Secondary outcome was atonic postpartum hemorrhage. Crude and adjusted odds ratios were calculated with 95% confidence intervals using univariable and multivariable logistic regression. Three different adjustment methods were used, adjusting for maternal, obstetrical and neonatal confounders. RESULTS Postpartum hemorrhage and severe postpartum hemorrhage afflicted 31.3% and 6.4% of the women, respectively. Rate of atonic postpartum hemorrhage was 21% in the whole population. Rate of vitamin D insufficiency and deficiency was 57%. Vitamin D insufficiency or deficiency was neither found to be associated with postpartum hemorrhage, nor with atonic postpartum hemorrhage. CONCLUSIONS In this study, the vitamin D status of women at the time of delivery was not a predictor of postpartum hemorrhage overall or atonic postpartum hemorrhage.
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Affiliation(s)
| | - Sofia Pihl
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Daniel Axelsson
- Department of Obstetrics and GynecologyRyhov County HospitalJönköpingSweden
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
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Forsby M, Winkvist A, Bärebring L, Augustin H. Supplement use in relation to dietary intake in pregnancy: an analysis of the Swedish GraviD cohort. Br J Nutr 2024; 131:256-264. [PMID: 37565530 PMCID: PMC10751946 DOI: 10.1017/s0007114523001794] [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: 06/01/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
We aimed to study supplement use in relation to dietary intake among pregnant women in Sweden, and adherence to the Nordic Nutrition Recommendations among supplement and non-supplement users. Pregnant women were recruited at registration to antenatal care in 2013–2014. In third trimester, supplement use was collected using a questionnaire, and dietary intake was collected using a FFQ. The majority (64 %) of the 1044 women reported use of one or more supplements. Among all, 0–23 % reported dietary intakes above recommended intake (RI) of vitamin D, folate, Fe and Se. Median dietary intakes of thiamine (1·4 v. 1·3 mg P = 0·013), phosphorus (1482 v. 1440 mg P = 0·007), folate (327 v. 316 µg P = 0·02), Fe (12 v. 11·5 mg P = 0·009), Mg (361 v. 346 mg P < 0·001) and Zn (10·7 v. 10·4 mg P = 0·01) were higher among supplement users compared with non-users. Larger proportions of supplement users than non-users adhered to RI of dietary intakes of thiamine (42 % v. 35 % P = 0·04) and Mg (75 % v. 69 % P = 0·05). Among non-users, a minority had dietary intakes above RI for vitamin D (6 %), folate (10 %) and Fe (21 %). The majority (75–100 %) of supplement users had total intakes above RI for most nutrients. In conclusion, supplement use contributed substantially to reaching RI for vitamin D, folate and Fe. Supplement users had a higher dietary intake of several nutrients than non-users. This highlights that non-supplement users are at risk of inadequate nutrient intakes during pregnancy, suggesting a need for heightened awareness of nutritional adequacy for pregnant women.
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Affiliation(s)
- Mathilda Forsby
- Institute of Medicine, University of Gothenburg, Gothenburg40530, Sweden
| | - Anna Winkvist
- Institute of Medicine, University of Gothenburg, Gothenburg40530, Sweden
| | - Linnea Bärebring
- Institute of Medicine, University of Gothenburg, Gothenburg40530, Sweden
| | - Hanna Augustin
- Institute of Medicine, University of Gothenburg, Gothenburg40530, Sweden
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Amberntsson A, Bärebring L, Winkvist A, Lissner L, Meltzer HM, Brantsæter AL, Papadopoulou E, Augustin H. Maternal vitamin D status and risk of childhood overweight at 5 years of age in two Nordic cohort studies. Front Nutr 2023; 10:1201171. [PMID: 37565036 PMCID: PMC10410266 DOI: 10.3389/fnut.2023.1201171] [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: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Maternal vitamin D status during pregnancy has been suggested to have a role in childhood adiposity development, but results are conflicting. Our aims were to investigate [1] the relationships between maternal 25-hydroxyvitamin D (25OHD) during pregnancy and the child's body mass index (BMI) and risk of overweight at 5 years of age, and [2] maternal pre-pregnancy BMI as effect modifier for these associations. Methods Data sources included a subsample from the Norwegian Mother, Father and Child Cohort Study (MoBa sub-cohort; N = 2,744) and the Swedish GraviD cohort study (N = 891). Maternal 25OHD was analyzed in gestational week 18 in the MoBa sub-cohort and week 10 in the GraviD cohort. In the MoBa sub-cohort, parents reported their child's documented measures of weight and length or height from the health card at routine check-up. In the GraviD cohort, this information was collected directly from medical records. Childhood overweight (including obesity) was identified using the International Obesity Task Force cut-offs. Linear and logistic regression models were used to investigate the association between maternal 25OHD and child's BMI and risk of overweight at 5 years of age in each cohort separately, and in a pooled dataset. Results In the pooled analysis, maternal 25OHD <30 nmol/L was associated with lower BMI in children at 5 years of age, but not with risk of overweight. Interaction analysis showed that the association was predominant among children of mothers with pre-pregnancy BMI ≥25 kg/m2. Conclusion Low maternal vitamin D status, particularly in mothers with overweight or obesity, predicted lower BMI in their five-year-old children. However, there was no evidence of an effect on overweight in these children.
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Affiliation(s)
- Anna Amberntsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Margrete Meltzer
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lise Brantsæter
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eleni Papadopoulou
- Global Health Cluster, Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Hanna Augustin
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Amberntsson A, Bärebring L, Winkvist A, Lissner L, Meltzer HM, Brantsæter AL, Papadopoulou E, Augustin H. Vitamin D intake and determinants of vitamin D status during pregnancy in The Norwegian Mother, Father and Child Cohort Study. Front Nutr 2023; 10:1111004. [PMID: 37426186 PMCID: PMC10327547 DOI: 10.3389/fnut.2023.1111004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/24/2023] [Indexed: 07/11/2023] Open
Abstract
Background Norwegian data on vitamin D status among pregnant women indicate a moderate to high prevalence of insufficient vitamin D status (25-hydroxyvitamin D (25OHD) concentrations ≤50 nmol/L). There is a lack of population-based research on vitamin D intake and determinants of 25OHD in pregnant women from northern latitudes. The aims of this study were (1) to evaluate total vitamin D intake from both diet and supplements, (2) to investigate determinants of vitamin D status, and (3) to investigate the predicted response in vitamin D status by total vitamin D intake, in pregnant Norwegian women. Methods In total, 2,960 pregnant women from The Norwegian Environmental Biobank, a sub-study within The Norwegian Mother, Father and Child Cohort Study (MoBa), were included. Total vitamin D intake was estimated from a food frequency questionnaire in gestational week 22. Concentrations of plasma 25OHD was analyzed by automated chemiluminescent microparticle immunoassay method in gestational week 18. Candidate determinant variables of 25OHD were chosen using stepwise backward selection and investigated using multivariable linear regression. Predicted 25OHD by total vitamin D intake, overall and stratified by season and pre-pregnancy BMI, was explored using restricted cubic splines in an adjusted linear regression. Results Overall, about 61% of the women had a total vitamin D intake below the recommended intake. The main contributors to total vitamin D intake were vitamin D supplements, fish, and fortified margarine. Higher 25OHD concentrations were associated with (in descending order of the beta estimates) summer season, use of solarium, higher vitamin D intake from supplements, origin from high income country, lower pre-pregnancy BMI, higher age, higher vitamin D intake from foods, no smoking during pregnancy, higher education and energy intake. During October-May, a vitamin D intake according to the recommended intake was predicted to reach sufficient 25OHD concentrations >50 nmoL/L. Conclusion The findings from this study highlight the importance of the vitamin D intake, as one of few modifiable determinants, to reach sufficient 25OHD concentrations during months when dermal synthesis of vitamin D is absent.
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Affiliation(s)
- Anna Amberntsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Margrete Meltzer
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lise Brantsæter
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eleni Papadopoulou
- Global Health Cluster, Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Hanna Augustin
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Malm G, Lindh CH, Hansson SR, Källén K, Malm J, Rylander L. Maternal serum vitamin D level in early pregnancy and risk for preeclampsia: A case-control study in Southern Sweden. PLoS One 2023; 18:e0281234. [PMID: 36749741 PMCID: PMC9904465 DOI: 10.1371/journal.pone.0281234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Preeclampsia is considered a major cause of maternal and fetal morbidity and mortality. The aim of the present case-control study in Sweden was to assess the hypothesized association between low serum vitamin D concentrations in early pregnancy and the risk of developing preeclampsia since vitamin D may play a role in early placental development. METHODS The study included 296 women diagnosed with preeclampsia (cases) and 580 healthy pregnant women (controls). Serum samples were obtained from a biobank of samples collected in early pregnancy including almost all pregnancies in Southern Sweden. Concentrations of 25-hydroxyvitamin D3 (vitamin D) were analyzed using liquid chromatography-tandem-mass-spectrometry (LC/MS/MS). The cases were divided into two categories: i) infants were born before gestational week 34 (early onset) and/or born small-for-gestational age (SGA)(n = 51), ii) and others defined as late onset (n = 245). Vitamin D concentrations were analyzed both as a continuous and a categorized variable. RESULTS When all preeclampsia cases were included in the analyses no consistent patterns were observed. However, the median serum concentrations of vitamin D were significantly lower among the cases who were early onset and/or were born SGA (median 39.2 nmol/L, range 1.2-93.6) as compared to the controls (49.0 nmol/L, 0.1-219; p = 0.01). In addition, high concentrations were statistically significantly associated with a decreased risk of preeclampsia (>66.9 vs ≤30.1 nmol/L; crude OR 0.39, 95% CI 0.16-0.96). When potential confounders were included in the models the associations were even more pronounced. CONCLUSIONS Our results support the hypothesis that vitamin D deficiency is a risk factor for preeclampsia, but only in preeclampsia cases who were early-onset and/or were born SGA. Preeclampsia is not a homogenous condition and more studies are needed before vitamin D supplementation during pregnancy can be recommended.
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Affiliation(s)
- Gunilla Malm
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden,* E-mail:
| | - Christian H. Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Stefan R. Hansson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Karin Källén
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden,Tornblad Institute, Lund University, Lund, Sweden
| | - Johan Malm
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Al-Musharaf S. Changes in Sleep Patterns during Pregnancy and Predictive Factors: A Longitudinal Study in Saudi Women. Nutrients 2022; 14:nu14132633. [PMID: 35807814 PMCID: PMC9268456 DOI: 10.3390/nu14132633] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to assess sleep patterns during the three trimesters of pregnancy and whether vitamin D concentrations, along with other risk factors, are associated with these alterations. In a longitudinal study, 140 pregnant women (age 18 to 39 years) were followed throughout their first, second, and third trimesters. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) at each trimester, along with an assessment of biochemical parameters, including serum vitamin D levels. The information that was collected included anthropometric data, socio-economic status, dietary intake, and physical activity. The PSQI was higher in mid and late pregnancy than in early pregnancy (both p = 0.001), and the sleep duration was also higher in late versus early pregnancy. Linear regression analyses revealed independent predictors of deteriorating sleep quality from early to late pregnancy, including low income (B ± SE −0.60 ± 0.26, p = 0.03) and low serum vitamin D levels in the second trimester (B ± SE −0.20 ± 0.01, p = 0.04). Energy intake and sitting in the second half of pregnancy were positively associated with changes in the PSQI score from the second to third trimesters (B ± SE 0.15 ± 0.07, p = 0.048) and (B ± SE 0.01 ± 0.00, p = 0.044), respectively. Low socio-economic status, low serum vitamin D levels, greater energy intake, and sitting time were associated with worsening patterns of sleep quality from early to late pregnancy.
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Affiliation(s)
- Sara Al-Musharaf
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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Amberntsson A, Carlson Kjellberg E, van Odijk J, Mikkelsen A, Bärebring L, Augustin H. Atopic heredity modifies the association between maternal vitamin D status in pregnancy and the risk of atopic disease in childhood: an observational study. Nutr J 2022; 21:32. [PMID: 35578340 PMCID: PMC9112577 DOI: 10.1186/s12937-022-00787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between maternal vitamin D status in pregnancy and the development of atopic diseases in the offspring has been frequently studied, but with contradictory results. Previous studies have found an inverse relation between maternal vitamin D in pregnancy and the risk of atopic diseases in the child. In contrast, others have found a higher maternal 25OHD to be related to a higher risk of atopic diseases. Thus, the aim was to investigate the associations between maternal vitamin D status and intake in pregnancy with asthma, eczema and food allergies in the children up to 5 years. In addition, effect modification by reported atopic heredity was studied. Methods Participants in the GraviD study had 25-hydroxyvitamin D (25OHD) analyzed in serum in early (T1) and late (T3) pregnancy. Maternal dietary vitamin D intake was estimated from a short food frequency questionnaire and supplement use by questionnaires. At 5 years of age the child´s history of asthma, eczema and food allergy, including atopic heredity, was reported by questionnaire. Multivariable logistic regression was used. Results The cumulative incidence of asthma was 13%, eczema 22%, and food allergy 18%. Only among children without reported atopic heredity, maternal 25OHD of 50–75 nmol/L in T1 was associated with lower odds of asthma (OR 0.271, 95% CI 0.127–0.580), compared to maternal 25OHD > 75 nmol/L. Additionally in these children, maternal 25OHD in T3 (continuous) was associated with asthma (OR 1.014, 95% CI 1.002–1.009), and dietary vitamin D intake with eczema (OR 1.141, 95% CI 1.011–1.288). Conclusions Among children without reported atopic heredity, higher maternal vitamin D status and intake during pregnancy was associated with increased risk of reported atopic disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-022-00787-9.
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Affiliation(s)
- Anna Amberntsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ellinor Carlson Kjellberg
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny van Odijk
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andrea Mikkelsen
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Gothenburg and Södra Bohuslän, Region Västra Götaland, Sweden
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Augustin
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Amberntsson A, Bärebring L, Winkvist A, Lissner L, Meltzer HM, Brantsæter AL, Papadopoulou E, Augustin H. Maternal vitamin D status in relation to infant BMI growth trajectories up to 2 years of age in two prospective pregnancy cohorts. Obes Sci Pract 2022; 8:670-681. [PMID: 36238227 PMCID: PMC9535664 DOI: 10.1002/osp4.602] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/10/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background Early childhood growth can affect the child's health status later in life. Maternal vitamin D status has been suggested to affect early childhood growth. However, there is a lack of studies investigating the role of maternal vitamin D status on growth trajectories during infancy. By using growth mixture modeling (GMM), maternal vitamin D status during pregnancy can be investigated in relation to different classes of infant growth trajectories. Objectives To examine the association between maternal 25‐hydroxyvitamin D (25OHD) and classes of infant body mass index (BMI) growth trajectories. Methods Mother–child pairs were included from the Norwegian Mother, Father, and Child Cohort Study (MoBa, n = 2522) and the Swedish GraviD cohort (n = 862). Maternal 25OHD in pregnancy was analyzed by liquid chromatography tandem mass spectrometry. Children's weights and heights were registry‐based. GMM identified classes of infant BMI growth trajectories up to 2 years. The association between maternal 25OHD and infant BMI class by cohort was estimated using a log‐link generalized linear model. Mixed model analysis estimated the pooled association including both cohorts. Results Two infant BMI classes were identified, stable normal and stable high. In MoBa, maternal 25OHD <50 and 50–75 nmol/L were associated (RR 2.70, 95% CI 1.26–5.77 and RR 2.56, 95% CI 1.20–5.47) with a higher risk of the infant stable high BMI class, compared with 25OHD >75 nmol/L. In GraviD, no association was found. In pooled analysis, maternal 25OHD ≤75 nmol/L was non‐significantly associated with a higher risk of the stable high BMI growth class. Conclusions Maternal 25OHD ≤75 nmol/L may be associated with a higher class of BMI growth trajectory during infancy.
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Affiliation(s)
- Anna Amberntsson
- Department of Internal Medicine and Clinical Nutrition Institute of Medicine Sahlgrenska Academy University of Gothenburg Goteborg Sweden
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition Institute of Medicine Sahlgrenska Academy University of Gothenburg Goteborg Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition Institute of Medicine Sahlgrenska Academy University of Gothenburg Goteborg Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Helle Margrete Meltzer
- Department of Food Safety Division of Climate and Environmental Health, Norwegian Institute of Public Health Oslo Norway
| | - Anne Lise Brantsæter
- Department of Food Safety Division of Climate and Environmental Health, Norwegian Institute of Public Health Oslo Norway
| | - Eleni Papadopoulou
- Global Health Cluster Division of Health Services, Norwegian Institute of Public Health Oslo Norway
| | - Hanna Augustin
- Department of Internal Medicine and Clinical Nutrition Institute of Medicine Sahlgrenska Academy University of Gothenburg Goteborg Sweden
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10
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A validated screening tool correctly identifies the majority of pregnant women at high risk of vitamin D deficiency. Clin Nutr ESPEN 2022; 49:301-306. [DOI: 10.1016/j.clnesp.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 02/03/2022] [Accepted: 03/19/2022] [Indexed: 11/17/2022]
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Adebayo FA, Itkonen ST, Öhman T, Kiely M, Cashman KD, Lamberg-Allardt C. Safety of Vitamin D Food Fortification and Supplementation: Evidence from Randomized Controlled Trials and Observational Studies. Foods 2021; 10:foods10123065. [PMID: 34945616 PMCID: PMC8701201 DOI: 10.3390/foods10123065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 12/31/2022] Open
Abstract
The safety considerations of food-based solutions for vitamin D deficiency prevention, such as fortification and supplementation, are critical. On the basis of collective data from 20 randomized controlled trials (RCTs) and 20 national healthy surveys, as well as prospective cohort studies (PCSs) across the ODIN project (“Food-based solutions for optimal vitamin D nutrition and health through the life cycle”, FP7-613977), we analyzed the potential safety issues arising from vitamin D intakes and/or supplementation. These adverse consequences included high serum 25-hydroxyvitamin D (S-25(OH)D) concentrations (>125 nmol/L), high serum calcium concentrations, and vitamin D intakes in excess of the tolerable upper intake levels (ULs). In the RCTs (n = 3353, with vitamin D doses from 5–175 µg/day), there were no reported adverse effects. The prevalence of high S-25(OH)D was <10% when vitamin D supplements were administered, and <0.1% for fortified foods. Elevated serum calcium was observed among <0.5% in both administration types. No ODIN RCT participants exceeded the age-specific ULs. In observational studies (n = 61,082), the prevalence of high 25(OH)D among children/adolescents, adults, and older adults was <0.3%, with no evidence of adverse effects. In conclusion, high S-25(OH)D concentrations >125 nmol/L were rare in the RCTs and PCSs, and no associated adverse effects were observed.
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Affiliation(s)
- Folasade A. Adebayo
- Calcium Research Unit, Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (F.A.A.); (S.T.I.); (T.Ö.)
| | - Suvi T. Itkonen
- Calcium Research Unit, Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (F.A.A.); (S.T.I.); (T.Ö.)
| | - Taina Öhman
- Calcium Research Unit, Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (F.A.A.); (S.T.I.); (T.Ö.)
| | - Mairead Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland; (M.K.); (K.D.C.)
| | - Kevin D. Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland; (M.K.); (K.D.C.)
| | - Christel Lamberg-Allardt
- Calcium Research Unit, Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (F.A.A.); (S.T.I.); (T.Ö.)
- Correspondence:
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Amberntsson A, Papadopoulou E, Winkvist A, Lissner L, Meltzer HM, Brantsaeter AL, Augustin H. Maternal vitamin D intake and BMI during pregnancy in relation to child's growth and weight status from birth to 8 years: a large national cohort study. BMJ Open 2021; 11:e048980. [PMID: 34598984 PMCID: PMC8488702 DOI: 10.1136/bmjopen-2021-048980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine the associations between maternal vitamin D intake and childhood growth and risk of overweight up to 8 years. We further examined the effect modification by maternal prepregnancy body mass index (BMI). DESIGN Prospective population-based pregnancy cohort study. SETTING The Norwegian Mother, Father and Child Cohort Study. PARTICIPANTS In total, 58 724 mothers and 66 840 singleton children, with information on maternal vitamin D intake during the pregnancy and minimum one postnatal anthropometric measurement. OUTCOME MEASURES Predicted weight and height growth trajectories and velocities from 1 month to 8 years, rapid growth during infancy and toddlerhood, and risk of overweight in preschool and school age. RESULTS Overall, maternal vitamin D intake was associated with lower weight trajectory, lower odds of rapid weight growth and higher odds of childhood overweight. In children of mothers with prepregnancy normal weight, maternal vitamin D intake was negatively associated with weight trajectory and lower OR of a rapid weight growth during the first year, compared with reference (<5 µg/day). Children of mothers with normal weight, with maternal vitamin D intakes of 10-15 and >15 µg/day, also had 0.86 (95% CI 0.77 to 0.97) and 0.88 (95% CI 0.79 to 0.99) lower odds for overweight at 3 years, compared with reference. In contrast, in children of mothers with prepregnancy overweight (BMI ≥25 kg/m2), vitamin D intake was positively associated with weight trajectory. Children of mothers with overweight, with maternal vitamin D intake of 5-9.9 µg/day, also had (1.09 (95% CI 1.01 to 1.18) and 1.12 (95% CI 1.02 to 1.23)) higher odds for overweight at 5 years and 8 years, compared with reference. CONCLUSIONS Maternal vitamin D intake affects postnatal growth and is inversely associated with childhood overweight in children of mothers with normal weight. Associations between maternal vitamin D intake and child growth and risk of overweight varied by prepregnancy BMI.
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Affiliation(s)
- Anna Amberntsson
- Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | | | - Anna Winkvist
- Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Lauren Lissner
- Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | | | | | - Hanna Augustin
- Institute of Medicine, University of Gothenburg, Goteborg, Sweden
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Miller KM, Klerk NHD, Davis EA, Lucas RM, Hart PH, Haynes A. Demographic and clinical predictors of vitamin D status in pregnant women tested for deficiency in Western Australia. Aust N Z J Public Health 2021; 45:474-481. [PMID: 34473387 DOI: 10.1111/1753-6405.13150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/01/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to describe the vitamin D status of pregnant women in Western Australia and identify predictors of deficiency in pregnancy. METHODS A cross-sectional study was conducted using linked data from statewide administrative data collections. Participants included pregnant women aged 18-44 years who gave birth between 2012 and 2014. RESULTS The mean 25-hydroxyvitamin D (25[OH]D) concentration was 70.7 nmol L-1 (SD 25.7; range 5-255 nmol L-1 ). Approximately one-fifth of the pregnant women were vitamin D deficient (<50 nmol L-1 ). Maternal age (under 25 years) was identified as an independent risk factor of vitamin D deficiency in addition to known predictors. Only 20% of women were screened within the first 10 weeks of their pregnancy. CONCLUSIONS In addition to the existing risk factors for deficiency, maternal age was an independent predictor of vitamin D deficiency. There was a large discrepancy between the time of first antenatal visit and screening for vitamin D deficiency. Implications for public health: Our findings support the addition of maternal age (under 25 years) to the current clinical guidelines for targeted screening of 25(OH)D levels in pregnancy and the practical application of screening for vitamin D deficiency at the first antenatal visit.
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Affiliation(s)
- Kate M Miller
- School of Medicine, University of Western Australia.,Telethon Kids Institute, Western Australia
| | - Nick H de Klerk
- School of Medicine, University of Western Australia.,Telethon Kids Institute, Western Australia
| | - Elizabeth A Davis
- Telethon Kids Institute, Western Australia.,Perth Children's Hospital, Nedlands, Western Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australian Capital Territory
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Bergløv A, Moseholm E, Katzenstein TL, Johansen IS, Storgaard M, Pedersen G, Weis N. Prevalence and association with birth outcomes of low vitamin D levels among pregnant women living with HIV. AIDS 2021; 35:1491-1496. [PMID: 33813556 DOI: 10.1097/qad.0000000000002899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the prevalence of low vitamin D levels among well treated pregnant women living with HIV (WLWH) on combination antiretroviral therapy in Denmark, to identify risk factors of low vitamin D levels, and to assess the association between vitamin D status and birth outcomes. DESIGN Nationwide cohort study. METHODS All WLWH in Denmark giving birth from 2000 to 2018 with a vitamin D measurement during pregnancy were identified. Risk factors for low vitamin D (deficiency or insufficiency) were assessed using log-binomial regression models, both univariate and adjusted for maternal and HIV factors. The association between vitamin D status and birth outcomes was assessed using linear regression models for continuous outcomes and log-binomial models for binary outcomes. RESULTS Among 208 WLWH, the prevalence of vitamin D deficiency was 13%, insufficiency 34%, and sufficiency 53%. Being of African origin (RR 2.68, P = 0.01), Asian origin (RR 3.38, P = < 0.01), or having HIV RNA levels more than 50 copies/ml (RR 1.43, P = 0.04) was associated with an increased risk of low vitamin D level. WLWH with vitamin D deficiency had an increased risk of preterm birth (RR 2.66, P = 0.03) and giving birth to small for gestational age (SGA) children (RR 6.83, P = 0.02) compared with WLWH with sufficient vitamin D level. CONCLUSION Low vitamin D level was prevalent among well treated pregnant WLWH in Denmark, especially among women of African or Asian origin, and women with detectable viral loads. Vitamin D deficiency was associated with an increased risk of preterm birth and SGA.
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Affiliation(s)
- Anne Bergløv
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
| | - Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Isik S Johansen
- Research Unit for infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Late Pregnancy Vitamin D Deficiency is Associated with Doubled Odds of Birth Asphyxia and Emergency Caesarean Section: A Prospective Cohort Study. Matern Child Health J 2021; 24:1412-1418. [PMID: 32844359 PMCID: PMC7560912 DOI: 10.1007/s10995-020-02999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objectives The aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS) and birth asphyxia, in a population based sample of women in Sweden. Methods Pregnant women were recruited at the antenatal care in Sweden and 1832 women were included after exclusion of miscarriages, terminated pregnancies and missing data on vitamin D status. Mode of delivery was retrieved from medical records. EMCS was defined as caesarean section after onset of labour. Birth asphyxia was defined as either 5 min Apgar score < 7 or arterial umbilical cord pH < 7.1. Serum was sampled in the third trimester of pregnancy (T3) and 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography tandem mass spectrometry. Vitamin D deficiency was defined as 25OHD < 30 nmol/L, and associations were studied using logistic regression analysis and expressed as adjusted odds ratios (AOR). Results In total, 141 (7.7%) women had an EMCS and 58 (3.2%) children were born with birth asphyxia. Vitamin D deficiency was only associated with higher odds of EMCS in women without epidural anaesthesia (AOR = 2.01, p = 0.044). Vitamin D deficiency was also associated with higher odds of birth asphyxia (AOR = 2.22, p = 0.044). Conclusions for Practice In this Swedish prospective population-based cohort study, vitamin D deficiency in late pregnancy was associated with doubled odds of birth asphyxia and with EMCS in deliveries not aided by epidural anaesthesia. Prevention of vitamin D deficiency among pregnant women may reduce the incidence of EMCS and birth asphyxia. The mechanism behind the findings require further investigation.
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Iron, iodine and vitamin D deficiencies during pregnancy: epidemiology, risk factors and developmental impacts. Proc Nutr Soc 2021; 80:290-302. [PMID: 33988109 DOI: 10.1017/s0029665121001944] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Micronutrient deficiency persists throughout the world, and although the burden is higher in low-resource settings, it is also prevalent in wealthy countries, a phenomenon termed 'hidden hunger'. Due to their high requirements for vitamins and minerals relative to their energy intake, young women and children are particularly vulnerable to hidden hunger. As they share several risk factors and impact on overlapping outcomes, we consider how deficiency of iron, iodine and vitamin D can have profound impacts on perinatal health and infant development. We review the epidemiology of these micronutrient deficiencies during pregnancy, including social, environmental and dietary risk factors. We identify the main challenges in defining nutritional status of these nutrients using validated diagnostic criteria linked with meaningful clinical outcomes. Public health strategies are urgently required to improve the overall health and nutritional status of women of reproductive age. Obesity prevention and early detection of malnutrition with standardised screening methods would detect pregnant women at increased risk of iron deficiency. Development of sensitive, individual biomarkers of iodine status is required to protect maternal health and fetal/infant brain development. Risk assessments of vitamin D requirements during pregnancy need to be revisited from the perspective of fetal and neonatal requirements. International consensus on standardised approaches to micronutrient assessment, analysis and reporting as well as sensitive, clinically validated infant and child neuro-behavioural outcomes will enable progression of useful observational and intervention studies.
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Fondjo LA, Tashie W, Owiredu WKBA, Adu-Gyamfi EA, Seidu L. High prevalence of vitamin D deficiency among normotensive and hypertensive pregnant women in Ghana. BMC Pregnancy Childbirth 2021; 21:331. [PMID: 33902494 PMCID: PMC8077698 DOI: 10.1186/s12884-021-03802-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypovitaminosis D in pregnancy is associated with adverse health outcomes in mothers, newborns and infants. This study assessed the levels of 25-hydroxyvitamin D [25(OH)D] in normotensive pregnancies and in preeclampsia, evaluated the association between vitamin D deficiency and preeclampsia risk; and determined the foeto-maternal outcome in preeclamptic women with vitamin D deficiency. METHODS This case-control study was conducted among pregnant women who visited the Comboni Hospital, in Ghana from January 2017 to May 2018 for antenatal care. A total of 180 pregnant women comprising 88 preeclamptic women (PE) and 92 healthy normotensive pregnant women (NP) were recruited. Socio-demographic, clinical and obstetric data were obtained using validated questionnaires. Blood pressure and anthropometrics were measured, and blood samples were collected for the estimation of 25- hydroxyvitamin D [25(OH)D] using enzyme-linked immunosorbent assay technique. Lipids (total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol) were also estimated. RESULTS A total of 81.7% of the study participants had vitamin D deficiency. Of these, 88.6% of the women with PE had vitamin D deficiency compared to 75.0% in the NP. Vitamin D levels were significantly reduced in the PE women compared to the normotensive pregnant women (p = 0.001). A higher proportion of the preeclamptic women who were vitamin D deficient had preterm delivery (p < 0:0001) and delivered low birth weight infants (p < 0:0001), and infants with IUGR (p < 0:0001) compared to the control group (p < 0:0001). Pregnant women with PE presented with significant dyslipidemia, evidenced by significantly elevated TC (p = 0.008), LDL (p < 0.0001), triglycerides (p = 0.017) and a significantly reduced HDL (p = 0.001) as compared to NP. In the preeclamptic women, serum 25(OH) D showed an inverse, but not significant association with TC (β = - 0.043, p = 0.722, TG (β = - 0.144, p = 0.210) and LDL (β = - 0.076, p = 0.524) and a positive, but not significant association with HDL (β = 0.171, p = 0.156). CONCLUSION The prevalence of vitamin D deficiency is high in both normotensive pregnancies and pregnancies complicated by preeclampsia but amplified in preeclampsia. Higher proportion of pregnant women with hypovitaminosis D had preterm babies and delivered low birth weight neonates. Additional studies are needed to explore the potential benefits and optimal dosing of vitamin D use in pregnancy, especially in sub-Saharan Africa.
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Kalliokoski P, Widarsson M, Rodhe N, Löfvander M. Positive impact on vitamin D related lifestyle of medical advice in pregnant Somali-born women and new mothers: a mixed method study in Swedish primary care. BMC Public Health 2021; 21:297. [PMID: 33546641 PMCID: PMC7866682 DOI: 10.1186/s12889-021-10277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A previous study showed that pregnant women/new mothers especially Somali-born and some Swedish-born had extremely low vitamin D levels and poor physical performance. Our study aimed to examine vitamin D related lifestyle, attitudes and behaviour before and after brief information about vitamin D, with special long-term focus on Somali-born women. METHODS A cohort of 91 pregnant women/new mothers having serum hydroxyvitamin D (S-25-OHD) ≤ 50 nmol/L (n = 51 Somali-born with one third < 10 nmol/L of S-25-OHD) in primary health care in Sweden was targeted for intervention. Brief individual oral and visual information on vitamin D was given by doctors at baseline and after four and ten months. Questionnaires with ordinal scales on vitamin D related lifestyle of food, clothing, and outdoor activities were distributed on all occasions. Focus-group interviews with 15 women from the target-group were performed after two years. A Somali interpreter was available. RESULTS Veiled clothing, indoor living, and a low intake of milk, cheese, and fatty fish were common in the target group. Consumption pattern had increased significantly among the Somali-born women at the four-month follow-up but declined to non-significant levels at the ten-month follow-up. The focus-group interviews showed improved understanding of vitamin D deficiency, symptoms and attitudes, but varying applied behaviours related to sun exposure. Sun exposure for the children and increased fish consumption was the most evident positive results. CONCLUSIONS Vitamin D related lifestyle, attitudes and behaviour improved in a Somali-born group of pregnant women/new mothers with severe vitamin D deficiency. The preventive measures suggested in our study may have impact on public health in relation to bone and muscle strength and immunity especially in vitamin D deficiency risk groups. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02922803 . Date of registration: 28 September 2016.
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Affiliation(s)
- P Kalliokoski
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Husargatan 3, Postal address: Box 564, 751 22, Uppsala, Sweden.
| | - M Widarsson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - N Rodhe
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Husargatan 3, Postal address: Box 564, 751 22, Uppsala, Sweden
| | - M Löfvander
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Husargatan 3, Postal address: Box 564, 751 22, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
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Lee SS, Ling KH, Tusimin M, Subramaniam R, Rahim KF, Loh SP. Influence of vitamin D binding protein polymorphism, demographics and lifestyle factors on vitamin D status of healthy Malaysian pregnant women. BMC Pregnancy Childbirth 2020; 20:714. [PMID: 33228578 PMCID: PMC7684735 DOI: 10.1186/s12884-020-03397-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin D deficiency (VDD) has been related to vitamin D binding protein (GC) gene polymorphism, demographics and lifestyle factors in different populations. However, previous studies only focused on demographic and lifestyle factors or genetic factors alone. Therefore, this cross-sectional study aimed to assess the association between GC gene polymorphism, demographics and lifestyle factors with VDD among Malaysian pregnant women. METHOD Information on demographic characteristics, dietary vitamin D intake from supplement and food, time spent outdoors, skin type and clothing were collected using a questionnaire. Plasma total 25-hydroxyvitamin D (25OHD) levels were measured using an Ultra-High-Performance Liquid Chromatography (UHPLC). Maternal GC single nucleotide polymorphisms (SNPs) (rs4588 and rs7041) were determined using restriction fragment length polymorphism (RFLP) technique. RESULTS Results showed that 50.2% of pregnant women were vitamin D deficient (25OHD < 30 nmol/L). VDD (25OHD < 30 nmol/L) was significantly associated with age, veiled clothing, maternal vitamin D intakes from both food and supplements, and GC rs7041(and GC diplotypes). In contrast to previous studies that reported for non-pregnant population, a significant positive association was found between CC genotype for SNP GC rs7041, GC 1s-1s and GC If-2 with risk of VDD (25OHD < 30 nmol/L). CONCLUSIONS The high prevalence of maternal VDD found in this study suggests the need for urgent development and implementation of vitamin D supplementation or fortification strategies to reduce VDD among pregnant women. The discrepancy in the association between GC rs7041 gene polymorphism and VDD reflects the variation in the factors associated with VDD in pregnancy compared to non-pregnant state.
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Affiliation(s)
- Siew-Siew Lee
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
| | - King-Hwa Ling
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia.,Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA
| | - Maiza Tusimin
- Prince Court Medical Centre, 50450, Kuala Lumpur, Malaysia
| | - Raman Subramaniam
- Fetal Medicine and Gynaecology Centre (FMGC), 46200, Petaling Jaya, Selangor, Malaysia
| | | | - Su-Peng Loh
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia. .,Research Centre of Excellence for Nutrition and Non-Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43300 UPM, Serdang, Selangor, Malaysia.
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Iqbal S, Malik M, Bano G. Serum Vitamin D levels and gestational diabetes mellitus: analysis of early pregnancy cohort from a teaching hospital of Kashmir Valley. J Family Med Prim Care 2020; 9:4323-4328. [PMID: 33110853 PMCID: PMC7586579 DOI: 10.4103/jfmpc.jfmpc_900_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/14/2020] [Accepted: 07/01/2020] [Indexed: 12/20/2022] Open
Abstract
Background and Aims: The association of gestational diabetes mellitus and serum Vitamin D levels in different trimesters of pregnancy has been studied recently. We conducted this study in an prospective observational cohort of well-characterized healthy pregnant women to examine the relationship between 1st trimester Vitamin D levels and Gestational Diabetes Mellitus (GDM) status during pregnancy. Methods: All pregnant women attending the out-patient department of Gynecology & Obstetrics, aged less than 35 years, and who were in their first trimester were included in the study. Socio-demographic, anthropometric details, clinical details, food frequency questionnaire and physical activity data was collected using validated pretested questionnaire. Results: The comparison between those with GDM and those with normal glucose levels has been illustrated. Women in the GDM are older than those in the non-GDM group. The women in GDM group were taller, heavier and their BMI was greater than those in the non-GDM group. There were no significant differences in dietary intake at baseline between mothers with GDM and those with normal glucose levels. Further, it was found that Vitamin D concentration of <30 nmol/L was found among higher among those with GDM and the relationship was statistically significant. Conclusion: There is an association between maternal Vitamin D deficiency and increased risk for GDM in early pregnancy among Kashmiri women.
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Affiliation(s)
- Suhail Iqbal
- Department of Obstetrics & Gynecology, Government Medical College, Baramulla, J&K, India
| | - Mehak Malik
- Department of Obstetrics & Gynecology, Government Medical College, Baramulla, J&K, India
| | - Gulshan Bano
- Department of Obstetrics & Gynecology, Government Medical College, Baramulla, J&K, India
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Waldenström J, Nyström K, Nilsson S, Norkrans G, Ydreborg M, Langeland N, Mørch K, Westin J, Lagging M. The relation of 25-hydroxy vitamin D concentrations to liver histopathology, seasonality and baseline characteristics in chronic hepatitis C virus genotype 2 or 3 infection. PLoS One 2020; 15:e0237840. [PMID: 32822420 PMCID: PMC7442235 DOI: 10.1371/journal.pone.0237840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 08/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background and objectives The hydroxylation to 25-hydroxy vitamin D (25(OH)D) occurs in the liver and the impact of liver disease on vitamin D is unclear. This study evaluated the relationship between vitamin D concentrations and hepatic histopathology, seasonality and patient characteristics in well-characterized patients having undergone a liver biopsy. Method 25(OH)D was measured post-hoc in pre-treatment serum from 331 North European patients with chronic HCV genotype 2 or 3 infection (NORDynamIC study). Liver biopsies were scored for fibrosis and inflammation according to the Ishak protocol, and graded for steatosis. Non-invasive markers of hepatic fibrosis as well as baseline viral and host characteristics, including genetic polymorphisms rs2228570, rs7975232, and rs10877012 were also evaluated. Results Mean 25(OH)D concentration was 59 ±23 nmol/L, with 41% having values <50 nmol/L and 6% were <30 nmol/L. 25(OH)D correlated with fibrosis (r = -0.10, p ≤0.05) in univariate but not in multivariate analyses. No association was observed between 25(OH)D and hepatic inflammation, but with steatosis in HCV genotype 2 infected patients. None of the genetic polymorphisms impacted on 25(OH)D levels or fibrosis. 25(OH)D levels were significantly inversely correlated to BMI (r = -0.19, p = 0.001), and was also associated with season and non-Caucasian ethnicity. Conclusion Fibrosis was not independently associated with 25(OH)D concentration and no association was seen with hepatic inflammation, but HCV genotype 2 infected patients with moderate-to-severe steatosis had lower 25(OH)D levels compared to those without steatosis. A high percentage had potential risk of 25(OH)D deficiency, and BMI, seasonality and ethnicity were independently associated with 25(OH)D as previously reported.
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Affiliation(s)
- Jesper Waldenström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
- * E-mail:
| | - Kristina Nyström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Gunnar Norkrans
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magdalena Ydreborg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
| | - Nina Langeland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristine Mørch
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Johan Westin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
| | - Martin Lagging
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden
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Adherence to the infant vitamin D supplementation policy in Ireland. Eur J Nutr 2020; 60:1337-1345. [PMID: 32681322 DOI: 10.1007/s00394-020-02334-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE From September 2010 until November 2019, Ireland's infant vitamin D supplementation policy recommended administration of 5 μg/day of vitamin D3 from birth to 12 months to all infants, regardless of feeding method. This study aims to examine policy adherence. METHODS In the prospective COMBINE birth cohort study (recruited 2015-2017), detailed longitudinal supplement data were examined in 364 infants across the first year of life, according to product type, dose, frequency, and duration. Vitamin D supplement use at 2, 6, and 12 months in COMBINE was compared with the BASELINE cohort (recruited 2008-2011, n = 1949). RESULTS In COMBINE, 92% of infants initiated supplementation at birth. The median supplementation duration was 51 (40, 52) weeks, with a range of 3-52 weeks. While supplementing, most parents (92%) used an exclusive vitamin D supplement as recommended and 88% gave 5 µg/day. Half (51%) gave vitamin D daily and a further 33% supplemented at least 3-6 times/week. Overall, 30% adhered fully to the policy, providing 5 µg vitamin D3 daily from birth to 12 months. A further 16% were broadly compliant, giving 5 µg frequently for the full 12 months. Vitamin D supplement use at 2, 6, and 12 months in COMBINE was 93%, 89%, and 72%, considerably higher than our earlier BASELINE cohort at 49%, 64%, and 44% at the same time points (all P < 0.001). CONCLUSIONS We report a high level of vitamin D supplementation initiation at birth, with full to broad policy adherence among more than half of infants. There is scope to improve overall compliance by focusing on supplementation frequency.
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Schoenmakers I, Piec I, Baban S, Bärebring L, Green D, Washbourne CJ, Tang JCY, Fraser WD, Augustin H. Gestational hypercalcemia: Prevalence and biochemical profile. J Steroid Biochem Mol Biol 2020; 199:105611. [PMID: 32007562 DOI: 10.1016/j.jsbmb.2020.105611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 01/29/2020] [Indexed: 11/25/2022]
Abstract
Gestational hypercalcemia is associated with an increased risk of maternal, fetal and neonatal morbidity and mortality. Hypercalcemia may develop during pregnancy in individuals who were previously asymptomatic. The increased sensitivity during pregnancy may be related to physiological, gestational alterations in vitamin D and calcium metabolism and may be influenced by gene variants. The prevalence is unknown. We investigated the prevalence of hypercalcemia in trimester 3 (T3) in a population representative prospective cohort study (n = 1832) in South-West Sweden. Women with serum albumin (Alb) adjusted calcium (CaAlb) ≥ 2.65 mmol/L in T3 (n = 30) were matched to normo-calcemic controls, and markers of calcium and vitamin D metabolism were investigated in trimester 1 (T1) and T3. Serum concentrations of Ca, phosphate (P), Magnesium (Mg), Alb and creatinine (Cr), parathyroid hormone (PTH; T3 only), vitamin D metabolites (total 25(OH)D, 1,25(OH)2D, 24,25(OH)2D, and free 25(OH)D) were analysed in T1 and T3. CaAlb (Payne; inter-laboratory difference: UEA = 0.15 + 0.9*UGOT; UEA 2.54 = UGOT 2.65) and estimated glomerular filtration rate (eGFR; modified 4-variable MDRD) and vitamin D metabolites ratios (VMR) were calculated. Normally and non-normally distributed data were presented as mean (SD) or median (95 %CI). Group differences in relationships between vitamin D metabolites and with PTH were investigated with multiple regression analyses. Hypercalcemia in T3 was found in 1.7 % of women. PTH concentrations suggestive of primary hyperparathyroidism was found in 1 woman and none had 25(OH)D or 24,25(OH)2D concentrations in the toxicity range or suggestive of mutations in the CYP24A1 gene. CaAlb was significantly higher in hypercalcemic cases compared to controls in T1 (2.44 (2.30-2.80) vs 2.37 (2.25-2.49) mmol/L) and T3 (2.63 (2.52-2.78) vs 2.46 (2.31-2.58) mmol/L). Serum P was higher among cases than controls in T3 (1.12 (0.16) vs 1.07 (0.18) mmol/L) but not in T1 (1.12 (0.18) and 1.12 (0.16) mmol/L). PTH in T3 was lower in cases (1.6 (1.6-2.8) vs 2.3 (2.1-2.8) pmol/L) but 1,25(OH)2D concentrations were similar. There were no significant group differences in serum 25(OH)D, free 25(OH)D, 24,25(OH)2D, Mg, Alb, Cr and eGFR. Regression analyses did not show significant differences between cases and controls in relationships between vitamin D metabolites and with PTH, except for the free 25(OH)D-PTH relationship and a higher free:total 25(OH)D ratio in cases at T1. In conclusion, most common causes of hypercalcemia were excluded in the majority of women. Hypercalcemic women had a relatively high serum 1,25(OH)2D concentration despite an appropriately suppressed PTH, suggestive of abnormal gestational adaptions.
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Affiliation(s)
- I Schoenmakers
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK.
| | - I Piec
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - S Baban
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - L Bärebring
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - D Green
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - C J Washbourne
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - J C Y Tang
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - W D Fraser
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, UK
| | - H Augustin
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden
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24
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Jones KS, Meadows SR, Schoenmakers I, Prentice A, Moore SE. Vitamin D Status Increases During Pregnancy and in Response to Vitamin D Supplementation in Rural Gambian Women. J Nutr 2020; 150:492-504. [PMID: 31834380 PMCID: PMC7056615 DOI: 10.1093/jn/nxz290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/11/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Vitamin D is important to maternal, fetal, and infant health, but quality data on vitamin D status in low- and middle-income countries and response to cholecalciferol supplementation in pregnancy are sparse. OBJECTIVE We characterized vitamin D status and vitamin D metabolite change across pregnancy and in response to cholecalciferol supplementation in rural Gambia. METHODS This study was a secondary analysis of samples collected in a 4-arm trial of maternal nutritional supplementation [iron folic acid (FeFol); multiple micronutrients (MMN); protein energy (PE) as lipid-based supplement; PE + MMN]; MMN included 10 μg/d cholecalciferol. Plasma 25-hydroxycholecalciferol [25(OH)D3], 24,25-dihydroxycholecalciferol [24,25(OH)2D3], and C3-epimer-25-hydroxycholecalciferol [3-epi-25(OH)D3] were measured by LC-MS/MS in 863 women [aged 30 ± 7 y (mean ± SD)] in early pregnancy (presupplementation) and late pregnancy, (gestational age 14 ± 3 and 30 ± 1 wk). Changes in 25(OH)D3 and vitamin D metabolite concentrations and associations with pregnancy stage and maternal age and anthropometry were tested. RESULTS Early pregnancy 25(OH)D3 concentration was 70 ± 15 nmol/L and increased according to pregnancy stage (82 ± 18 and 87 ± 17 nmol/L in the FeFol and PE-arms) and to cholecalciferol supplementation (95 ± 19 and 90 ± 20 nmol/L in the MMN and PE + MMN-arms) (P < 0.0001). There was no difference between supplemented groups. Early pregnancy 25(OH)D3 was positively associated with maternal age and gestational age. Change in 25(OH)D3 was negatively associated with late pregnancy, but not early pregnancy, triceps skinfold thickness. The pattern of change of 24,25(OH)2D3 mirrored that of 25(OH)D3 and appeared to flatten as pregnancy progressed, whereas 3-epi-25(OH)D3 concentration increased across pregnancy. CONCLUSION This study provides important data on the vitamin D status of a large cohort of healthy pregnant women in rural Africa. Without supplementation, vitamin D status increased during pregnancy, demonstrating that pregnancy stage should be considered when assessing vitamin D status. Nutritionally relevant cholecalciferol supplementation further increased vitamin D status. These data are relevant to the development of fortification and supplementation policies in pregnant women in West Africa.
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Affiliation(s)
- Kerry S Jones
- MRC Nutrition and Bone Health Research Group, MRC Elsie Widdowson Laboratory, Cambridge, UK,NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK,Address correspondence to KSJ (e-mail: )
| | - Sarah R Meadows
- MRC Nutrition and Bone Health Research Group, MRC Elsie Widdowson Laboratory, Cambridge, UK,NIHR Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Inez Schoenmakers
- MRC Nutrition and Bone Health Research Group, MRC Elsie Widdowson Laboratory, Cambridge, UK,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ann Prentice
- MRC Nutrition and Bone Health Research Group, MRC Elsie Widdowson Laboratory, Cambridge, UK,MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sophie E Moore
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia,Department of Women and Children's Health, King's College London, UK
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25
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Poor Dietary Quality is Associated with Low Adherence to Gestational Weight Gain Recommendations among Women in Sweden. Nutrients 2020; 12:nu12020317. [PMID: 31991776 PMCID: PMC7071171 DOI: 10.3390/nu12020317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/11/2020] [Accepted: 01/20/2020] [Indexed: 11/22/2022] Open
Abstract
Appropriate gestational weight gain (GWG) is important for fetal development and maternal health, but it is unclear what dietary factors predict GWG. The aim of this study was to investigate the association between dietary quality during pregnancy and GWG. In total, 1113 pregnant women were recruited when registering for antenatal care. GWG was defined according to the Institute of Medicine (IOM) guidelines. GWG was calculated as measured body weight at registration for antenatal care, to gestational week 37 ± 2. Dietary intake was assessed using a food frequency questionnaire (FFQ) administered in gestational week >31. In total, 40% gained within the IOM GWG recommendations, 25% had insufficient GWG and 35% excessive GWG. Women with a poor or fair quality diet gained approximately 2 kg more than women with a high-quality diet. Poor dietary quality was also associated with higher odds of excessive GWG, due to fat quality and intake of discretionary foods. In conclusion, poor quality dietary intake is associated with lower adherence to the guidelines on weight gain in pregnancy. A diet characterised by high-quality fat intake, low consumption of discretionary foods and high nutrient intake may promote healthy weight gain and prevent excessive GWG.
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26
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Itkonen ST, Andersen R, Björk AK, Brugård Konde Å, Eneroth H, Erkkola M, Holvik K, Madar AA, Meyer HE, Tetens I, Torfadóttir JE, Thórisdóttir B, Lamberg-Allardt CJE. Vitamin D status and current policies to achieve adequate vitamin D intake in the Nordic countries. Scand J Public Health 2020; 49:616-627. [PMID: 31916497 DOI: 10.1177/1403494819896878] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: Nordic countries share fairly similar food culture and geographical location as well as common nutrition recommendations. The aim of this paper was to review the latest data on vitamin D status and intake and to describe the national supplementation and food fortification policies to achieve adequate vitamin D intake in the Nordic countries. Methods: The data are based on results derived from a literature search presented in a workshop held in Helsinki in November 2018 and completed by recent studies. Results: Vitamin D policies and the implementation of the recommendations differ among the Nordic countries. Vitamin D fortification policies can be mandatory or voluntary and widespread, moderate or non-existent. Vitamin D supplementation recommendations differ, ranging from all age groups being advised to take supplements to only infants. In the general adult population of the Nordic countries, vitamin D status and intake are better than in the risk groups that are not consuming vitamin D supplements or foods containing vitamin D. Non-Western immigrant populations in all Nordic countries share the problem of vitamin D insufficiency and deficiency. Conclusions: Despite the common nutrition recommendations, there are differences between the Nordic countries in the implementation of the recommendations and policies to achieve adequate vitamin D intake and status. There is a need for wider Nordic collaboration studies as well as strategies to improve vitamin D status, especially in risk groups.
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Affiliation(s)
- Suvi T Itkonen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Rikke Andersen
- Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Anne K Björk
- Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden
| | | | - Hanna Eneroth
- Science Division, National Food Agency, Uppsala, Sweden
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Ahmed A Madar
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Haakon E Meyer
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Inge Tetens
- Vitality - Centre for Good Older Lives, Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jóhanna E Torfadóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Cancer Society, Reykjavik, Iceland
| | - Birna Thórisdóttir
- Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Sociology, Anthropology and Folkloristics, School of Social Sciences, University of Iceland, Reykjavik, Iceland
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27
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Axelsson D, Brynhildsen J, Blomberg M. Vitamin D deficiency at the time of delivery - Prevalence and risk of postpartum infections. PLoS One 2019; 14:e0226673. [PMID: 31856242 PMCID: PMC6922419 DOI: 10.1371/journal.pone.0226673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background Postpartum infections are a common cause of morbidity after childbirth. Vitamin D deficiency has been shown to increase the risk for several infections in a non-pregnant population. Vitamin D deficiency has been described as common in pregnant women. Objective To investigate whether vitamin D deficiency in pregnant women in labor was associated with an increased risk of overall postpartum infectious morbidity within eight weeks of delivery. A secondary aim was to estimate the prevalence of vitamin D deficiency among pregnant women in Linköping, Sweden at the time of delivery. Material and methods Serum vitamin D levels in labor were analyzed for 1397 women. Vitamin D deficiency was defined as serum levels <50 nmol/L. All ICD-10 codes given to the women eight weeks postpartum were reviewed and postpartum infections were defined as the presence of an ICD-10 code suggestive of infection. The prevalence of postpartum infections among women with sufficient vitamin D levels was compared with women with vitamin D deficiency. Adjusted Odds Ratios and 95% confidence intervals for postpartum infections were calculated using multivariate logistic regression analysis. Results Fifty eight per cent of the women had serum vitamin D levels <50 nmol/L. The proportion of women with vitamin D deficiency varied, as expected, with season. No association between vitamin D deficiency and postpartum infections was found. For vitamin D 25–50 nmol/L the adjusted Odds Ratio was 0.85 (95% confidence interval 0.56–1.29) and for vitamin D <25 nmol/L the adjusted Odds Ratio was 1.15 (95% confidence interval 0.66–2.03). Women who smoked or who had a cesarean section had an increased risk of postpartum infections. Conclusions Vitamin D deficiency was more common than previously reported in Swedish pregnant women. No association between vitamin D deficiency and postpartum infections was found. Other well-known risk factors for postpartum infection were identified.
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Affiliation(s)
- Daniel Axelsson
- Department of Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- * E-mail:
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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28
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Aguiar M, Andronis L, Pallan M, Högler W, Frew E. The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales. Eur J Clin Nutr 2019; 74:825-833. [PMID: 31427760 DOI: 10.1038/s41430-019-0486-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vitamin D deficiency (VDD) affects the health and wellbeing of millions worldwide. In high latitude countries such as the United Kingdom (UK), severe complications disproportionally affect ethnic minority groups. OBJECTIVE To develop a decision-analytic model to estimate the cost effectiveness of population strategies to prevent VDD. METHODS An individual-level simulation model was used to compare: (I) wheat flour fortification; (II) supplementation of at-risk groups; and (III) combined flour fortification and supplementation; with (IV) a 'no additional intervention' scenario, reflecting the current Vitamin D policy in the UK. We simulated the whole population over 90 years. Data from national nutrition surveys were used to estimate the risk of deficiency under the alternative scenarios. Costs incurred by the health care sector, the government, local authorities, and the general public were considered. Results were expressed as total cost and effect of each strategy, and as the cost per 'prevented case of VDD' and the 'cost per Quality Adjusted Life Year (QALY)'. RESULTS Wheat flour fortification was cost saving as its costs were more than offset by the cost savings from preventing VDD. The combination of supplementation and fortification was cost effective (£9.5 per QALY gained). The model estimated that wheat flour fortification alone would result in 25% fewer cases of VDD, while the combined strategy would reduce the number of cases by a further 8%. CONCLUSION There is a strong economic case for fortifying wheat flour with Vitamin D, alone or in combination with targeted vitamin D3 supplementation.
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Affiliation(s)
- M Aguiar
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - L Andronis
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Population, Evidence and Technologies, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - M Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - W Högler
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Johannes Kepler University, Linz, A-4040, Austria.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - E Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
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29
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Bärebring L, O'Connell M, Winkvist A, Johannsson G, Augustin H. Serum cortisol and vitamin D status are independently associated with blood pressure in pregnancy. J Steroid Biochem Mol Biol 2019; 189:259-264. [PMID: 30710744 DOI: 10.1016/j.jsbmb.2019.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022]
Abstract
The aim was to study if serum cortisol during pregnancy was associated with blood pressure and development of gestational hypertensive disorders. Additionally, associations between 25-hydroxyvitamin D (25OHD) and cortisol, including confounding effects and interactions in their relation to blood pressure were investigated. In total, 1413 pregnant women from the prospective Swedish GraviD cohort were included. Serum was collected in the first (T1) and third trimester (T3) and analyzed for 25OHD by liquid chromatography mass spectrometry and cortisol using an electro-chemiluminescence immunoassay. The main outcome measures were T1 blood pressure and development of gestational hypertensive disorders (gestational hypertension or preeclampsia). Gestational hypertensive disorders were defined as new onset hypertension, with or without proteinuria, after gestational week 20. Mean ± SD cortisol increased significantly from T1 to T3 (312 ± 123 vs. 659 ± 201 nmol/L, p < 0.001) and this increase was influenced by ethnicity. Serum concentrations of cortisol and 25OHD correlated in both T1 (B = 0.35, p < 0.001) and T3 (B = 0.30, p < 0.001). Cortisol and 25OHD were positively associated with T1 blood pressure, and there were non-significant trends for associations with gestational hypertensive disorders. Cortisol and 25OHD did not display any confounding effect or effect modification in their relationships with blood pressure. In conclusion, there was a positive correlation between serum cortisol and 25OHD in both early and late pregnancy. Both cortisol and 25OHD were positively associated with early pregnancy blood pressure. These results imply that the two hormones might be on different paths in their relationship with blood pressure.
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Affiliation(s)
- Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 40530, Gothenburg, Sweden.
| | - Moira O'Connell
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 40530, Gothenburg, Sweden.
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 40530, Gothenburg, Sweden.
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 40530, Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Medicinmottagning Sahlgrenska, 413 45, Gothenburg, Sweden.
| | - Hanna Augustin
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 40530, Gothenburg, Sweden.
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30
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Looman M, Geelen A, Samlal RAK, Heijligenberg R, Klein Gunnewiek JMT, Balvers MGJ, Wijnberger LDE, Brouwer-Brolsma EM, Feskens EJM. Changes in Micronutrient Intake and Status, Diet Quality and Glucose Tolerance from Preconception to the Second Trimester of Pregnancy. Nutrients 2019; 11:nu11020460. [PMID: 30813281 PMCID: PMC6412670 DOI: 10.3390/nu11020460] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/10/2019] [Accepted: 02/19/2019] [Indexed: 12/14/2022] Open
Abstract
Data on changes in dietary intake and related blood parameters throughout pregnancy are scarce; moreover, few studies have examined their association with glucose homeostasis. Therefore, we monitored intake of folate, vitamin B6, vitamin B12, vitamin D and iron, their status markers, and diet quality from preconception to the second trimester of pregnancy, and we examined whether these dietary factors were associated with glucose homeostasis during pregnancy. We included 105 women aged 18⁻40 years with a desire to get pregnancy or who were already <24 weeks pregnant. Women at increased gestational diabetes (GDM) risk were oversampled. Measurements were scheduled at preconception (n = 67), and 12 (n =53) and 24 weeks of pregnancy (n =66), including a fasting venipuncture, 75-grams oral glucose tolerance test, and completion of a validated food frequency questionnaire. Changes in micronutrient intake and status, and associations between dietary factors and glucose homeostasis, were examined using adjusted repeated measures mixed models. Micronutrient intake of folate, vitamin B6 and vitamin D and related status markers significantly changed throughout pregnancy, which was predominantly due to changes in the intake of supplements. Micronutrient intake or status levels were not associated with glucose homeostasis, except for iron intake (FE µg/day) with fasting glucose (β = -0.069 mmol/L, p = 0.013) and HbA1c (β = -0.4843 mmol, p = 0.002). Diet quality was inversely associated with fasting glucose (β = -0.006 mmol/L for each DHD15-index point, p = 0.017). It was shown that micronutrient intakes and their status markers significantly changed during pregnancy. Only iron intake and diet quality were inversely associated with glucose homeostasis.
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Affiliation(s)
- Moniek Looman
- Division of Human Nutrition, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Rahul A K Samlal
- Department of Gynaecology and Obstetrics, Hospital Gelderse Vallei Ede, P.O. Box 9025, 6710 HN Ede, The Netherlands.
| | - Rik Heijligenberg
- Department of Internal Medicine, Hospital Gelderse Vallei Ede, P.O. Box 9025, 6710 HN Ede, The Netherlands.
| | - Jacqueline M T Klein Gunnewiek
- Clinical Chemistry and Haematology Laboratory, Hospital Gelderse Vallei Ede, P.O. Box 9025, 6710 HN Ede, The Netherlands.
| | - Michiel G J Balvers
- Clinical Chemistry and Haematology Laboratory, Hospital Gelderse Vallei Ede, P.O. Box 9025, 6710 HN Ede, The Netherlands.
| | - Lia D E Wijnberger
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, The Netherlands.
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Edith J M Feskens
- Division of Human Nutrition, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
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31
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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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32
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Walsh M, Bärebring L, Augustin H. Avoiding maternal vitamin D deficiency may lower blood glucose in pregnancy. J Steroid Biochem Mol Biol 2019; 186:117-121. [PMID: 30308320 DOI: 10.1016/j.jsbmb.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/04/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Vitamin D status is hypothesised to play a role in gestational glucose control. No studies to date have examined vitamin D in relation to changes in blood glucose in pregnancy. Thus, the aim was to examine if vitamin D in early pregnancy and vitamin D trajectory associate with blood glucose trajectory over pregnancy in a Swedish cohort. We also investigated the relation between maternal vitamin D status and excessive fetal growth. METHODS In 2013-2014, pregnant women were recruited to the GraviD cohort study when registering at the antenatal clinics in south-west Sweden. In the present analysis, 1928 women were included. Women with preexisting diabetes and multifetal pregnancy were excluded. Random blood glucose was assessed according to routine practice, in first trimester (T1, gestational week 4-16), second trimester (T2, gestational week 17-27), early (T3a, gestational week 28-35) and late third trimester (T3b, gestational week 36-41). In T1 and T3a, serum 25-hydroxyvitamim D (25OHD) was analyzed by liquid chromatography tandem mass spectrometry. Large for gestational age (LGA), as a proxy of excessive fetal growth, was defined as body weight at birth above 2 standard deviations of the gender specific population mean. Adjusted linear regression, linear mixed models analysis and logistic regression analysis were used to study 25OHD in relation to T1 blood glucose, glucose trajectory and LGA, respectively. RESULTS Mean blood glucose increased during pregnancy (5.21 mmol/L in T1, 5.27 mmol/L in T2, 5.31 mmol/L in T3a and 5.34 mmol/L in T3b; p = 0.003). In T1, 25OHD was negatively associated with blood glucose, i.e. 25OHD ≥ 30 nmol/L was associated with 0.25-0.35 mmol/L lower glucose. T1 25OHD was also negatively associated with blood glucose trajectory. Higher T3 25OHD was associated with higher odds of LGA (p = 0.032). CONCLUSION Avoiding maternal vitamin D deficiency in early pregnancy is associated with lower blood glucose in early pregnancy and throughout pregnancy. Higher 25OHD in late pregnancy was associated with higher odds of LGA at birth.
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Affiliation(s)
- Meabh Walsh
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden; Dublin Institute of Technology, Trinity College Dublin, Ireland
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Hanna Augustin
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Sharma N, Nath C, Mohammad J. Vitamin D status in pregnant women visiting a tertiary care center of North Eastern India. J Family Med Prim Care 2019; 8:356-360. [PMID: 30984638 PMCID: PMC6436274 DOI: 10.4103/jfmpc.jfmpc_404_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Studies of vitamin D (VD) physiology suggest that effects of vitamin D deficiency (VDD) could be much broader than rickets including cardiovascular disease, cancers, diabetes, infection, and allergy and pregnancy complications. Data regarding the prevalence of hypovitaminosis in pregnancy are scanty especially in north eastern part of India. Therefore, this study has undertaken with the intention to find out prevalence and outcome of hypovitaminosis of VD in pregnancy. Materials and Method: In total, 177 pregnant women with singleton pregnancy, <16 weeks of gestational age, visited to antenatal clinic of our institute were consecutively enrolled for the study. The serum VD was estimated by Beckman coulter unicel DXI immunoassay system using the principle of Chemiluminescence. Incidence of vitamin deficiency and insufficiency calculated. VDD was defined as 25(OH)D levels in blood <20 ng/mL, and insufficiency of VD was defined as 25(OH)D levels <32 ng/mL. Antenatal complications, such as intrauterine growth restriction (IUGR), oligohydramnios, pre-eclampsia, preterm labor, gestational diabetes, if any, were noted. Labor and delivery information including induction of labor, mode of delivery, and newborn birth weight were noted. Result: In total, 177 women recruited for the study. Mean age and parity of the subjects were 26.71 ± 9.96 and 2.10 ± 1.8, respectively. For detailed statistical analysis, women were divided into three groups depending upon their VD levels: deficiency group [25(OH)D level <20 ng/mL], insufficiency group [25(OH)D level <32 ng/mL], and sufficient group [25(OH)D level >32 ng/mL]. VDD was present in 84.18% subjects. VD insufficiency was present in 12.44% of cases. There is association of preeclampsia, cesarean section, and low birth weight babies with lower level of VD. Conclusion: This study showed that the prevalence of VDD in pregnancy is astonishingly high till now there is no guideline to screen antenatal women for VDD. As the test is costly even, offering it to all at-risk women may not be cost effective compared with offering universal supplementation, particularly as treatment is regarded as being very safe.
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Affiliation(s)
- Nalini Sharma
- Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Chandan Nath
- Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Jamil Mohammad
- Department of Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Vitamin D status during pregnancy and in cord blood in a large prospective French cohort. Clin Nutr 2018; 38:2136-2144. [PMID: 30224306 DOI: 10.1016/j.clnu.2018.08.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Vitamin D status during pregnancy and in newborns has never been studied in France. This study aims at determining the vitamin D status during the first and third trimesters of pregnancy (T1, T3) and in cord blood (CB) in the middle-north of France. METHODS We conducted a prospective cohort study in five French centers (latitude 47.22 to 48.86°N). Serum 25(OH)-vitamin D (25(OH)D) concentrations were measured using a radioimmunoassay during T1, T3 and in CB. According to the French guidelines, pregnant women received cholecalciferol, 100,000 IU, in the seventh month. RESULTS Between April 2012 and July 2014, 2832 women were included, of whom 2803 were analyzed (mean ± SD age: 31.5 ± 5.0 years; phototypes 5-6: 21.8%). Three and 88.6% of participants received supplementation during the month before inclusion and in the seventh month, respectively. At T1, T3, and CB, mean 25(OH)D concentrations were 21.9 ± 10.4, 31.8 ± 11.5, and 17.0 ± 7.2 ng/mL, respectively, and 25(OH)D was <20 ng/mL in 46.5%, 14.0%, and 68.5%, respectively. At T1, body mass index ≥25 kg/m2, dark phototypes, sampling outside summer, and no supplementation before inclusion were independently associated with vitamin D insufficiency (25(OH)D < 20 ng/mL). Women who received cholecalciferol supplementation in month 7 had higher 25(OH)D at T3 than non-supplemented women (32.5 ± 11.4 versus 25.8 ± 11.4 ng/mL, p = <0.001) and marginally higher 25(OH)D in CB (17.2 ± 7.2 versus 15.5 ± 7.1 ng/mL, p = 0.004). CONCLUSIONS Despite the recommended supplementation, vitamin D insufficiency is frequent during pregnancy and in newborns in France.
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Hemmingway A, O'Callaghan KM, Hennessy Á, Hull GLJ, Cashman KD, Kiely ME. Interactions between Vitamin D Status, Calcium Intake and Parathyroid Hormone Concentrations in Healthy White-Skinned Pregnant Women at Northern Latitude. Nutrients 2018; 10:E916. [PMID: 30018262 PMCID: PMC6073976 DOI: 10.3390/nu10070916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 01/02/2023] Open
Abstract
Adverse effects of low vitamin D status and calcium intakes in pregnancy may be mediated through functional effects on the calcium metabolic system. Little explored in pregnancy, we aimed to examine the relative importance of serum 25-hydroxyvitamin D (25(OH)D) and calcium intake on parathyroid hormone (PTH) concentrations in healthy white-skinned pregnant women. This cross-sectional analysis included 142 participants (14 ± 2 weeks' gestation) at baseline of a vitamin D intervention trial at 51.9 °N. Serum 25(OH)D, PTH, and albumin-corrected calcium were quantified biochemically. Total vitamin D and calcium intakes (diet and supplements) were estimated using a validated food frequency questionnaire. The mean ± SD vitamin D intake was 10.7 ± 5.2 μg/day. With a mean ± SD serum 25(OH)D of 54.9 ± 22.6 nmol/L, 44% of women were <50 nmol/L and 13% <30 nmol/L. Calcium intakes (mean ± SD) were 1182 ± 488 mg/day and 23% of participants consumed <800 mg/day. The mean ± SD serum albumin-adjusted calcium was 2.2 ± 0.1 mmol/L and geometric mean (95% CI) PTH was 9.2 (8.4, 10.2) pg/mL. PTH was inversely correlated with serum 25(OH)D (r = -0.311, p < 0.001), but not with calcium intake or serum calcium (r = -0.087 and 0.057, respectively, both p > 0.05). Analysis of variance showed that while serum 25(OH)D (dichotomised at 50 nmol/L) had a significant effect on PTH (p = 0.025), calcium intake (<800, 800⁻1000, ≥1000 mg/day) had no effect (p = 0.822). There was no 25(OH)D-calcium intake interaction effect on PTH (p = 0.941). In this group of white-skinned women with largely sufficient calcium intakes, serum 25(OH)D was important for maintaining normal PTH concentration.
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Affiliation(s)
- Andrea Hemmingway
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland.
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 Y337 Cork, Ireland.
| | - Karen M O'Callaghan
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland.
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 Y337 Cork, Ireland.
| | - Áine Hennessy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland.
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 Y337 Cork, Ireland.
| | - George L J Hull
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland.
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland.
- Department of Medicine, University College Cork, T12 Y337 Cork, Ireland.
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland.
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 Y337 Cork, Ireland.
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Bärebring L, Amberntsson A, Winkvist A, Augustin H. Validation of Dietary Vitamin D Intake from Two Food Frequency Questionnaires, Using Food Records and the Biomarker 25-Hydroxyvitamin D among Pregnant Women. Nutrients 2018; 10:nu10060745. [PMID: 29890634 PMCID: PMC6024652 DOI: 10.3390/nu10060745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/21/2022] Open
Abstract
Our objective was to validate vitamin D intake from a short vitamin D questionnaire (VDQ) and a longer online food frequency questionnaire (FFQ) against a food record and 25-hydroxyvitamin D (25OHD) as a biomarker of vitamin D status, among pregnant women in Sweden. The number of women included was 1125 with VDQ, FFQ and 25OHD, and of those, 64 also completed the food record. Median vitamin D intakes were 3.9 µg by VDQ (p < 0.001), and 5.3 µg by FFQ (p = 0.89), compared to 5.0 µg by food record. Correlations between vitamin D intake from food record and VDQ (rho = 0.51, p < 0.001) or FFQ (rho = 0.49, p < 0.001) were similar. The VDQ and FFQ also had a similar ability to rank the individuals according to vitamin D intake. However, only vitamin D intake from the VDQ was significantly associated with vitamin D status as assessed by 25OHD. The validation coefficient for the VDQ was 0.68 and 0.75 for the FFQ. In conclusion, assessing dietary vitamin D intake is challenging, regardless of the dietary assessment method. The VDQ, that includes only four food items, is a valid, simple and useful tool in assessing vitamin D intake of pregnant women in Sweden, while imposing a minimal burden on women and researchers.
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Affiliation(s)
- Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.
| | - Anna Amberntsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.
| | - Hanna Augustin
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.
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Uwitonze AM, Uwambaye P, Isyagi M, Mumena CH, Hudder A, Haq A, Nessa K, Razzaque MS. Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D? J Steroid Biochem Mol Biol 2018; 180:65-72. [PMID: 29341890 DOI: 10.1016/j.jsbmb.2018.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/06/2017] [Accepted: 01/12/2018] [Indexed: 01/22/2023]
Abstract
Studies have shown a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening of cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) in new-borns. Prematurity and immaturity are the leading causes of prenatal and infant mortality and is a major public health problem around the world. Inflamed periodontal tissues generate significantly high levels of proinflammatory cytokines that may have systemic effects on the host mother and the fetus. In addition, the bacteria that cause PDs produce endotoxins which can harm the fetus. Furthermore, studies have shown that microorganisms causing PDs can get access to the bloodstream, invading uterine tissues, to induce PBLBW. Another likely mechanism that connects PDs with adverse pregnancy outcome is maternal vitamin D status. A role of inadequate vitamin D status in the genesis of PDs has been reported. Administration of vitamin D supplementation during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes. As maternal PDs are significant risk factors for adverse pregnancy outcome, preventive antenatal care for pregnant women in collaboration with the obstetric and dental professions are required.
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Affiliation(s)
- Anne Marie Uwitonze
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Peace Uwambaye
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Moses Isyagi
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Chrispinus H Mumena
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Alice Hudder
- Department of Biochemistry, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Afrozul Haq
- Department of Food Technology, School of Interdisciplinary Sciences & Technology, Jamia Hamdard, New Delhi, India
| | - Kamrun Nessa
- Department of Obstetrics & Gynaecology, Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Mohammed S Razzaque
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda; Department of Applied Oral Sciences, Forsyth Institute, Harvard School of Dental Medicine Affiliate, Cambridge, MA, USA; Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
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von Websky K, Hasan AA, Reichetzeder C, Tsuprykov O, Hocher B. Impact of vitamin D on pregnancy-related disorders and on offspring outcome. J Steroid Biochem Mol Biol 2018; 180:51-64. [PMID: 29169993 DOI: 10.1016/j.jsbmb.2017.11.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 12/16/2022]
Abstract
Observational studies from all over the world continue to find high prevalence rates of vitamin D insufficiency and deficiency in many populations, including pregnant women. Beyond its classical function as a regulator of calcium and phosphate metabolism, vitamin D elicits numerous effects in the human body. Current evidence highlights a vital role of vitamin D in mammalian gestation. During pregnancy, adaptations in maternal vitamin D metabolism lead to a physiologic increase of vitamin D levels, mainly because of an increased renal production, although other potential sources like the placenta are being discussed. A sufficient supply of mother and child with calcium and vitamin D during pregnancy ensures a healthy bone development of the fetus, whereas lack of either of these nutrients can lead to the development of rickets in the child. Moreover, vitamin D insufficiency during pregnancy has consistently been associated with adverse maternal and neonatal pregnancy outcomes. In multitudinous studies, low maternal vitamin D status was associated with a higher risk for preeclampsia, gestational diabetes mellitus and other gestational diseases. Likewise, several negative consequences for the fetus have been reported, including fetal growth restriction, increased risk of preterm birth and a changed susceptibility for later-life diseases. However, study results are diverging and causality has not been proven so far. Meta-analyses on the relationship between maternal vitamin D status and pregnancy outcomes revealed a wide heterogeneity of studied populations and the applied methodology in vitamin D assessment. Until today, clinical guidelines for supplementation cannot be based on high-quality evidence and it is not clear if the required intake for pregnant women differs from non-pregnant women. Long-term safety data of vitamin D supplementation in pregnant women has not been established and overdosing of vitamin D might have unfavorable effects, especially in mothers and newborns with mutations of genes involved in vitamin D metabolism. Reliable data from large observational and interventional randomized control trials are urgently needed as a basis for any detailed and safe recommendations for supplementation in the general population and, most importantly, in pregnant women. This is of utmost importance, as ensuring a sufficient vitamin D-supply of mother and child implies a great potential for the prevention of birth complications and development of diseases.
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Affiliation(s)
- Karoline von Websky
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Center for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ahmed Abdallah Hasan
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Egypt
| | - Christoph Reichetzeder
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Center for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oleg Tsuprykov
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Institute for Laboratory Medicine, IFLB, Berlin, Germany
| | - Berthold Hocher
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; Institute for Laboratory Medicine, IFLB, Berlin, Germany; Department of Basic Medicine, Medical College of Hunan Normal University, Changsha, China.
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Bärebring L, Bullarbo M, Glantz A, Hulthén L, Ellis J, Jagner Å, Schoenmakers I, Winkvist A, Augustin H. Trajectory of vitamin D status during pregnancy in relation to neonatal birth size and fetal survival: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:51. [PMID: 29439677 PMCID: PMC5812027 DOI: 10.1186/s12884-018-1683-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated the associations between vitamin D status in early and late pregnancy with neonatal small for gestational age (SGA), low birth weight (LBW) and preterm delivery. Furthermore, associations between vitamin D status and pregnancy loss were studied. METHODS Serum 25-hydroxyvitamin D (25OHD) was sampled in gestational week ≤ 16 (trimester 1 (T1), N = 2046) and > 31 (trimester 3 (T3), N = 1816) and analysed using liquid chromatography tandem mass spectrometry. Pregnant women were recruited at antenatal clinics in south-west Sweden at latitude 57-58°N. Gestational and neonatal data were retrieved from medical records. Multiple gestations and terminated pregnancies were excluded from the analyses. SGA was defined as weight and/or length at birth < 2 SD of the population mean and LBW as < 2500 g. Preterm delivery was defined as delivery < 37 + 0 gestational weeks and pregnancy loss as spontaneous abortion or intrauterine fetal death. Associations between neonatal outcomes and 25OHD at T1, T3 and change in 25OHD (T3-T1) were studied using logistic regression. RESULTS T1 25OHD was negatively associated with pregnancy loss and 1 nmol/L increase in 25OHD was associated with 1% lower odds of pregnancy loss (OR 0.99, p = 0.046). T3 25OHD ≥ 100 nmol/L (equal to 40 ng/ml) was associated with lower odds of SGA (OR 0.3, p = 0.031) and LBW (OR 0.2, p = 0.046), compared to vitamin D deficiency (25OHD < 30 nmol/L, or 12 ng/ml). Women with a ≥ 30 nmol/L increment in 25OHD from T1 to T3 had the lowest odds of SGA, LBW and preterm delivery. CONCLUSIONS Vitamin D deficiency in late pregnancy was associated with higher odds of SGA and LBW. Lower 25OHD in early pregnancy was only associated with pregnancy loss. Vitamin D status trajectory from early to late pregnancy was inversely associated with SGA, LBW and preterm delivery with the lowest odds among women with the highest increment in 25OHD. Thus, both higher vitamin D status in late pregnancy and gestational vitamin D status trajectory can be suspected to play a role in healthy pregnancy.
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Affiliation(s)
- Linnea Bärebring
- The Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 405 30, Gothenburg, Sweden.
| | - Maria Bullarbo
- Södra Älvsborg Hospital, Borås, Sweden.,The Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Glantz
- Department of Antenatal Care, Närhälsan, Primary Care, Gothenburg, Sweden
| | - Lena Hulthén
- The Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 405 30, Gothenburg, Sweden
| | - Joy Ellis
- Department of Antenatal Care, Närhälsan, Primary Care, Södra, Bohuslän, Sweden
| | - Åse Jagner
- Department of Antenatal Care, Närhälsan, Primary Care, Gothenburg, Sweden
| | - Inez Schoenmakers
- MRC Human Nutrition Research, Nutrition and Bone Health Group, Cambridge, UK.,The Department of Medicine, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Anna Winkvist
- The Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 405 30, Gothenburg, Sweden
| | - Hanna Augustin
- The Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 459, 405 30, Gothenburg, Sweden
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Sociodemographic factors associated with dietary supplement use in early pregnancy in a Swedish cohort. Br J Nutr 2017; 119:90-95. [PMID: 29198190 DOI: 10.1017/s0007114517003270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sociodemographic factors have been associated with dietary supplement use among pregnant women but few data exist in a Swedish population. This study aimed to identify factors associated with overall supplement use as well as use of folic acid, vitamin D and n-3 in early pregnancy. Women in the first trimester of pregnancy were included at registration to the antenatal care in 2013-2014 (n 2109). Information regarding supplement use as well as sociodemographic and anthropometric data were obtained from questionnaires and medical records. Multivariable logistic regression analysis was performed to determine the relationship between sociodemographic variables and supplement use. A total of 78 % of the participants reported using at least one dietary supplement in the first trimester. Folic acid supplement use was reported by 74 %, vitamin D supplement use by 43 % and n-3 supplement use by <5 %. Use of any type of supplement in early pregnancy was related to gestational age, parity, birthplace, education and employment. Folic acid supplement use was related to gestational age, parity, birthplace, income, education and employment. Vitamin D supplement use was related to gestational age, birthplace and education. In conclusion, in the first trimester of pregnancy, folic acid supplements were used by three in four women, while vitamin D supplements were used by less than half of the women. The results of this study show a socioeconomic disparity between supplement users and non-users which may have a negative impact on the health of future generations.
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Sauder KA, Koeppen HJ, Shapiro ALB, Kalata KE, Stamatoiu AV, Ringham BM, Glueck DH, Norris JM, Dabelea D. Prenatal Vitamin D Intake, Cord Blood 25-Hydroxyvitamin D, and Offspring Body Composition: The Healthy Start Study. Nutrients 2017; 9:E790. [PMID: 28737667 PMCID: PMC5537904 DOI: 10.3390/nu9070790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022] Open
Abstract
Vitamin D deficiency in pregnancy may be associated with increased offspring adiposity, but evidence from human studies is inconclusive. We examined associations between prenatal vitamin D intake, 25-hydroxyvitamin D (25(OH)D) in cord blood, and offspring size and body composition at birth and 5 months. Participants included 605 mother-offspring dyads from the Healthy Start study, an ongoing, pre-birth prospective cohort study in Denver, Colorado, USA. Prenatal vitamin D intake was assessed with diet recalls and questionnaires, and offspring body composition was measured via air displacement plethysmography at birth and 5 months. General linear univariate models were used for analysis, adjusting for maternal age, race/ethnicity, pre-pregnancy body mass index (BMI), offspring sex, and gestational age at birth. Non-Hispanic white race, lower pre-pregnancy BMI, higher prenatal vitamin D intake, and summer births were associated with higher cord blood 25(OH)D. Higher 25(OH)D was associated with lower birthweight (β = -6.22, p = 0.02), but as maternal BMI increased, this association became increasingly positive in direction and magnitude (β = 1.05, p = 0.04). Higher 25(OH)D was also associated with lower neonatal adiposity (β = -0.02, p < 0.05) but not after adjustment for maternal BMI (β = -0.01, p = 0.25). Cord blood 25(OH)D was not associated with offspring size or body composition at 5 months. Our data confirm the hypothesis that vitamin D exposure in early life is associated with neonatal body size and composition. Future research is needed to understand the implications of these associations as infants grow.
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Affiliation(s)
- Katherine A Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Hallie J Koeppen
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Allison L B Shapiro
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Kathryn E Kalata
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Alexandra V Stamatoiu
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Brandy M Ringham
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Deborah H Glueck
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
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