Vitamin D deficiency in Turkish mothers and their neonates and in women of reproductive age

Association between 25-OH Vitamin D Deficiency and COVID-19 Severity in Pregnant Women

Evidence from studies in the general population suggests an association between vitamin D insufficiency/deficiency and COVID-19 susceptibility and disease severity. The present study was performed on 165 third-trimester pregnant women at the time of delivery. Seventy-nine women tested negative for SARS-CoV-2. From 86 women testing positive, 32 were asymptomatic, 44 presented a mild form of the disease, and 10 experienced severe symptoms. Serum 25-OH vitamin D levels were measured on blood samples collected on admission. Low vitamin D levels were detected in symptomatic but not asymptomatic COVID-19 patients compared to healthy women (p = 0.0227). In addition, 20 (45.4%) pregnant women in the mild COVID-19 group and 6 (60%) in the severe group were vitamin D deficient (p = 0.030). On the other hand, lasso regression analysis showed that 25-OH vitamin D deficiency is an independent predictor of severe COVID-19 with an odds ratio (OR) of 5.81 (95% CI: 1.108-30.541; p = 0.037). These results show the relationship between vitamin D deficiency in pregnant women and the severity of COVID-19 infection and support the recommendation to supplement with vitamin D to avoid worse COVID-19 outcomes during pregnancy.

Questioning the adequacy of standardized vitamin D supplementation protocol in very low birth weight infants: a prospective cohort study

OBJECTIVES

Preterm infants are at increased risk for vitamin D deficiency (VDD). We aimed to assess the adequacy of standardized vitamin D supplementation protocol in very low birth weight (VLBW) infants. Additionally, vitamin D status of mother/infant couples and the associations between vitamin D status at birth and morbidities of the infants were investigated.

METHODS

In this single-center, prospective cohort study blood samples were collected from 55 mothers just before delivery and from their infants at birth and on the 30th day of life (DOL) for 25 hydroxy vitamin D (25OHD) measurements. Vitamin D was initiated in dose of 160 IU/kg by parenteral nutrition on the first DOL and oral vitamin D supplementation (400 IU/day) was administered when enteral feedings reached 50% of total intake or on the 15th DOL.

RESULTS

The median 25OHD levels of the infants were 16.12 (9.14-20.50) in cord blood and 36.32 (31.10-44.44) in venous blood on the 30th DOL (p<0.01). In 98% of the VLBW infants 25OHD reached sufficient levels on the 30th DOL. None of the mothers had sufficient vitamin D levels (25OHD >30 ng/mL). Maternal 25OHD levels were correlated with the 25OHD levels of the infants in cord blood (r=0.665, p<0.001). There was a significant difference in mean cord 25OHD levels between winter (13.65 ± 5.69 ng/mL) and summer seasons (19.58 ± 11.67 ng/mL) (p=0.021). No association was found between neonatal morbidity and vitamin D status.

CONCLUSIONS

The results clearly show that by utilizing the current supplementation protocol, the majority of VLBW infants with deficient/insufficient serum 25OHD levels reached sufficient levels on the 30th DOL. Furthermore, vitamin D levels in mother/infant couples were found to be highly correlated.

Vitamin D Deficiency Prevalence in Late Neonatal Hypocalcemia: A Multicenter Study

OBJECTIVE

Late neonatal hypocalcemia (LNH) is a common metabolic problem associated with hypoparathyroidism, high phosphate intake and vitamin D deficiency, often presenting with seizures. In this cross-sectional study, we aimed to evaluate the role of vitamin D deficiency in LNH in Turkey and to describe the characteristics of affected newborns.

METHODS

Conducted with a cross-sectional design and with the participation of 61 neonatal centers from December 2015 to December 2016, the study included term neonates with LNH (n=96) and their mothers (n=93). Data were registered on the FAVOR Web Registry System. Serum samples of newborns and mothers were analyzed for calcium, phosphate, magnesium, albumin, alkaline phosphatase, intact parathyroid hormone (iPTH) and 25 hydroxyvitamin D [25(OH)D] levels.

RESULTS

The median (range) onset time of hypocalcemia was 5.0 (4.0-8.0) days of age, with a male preponderance (60.4%). The median (range) serum 25(OH)D levels of the neonates and their mothers were 6.3 (4.1-9.05) and 5.2 (4.7-8.8) ng/mL, respectively. The prevalence of vitamin D deficiency (<12 ng/mL) was high in both the neonates (86.5%) and mothers (93%). Serum 25(OH)D levels of the infants and mothers showed a strong correlation (p<0.001). While the majority (93.7%) of the neonates had normal/high phosphorus levels, iPTH levels were low or inappropriately normal in 54.2% of the patients.

CONCLUSION

Vitamin D deficiency prevalence was found to be high in LNH. Efforts to provide vitamin D supplementation during pregnancy should be encouraged. Evaluation of vitamin D status should be included in the workup of LNH.

Impact of vitamin D on the course of COVID-19 during pregnancy: A case control study

OBJECTIVE

We aimed to evaluate the vitamin D status of pregnant women with COVID-19, and the association between vitamin D level and severity of COVID-19.

METHODS

In this case control study, 159 women with a single pregnancy and tested positive for SARS-CoV-2, and randomly selected 332 healthy pregnant women with similar gestational ages were included. COVID-19 patients were classified as mild, moderate, and severe. Vitamin D deficiency was defined as 25-hydroxycholecalciferol <20 ng/mL (50 nmol/L), and 25-OH D vitamin <10 ng/mL was defined as severe vitamin D deficiency, also 25-OH D vitamin level between 20-29 ng/mL (525-725 nmol/L) was defined as vitamin D insufficiency.

RESULTS

Vitamin D levels of the pregnant women in the COVID-19 group (12.46) were lower than the control group (18.76). 25-OH D vitamin levels of those in the mild COVID-19 category (13.69) were significantly higher than those in the moderate/severe category (9.06). In terms of taking vitamin D supplementation, there was no statistically significant difference between the groups. However, it was observed that all of those who had severe COVID-19 were the patients who did not take vitamin D supplementation.

CONCLUSION

The vitamin D levels are low in pregnant women with COVID-19. Also, there is a significant difference regarding to vitamin D level and COVID-19 severity in pregnant women. Maintenance of adequate vitamin D level can be useful as an approach for the prevention of an aggressive course of the inflammation induced by this novel coronavirus in pregnant women.

Vitamin D levels and C-reactive protein/albumin ratio in pregnant women with cerebral venous sinus thrombosis

Changes in coagulation system during pregnancy have been put forth as risk factors for cerebral venous sinus thrombosis (CVT), yet we still have limited knowledge on markers for predicting the risk of CVT in pregnant women. Therefore, we aimed to investigate the significance of vitamin D (VD) levels and C-reactive protein (CRP)/albumin ratio (CAR), an inflammation marker, as risk factors for CVT in pregnant women. 23 pregnant women who were followed up for CVT, 26 healthy pregnant women who had no pregnancy complications, and 31 non-pregnant fertile women were included in the study. CAR and VD levels were compared between groups. CAR was significantly higher in the pregnant CVT group compared to the other two groups (p < 0.001). CAR was also significantly higher in the healthy pregnant group than the non-pregnant fertile group (p < 0.001). VD levels were determined to be statistically significantly lower in the pregnant CVT group compared to the other two groups (p < 0.001). However, VD levels did not significantly differ between healthy pregnant group and non-pregnant fertile group (p > 0.05). We found no significant correlation between CAR and VD levels in any of the three groups. Pregnant women with CVT were found to have a high rate of severe VD deficiency. Low VD levels and high CAR levels in pregnant women may be associated with an increased risk of CVT.

Perinatal outcomes of high-dose vitamin D administration in the last trimester

In recent years, interest in the evaluation of vitamin D levels and the possible outcomes of their deficiency during pregnancy has increased. However, there is no consensus on when to start vitamin D supplementation, its duration, dosage, and the optimum level during pregnancy. The toxicity of vitamin D is as important as its deficiency. From the history of a 5-day-old male baby who was investigated for hypercalcemia, it was learned that the mother took 300,000 IU vitamin D-five ampoules/oral at 30 weeks of gestation every other day. The infant was born prematurely, postpartum bradycardia required positive pressure ventilation, and his hypercalcemia lasted approximately 4 months despite treatment. Maternal excessive and inappropriate use of vitamin D can cause preterm labor and severe hypercalcemia, which is a life-threatening complication in the neonatal period. This case is presented to draw attention to the negative effects of maternal high-dose vitamin D during pregnancy.

Investigation of Vitamin D Deficiency in Pre-School Children During Summer Season

Aim: Vitamin D deficiency is an important public health problem, especially affecting children. The aim of our study is to evaluate the serum 25 (OH) vitamin D levels of children during the summer and to determine some features such as exposure to the sun, oral vitamin D supplementation, and to examine the parameters that affect serum vitamin D levels. Methods: In our study, children aged between 12 and 83 months were included. A questionnaire was answered by families. In this cross-sectional study, serum 25 (OH) vitamin D levels of children and biochemical parameters were examined. Results: The mean serum 25 (OH) vitamin D level was 27.0±12.4 ng/ml. Vitamin D deficiency was found 17%, and vitamin D insufficiency was 6%. The children that taking daycare indoors and body mass index <5th percentile had lower serum 25 (OH) vitamin D levels. Children between the ages of 12- 36 months and children with chronic diseases were found to have a shorter time to benefit from sunlight. Conclusion: The rate of vitamin D deficiency and insufficiency (<20 ng/ml) in children were found at 23% in summer season. Families and caregivers should be informed about vitamin D and should be aware of safe sun exposure. Keywords: Vitamin D, sunlight, summer, children, vitamin D deficiency

Vitamin D status and CYP27B1-1260 promoter polymorphism in Tunisian patients with systemic lupus erythematosus

Aim

An association between serum vitamin D (Vit D) levels and systemic lupus erythematosus (SLE) has been reported by several studies that suggested the involvement of genetically determined characteristics of enzymes of vitamin D metabolism. Our study aimed to evaluate the relationship between 25 hydroxyvitamin D (25[OH]D) level, the most representative metabolite of VitD status, and polymorphism of the cytochrome P450, CYP27B1 gene, which influence vitamin D metabolism, and serum levels, in SLE Tunisian patients.

Material and Methods

A cross‐sectional study has been conducted in SLE patients (supplemented and not supplemented patients), matched to healthy controls by age and gender. The 25[OH]D serum level was measured by chemiluminescence assay and CYP27B1‐1260 genetic polymorphism was carried out using PCR‐RFLP methods. Statistical analysis was made using Shesis and SPSS.20 Software.

Results

Controls and Vit D not supplemented patients’ groups presented the highest percentage of hypovitaminosis D. A significant difference in the mean level of circulating 25[OH]D between Vit D supplemented SLE patients and controls was observed (23.91 ng/ml and 7.18 ng/ml, respectively p = 3.4 10⁵). Our results showed a correlation of high 25[OH]D level with complement component 3 levels and prednisolone drug. Moreover, the analysis of CYP27B1‐1260 polymorphism in SLE patients and controls revealed a nonsignificant allelic or genotypic association.

Conclusion

Despite the sunny climate, the high prevalence of Vit D deficiency is common in Tunisia. This hypovitaminosis D feature may affect the Vit D levels in our SLE patients but a direct association with the disease or with the genetically determined features remains unclear. More studies are needed to establish thresholds and susceptibility genes according to the characteristics of each population.

Vitamin D deficiency in adolescent pregnancy and obstetric outcomes

OBJECTIVE

The aim of this study was to evaluate the rates of vitamin D deficiency in adolescent pregnants and its influence on the obstetric outcomes.

MATERIALS AND METHODS

A total of 300 singleton pregnant women aged between 14 and 20 years, were divided into three groups according to their gestational weeks (100 pregnant adolescents from each trimester). Randomly selected 300 singleton pregnant women older than 20 years of age with the similar gestational ages were designed as the control group at the same time period. We divided serum 25(OH)D levels into three categories deficiency, inadequacy and adequate levels according to the Endocrine Society guidelines. Serum 25(OH)D levels were also evaluated according to age, seasons and gestational periods. Adverse obstetric outcomes were recorded.

RESULTS

Overall, 86% of the subjects were found to have deficient 25(OH)D levels (<20 ng/ml). The levels indicated an inadequate state in 72 subjects (12%) and only 12 (2%) women had adequate 25 (OH) D levels. Among adult pregnant women the rates of deficient, inadequate and adequate levels were 88.3%, 11%, and 0.7% respectively. Among adolescent pregnant women these rates were 83.7%, 13%, and 3.3% respectively. The lowest 25(OH)D levels occurred during the winter while the highest levels were detected during the summer in both groups. Calcidiol, 25(OH)D, was a significant predictor for preterm delivery (AUC = 0,909; p < 0,001) and also for SGA (AUC = 0,915; p < 0,001). Maternal age was another significant predictor for SGA (AUC = 0,787; p < 0,001) and preterm delivery (AUC = 0,785; p < 0,001).

CONCLUSION

We found a high incidence of 25(OH)D deficiency in Turkish pregnant women. Adolescent age and low 25(OH)D levels are significant risk factors for PTD and SGA. Effective prophylaxis programs for vitamin D deficieny and/or fortification of foods with vitamin D are essential in pregnant women especially in the winter season.

Associations between vitamin D status in pregnancy and offspring neurodevelopment: a systematic literature review

CONTEXT

Vitamin D plays an important role in the development of the brain, which is one of the earliest fetal organs to develop. Results from epidemiological studies investigating associations between maternal levels of vitamin D during pregnancy and offspring neurodevelopment are mixed and inconclusive.

OBJECTIVE

This systematic review of studies that examined vitamin D levels in pregnancy and offspring neurodevelopment used 3 specific domains-timing of exposure during pregnancy trimesters, neurodevelopmental outcomes, and offspring age at assessment of outcomes-to determine whether vitamin D status in pregnancy is associated with offspring neurodevelopment.

DATA SOURCES

A search of the Embase, PsychInfo, Scopus, and The Cochrane Library databases in September 2017 and February 2018 identified 844 articles, of which 46 were retrieved for full-text assessment.

STUDY SELECTION

Eligibility criteria were used to select studies. All authors examined the studies, and consensus was reached through discussion. Results were divided according to the 3 domains.

DATA EXTRACTION

Authors examined the studies independently, and data from eligible studies were extracted using a modified version of the Cochrane data collection form. Using the modified Downs and Black checklist, 2 authors assessed the quality of the studies independently and were blinded to each other's assessment. Consensus was reached upon discussion and with the involvement of the third author.

RESULTS

Fifteen observational studies were included. Vitamin D in pregnancy was associated with offspring language and motor skills in young children. Associations persisted into adolescence, and results were not dependent on the timing of vitamin D exposure during pregnancy. No supplementation studies were identified.

CONCLUSIONS

There is some evidence that low vitamin D status in pregnancy is associated with offspring language and motor development, particularly in young children.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42017078312.

The prevalence of hypovitaminosis D and its risk factors in pregnant women and their newborns in the Middle East: A systematic review

BACKGROUND

Pregnant women and newborns are at risk for vitamin D deficiency (VDD). Also, poor health outcomes for pregnant women with VDD are reported in the published literature.

OBJECTIVE

The aim of this systematic review was to estimate the prevalence of hypovitaminosis D and the associated risk factors for hypovitaminosis D in Middle Eastern pregnant women and their newborns.

RESULTS

The prevalence of circulating 25-hydroxyvitamin D (25(OH)D) < 50 nmol/L as a marker of vitamin D status in pregnant women and their newborns was between 24.5-98% and 22-100%, respectively. The prevalence of 25(OH) D < 25 nmol/L in pregnant women and their newborns was over a wide range between 16.7-80% and 22-82%, respectively. Predictors for low maternal and neonatal 25(OH)D concentrations included decreased vitamin D synthesis due to reduced exposure to sunlight and decreased nutritional intake of vitamin D. A predictor of low neonatal 25(OH)D concentrations included maternal vitamin D status and the correlation between vitamin D concentrations in maternal and cord blood.

CONCLUSION

The high prevalence of VDD in the pregnant women of the Middle East underscores the necessity of implementing national prevention and intervention strategies. A clear policy for clinicians and healthcare workers is needed for screening and maintaining sufficient vitamin D status during pregnancy.

High prevalence of vitamin D deficiency in Turkish women undergoing in vitro fertilization: A descriptive study

The authors' aim in this study was to determine the vitamin D levels of Turkish women who were undergoing in vitro fertilization (IVF). The study design was a descriptive cohort study of a total of 208 infertile women at an IVF center in Turkey. Our findings showed that 4.3% of the women had a replete vitamin D level, 23.6% of the women had insufficient vitamin D levels, and 72.1% of women had deficient vitamin D levels. Our findings suggest that much more effective vitamin D support programs should be implemented for women who are seeking to become pregnant.

The association between 25-hydroxy vitamin D deficiency and diabetic complications in patients with type 2 diabetes mellitus

AIMS

To evaluation the relationship between serum 25-hydroxy vitamin D [25-(OH)D] deficiency and diabetic complications in patients with type 2 diabetes (T2DM).

METHODS

One hundred and sixty three patients with T2DM [DM + uncomplicated (n = 36), DM + nephropathy (n = 31), DM + neuropathy (n = 30), DM + retinopathy (n = 30), DM + cardiovascular disease (CAD) (n = 36)], 35 CAD and 40 healthy volunteers were included.

RESULTS

Serum 25-(OH)D levels were found as significantly lower in all patients compared to the control group (p < 0.05). 25-(OH)D in patients with DM + retinopathy (p < 0.006), DM + nephropathy (p < 0.001) and DM + neuropathy (p < 0.001) was significantly lower than that of the control group. 25-(OH)D in patients with DM + nephropathy (p < 0.001), DM + neuropathy (p < 0.01) and DM + retinopathy (p < 0.001) was significantly lower than in the DM + uncomplicated group. 25-(OH)D levels were found as significantly lower in DM + CAD compared to the CAD group (p < 0.01). Serum 25-(OH)D and HbA1c and parathyroid hormone (PTH) were found to be negatively correlated with each other in DM + all complications.

CONCLUSIONS

Low serum 25-OHD levels were found to be associated with the development of diabetes and complications. Low serum 25-OHD levels may be a consequence of even worse metabolic control of diabetes.

Severe 25-OH vitamin D deficiency as a reason for adverse pregnancy outcomes

Objective: There is a growing concern about the unfavorable effects of vitamin D deficiency in general population, including pregnant women, worldwide. The aim of this study is to evaluate the effect of severe maternal serum 25-OH vitamin D levels on adverse pregnancy outcomes in first trimester.Material and methods: Serum samples of 86 pregnant women in first trimester were collected prospectively from May 2017 to June 2017. Serum 25-OH vitamin D levels were analyzed by enzyme immunoassay method. Patients were classified according to maternal serum 25-OH vitamin D levels as group 1 (n = 34) <10 ng/ml and group 2 (n = 52) >10 ng/ml. The two groups were compared in terms of adverse pregnancy outcomes.Results: The mean 25-OH vitamin D levels of the total 86 pregnant women were 13.83 (6-48) ng/ml. 40% of the pregnant women had low level of 25-OH vitamin D levels (<10 ng/ml). The adverse pregnancy outcomes were significantly increased in group 1 (p<.018).Conclusions: Maternal serum 25-OH vitamin D levels <10 ng/ml is a risk factor for adverse pregnancy outcomes. 25-OH vitamin D levels should be screened in high-risk pregnant women and treated in case of deficiency.

Use of Vitamin D in Children and Adults: Frequently Asked Questions

In recent years, the increase in interest and use of vitamin D has been attributed mainly to the extra-skeletal effects of vitamin D and confusion about normal reference values for serum 25-hydroxy vitamin D (25-OHD). However, The Institute of Medicine, which determines daily intake of nutrients, vitamins and minerals in the United States, emphasizes that there is no additional benefit of having a 25-OHD level above 20 ng/mL in terms of parathyroid hormone suppression, calcium absorption and “fall risk”. Taking into consideration that there has not been a significant increase in vitamin D deficiency and related conditions in Turkey over the past five years, it is not hard to suppose that this increased interest is due to doctors, using mass media platforms, who have made claims that vitamin D is a “panacea”. This paper aims to answer some frequently asked questions such as the threshold values recommended for the evaluation of vitamin D status, the clinical indications for measuring 25-OHD and suggestions on the use of lifelong vitamin D starting from pregnancy.

Serum vitamin D concentrations in young Turkish women with primary dysmenorrhea: A randomized controlled study

OBJECTIVE

This study aims to investigate the possible role of vitamin D deficiency in primary dysmenorrhea by assessing serum 25-hydroxyvitamin D₃ levels in a cohort which includes young Turkish women with primary dysmenorrhea and healthy controls.

MATERIALS AND METHODS

A total of 683 women who were aged between 18 and 25 years and who were consecutively admitted to the study center were eligible. After the exclusion of 55 women, 184 women with primary dysmenorrhea were randomly assigned into the dysmenorrhea group and 184 women without dysmenorrhea were randomly allocated into the control group.

RESULTS

The dysmenorrhea group had significantly less consumption of dairy products (p = 0.001), lower serum calcium (p = 0.001), lower serum vitamin D (p = 0.001) and higher serum parathyroid hormone (p = 0.001) than those of the control group. Hyperparathyroidism was significantly less frequent whereas vitamin D deficiency was significantly more frequent in the dysmenorrhea group (p = 0.001 for each). The dysmenorrhea patients with vitamin D deficiency had significantly higher visual analogue scale (VAS) scores (p = 0.001). Depression, irritability, mood swings, fatigue, headache and breast tenderness were significantly more frequent in the vitamin D deficiency group (p < 0.05 for all). The VAS scores of the dysmenorrhea patients correlated positively and significantly with serum parathyroid hormone levels (r = 0.666, p = 0.001) whereas these VAS scores correlated negatively and significantly with serum vitamin D levels (r = -0.713, p = 0.001).

DISCUSSION

The significant and positive correlation between vitamin D levels and VAS scores and the significant reduction in serum vitamin D levels of the dysmenorrhea patients designate the possible role of vitamin D deficiency in the primary dysmenorrhea.

Vitamin D Deficiency in Pregnant Women and Their Infants

OBJECTIVE

Vitamin D deficiency is a serious health problem despite a general improvement in socio-economic status in Turkey. The aim of this study was to evaluate maternal vitamin D status and its effect on neonatal vitamin D concentrations after a support programme for pregnant women was introduced. A second aim was to identify risk factors for vitamin D deficiency in a district of İstanbul.

METHODS

A total of 97 pregnant women and 90 infants were included in this study, conducted between January and October 2016. The demographic data, risk factors and daily vitamin intake were recorded. Serum levels of vitamin D, calcium, phosphorus and alkaline phosphatase in all subjects were measured. The mothers and newborns were divided into groups based on their vitamin D levels. The relationship between vitamin D levels and risk factors was analyzed.

RESULTS

Mean ± standard deviation vitamin D levels for the women and their infants were found to be 14.82±11.45 and 13.16±7.16 ng/mL, respectively. The number of mothers and infants was significantly higher in the deficient group, and their mean vitamin D levels significantly lower (9.02±1.34 and 8.80±1.06 ng/mL, respectively) (p<0.001, p<0.001). Only 14.4% of pregnant women took 1000-1200 IU/day of vitamin D. When the mother groups were evaluated in terms of risk factors, there were significant differences in daily vitamin intake and clothing style (p<0.001 and p<0.001 respectively).

CONCLUSION

Vitamin D deficiency in pregnant women and their infants is still a serious health problem in Turkey, although a vitamin D support programme during pregnancy has been launched by the department of health.

How should we give vitamin D supplementation? evaluation of the pediatricians' knowledge in Turkey

Background

We aimed to determine the knowledge and attitudes of Turkish pediatricians concerning vitamin D supplement.

Methods

The study was planned cross-sectional to be carried out between April–May 2015 in Turkey. A questionnaire form that determined the participants’ opinions and practices concerning vitamin D supplement was completed via face-to-face interview.

Results

A total of 107 pediatricians (49.3%) and 110 pediatric residents (50.7%) participated in the study. Of the physicians, 85.2% recommended vitamin D supplement for all infants and children regardless of diet, 13.4% recommended for the infants which are solely breastfed. Vitamin D supplement is recommended at a dose of 400 IU/day by 88.8% of pediatricians and by 90% of pediatric residents. Of the pediatricians and pediatric residents, 72% and 68.2%, respectively commence vitamin D supplement when the newborn is 15 days old. The rates of recommending vitamin D supplement until the age of one and two years were higher among pediatricians (48.6% and 41.1%, respectively) than pediatric residents (40.9% and 32.7%, respectively). The rate of starting vitamin D supplement for fontanelle closure was significantly higher among pediatric residents (15.5%) than pediatricians (3.7%) (p = 0.002). It was determined that the rate of prescribing vitamin D supplement until fontanelle closure was higher among pediatric residents (18.2%) than pediatricians (0.9%).

Conclusions

The present study suggest that the knowledge of pediatricians about recommendation of vitamin D needs to be enhanced by education programs in addition to free vitamin D supplement provided by the Ministry of Health.

The effects of vitamin D supplementation during pregnancy and maternal vitamin D levels on neonatal vitamin D levels and birth parameters

OBJECTIVE

The current study aimed to measure the levels of vitamin 25(OH)D in pregnant women and in the umbilical cord blood of newborns and to evaluate the association of vitamin D levels with birth parameters.

METHODS

This cross-sectional analytic investigation was performed in 100 pregnant women at term and in 100 newborns born to these mothers. Plasma vitamin D level was measured and birth parameters of the babies were recorded.

RESULTS

Mean vitamin D levels in pregnant women and cord blood were 11.39 ± 6.24 ng/ml and 8.00 ± 4.95 ng/ml, respectively. Vitamin D levels were found to be higher in the women who had received vitamin D support during pregnancy (p < .001). Height (p = .004), head circumference (p = .003), and chest circumference (p = .005) of newborns born to mothers who had received vitamin D support were higher compared to non-receivers. Maternal vitamin D deficiency (<10 ng/ml) and insufficiency (10-30 ng/ml) was detected in 53.0% and 47.0% of the cases, respectively. None of the women had sufficient levels of vitamin D.

CONCLUSIONS

This study established that vitamin D levels were low in maternal and cord blood in spite of the administration program of Ministry of Health in pregnant women. The importance of vitamin D supplementation should be explained to the pregnant women in each visit.

Prevalence of Vitamin D Deficiency and Its Associations with Skin Color in Pregnant Women in the First Trimester in a Sample from Switzerland

Vitamin D deficiency in pregnancy has negative clinical consequences, such as associations with glucose intolerance, and has been shown to be distributed differently in certain ethnic groups. In some countries, a difference in the rate of vitamin D deficiency was detected in pregnant women depending on their skin color. We examined the prevalence of vitamin D deficiency (<20 ng/mL) in women in early pregnancy in Switzerland and evaluated the association of skin color with vitamin D deficiency. In a single-center cohort study, the validated Fitzpatrick scale and objective melanin index were used to determine skin color. Of the 204 pregnant women included, 63% were vitamin D deficient. The mean serum 25-hydroxyvitamin D concentration was 26.1 ng/mL (95% confidence interval (CI) 24.8-27.4) in vitamin D-sufficient women and 10.5 ng/mL (95% CI 9.7-11.5) in women with deficiency. In the most parsimonious model, women with dark skin color were statistically significantly more often vitamin D deficient compared to women with light skin color (OR 2.60; 95% CI 1.08-6.22; adjusted for age, season, vitamin D supplement use, body mass index, smoking, parity). This calls for more intense counseling as one policy option to improve vitamin D status during pregnancy, i.e., use of vitamin D supplements during pregnancy, in particular for women with darker skin color.

Relationship between newborn craniotabes and vitamin D status

OBJECTIVE

In recent studies, vitamin D deficiency during pregnancy and early infancy has been reported to predispose children to many chronic diseases, except those of the skeletal system. The aim of this study was to investigate whether craniotabes in otherwise healthy newborns is physiological, its relationship to vitamin D deficiency and whether or not it requires treatment.

METHODS

A total of 150 healthy newborns with a weight of over 2000 g were included. Newborns were divided into two groups during postnatal discharge (1-3.'s day): those with and without craniotabes. The 25-hydroxy (OH) vitamin D levels of the newborns' mothers were measured, and all infants were re-evaluated for craniotabes, as well as tested to determine levels of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (PTH) and 25(OH) vitamin D, urine calcium and creatinine.

RESULTS

Craniotabes was present in 45 (30%) of newborns enrolled in the study. Craniotabes of the newborns born during the winter months was significantly higher. PTH level was significantly higher in 1-month-old newborns with craniotabes than those without craniotabes. No relationship was observed between diet and craniotabes, but in exclusively breastfed infants, vitamin D level was statistically significantly lower. No statistically significant difference was found in the occurrence of craniotabes in newborns with or without vitamin D support.

CONCLUSION

The relationship between newborn craniotabes and maternal vitamin D deficiency is not clear. However, the present study illustrates that maternal vitamin D deficiency is still a major problem. Therefore, measures to prevent maternal vitamin D deficiency should be strengthened.

Effects of Vitamin D on Endometriosis-Related Pain: A Double-Blind Clinical Trial

Background

Endometriosis is a disabling disease of reproductive-age women. Dysmenorrhea, dyspareunia, and pelvic pain are the main symptoms of endometriosis. Its etiology is not clear. Endometriosis may have various causes, including vitamin D deficiency, but its effect is controversial.

Material/Methods

In this double-blind clinical trial, we enrolled patients with endometriosis diagnosed and treated by laparoscopy, with scores of at least 3 for of dysmenorrhea and/or pelvic pain at 8 weeks after surgical treatment. They were randomly prescribed vitamin D (50 000 IU weekly for 12 weeks) or placebo. Severity of pain in the 2 groups (placebo and treatment) was compared by VAS test at 24 weeks after surgical treatment.

Results

There were 19 patients in the vitamin D group and 20 in the placebo group. Baseline characteristics in the 2 groups were similar. Following the treatment with vitamin D or placebo, we did not find significant differences in severity of pelvic pain (p=0.24) and dysmenorrhea (p=0.45) between the 2 groups. Mean pelvic pain at 24 weeks after laparoscopy in the vitamin D group was 0.84±1.74 and in placebo group it was 0.68±1.70 (p=0.513). Mean dysmenorrhea was 2.10±2.33 in the vitamin D group and 2.73±2.84 in the placebo group (p=0.45).

Conclusions

After ablative surgery for endometriosis, vitamin D treatment did not have a significant effect in reducing dysmenorrhea and/or pelvic pain.

Effect of vitamin D replacement on maternal and neonatal outcomes: a randomised controlled trial in pregnant women with hypovitaminosis D. A protocol

INTRODUCTION

The vitamin D recommended doses during pregnancy differ between societies. The WHO guidelines do not recommend routine prenatal supplementation, but they underscore the fact that women with the lowest levels may benefit most. The effects of routine supplementation during pregnancy on maternal and neonatal clinical outcomes have not been investigated in the Middle East, where hypovitaminosis D is prevalent. Our hypothesis is that in Middle Eastern pregnant women, a vitamin D dose of 3000 IU/day is required to reach a desirable maternal 25-hydroxyvitamin D [25(OH)D] level, and to positively impact infant bone mineral content (BMC).

METHODS AND ANALYSIS

This is a multicentre blinded randomised controlled trial. Pregnant women presenting to the Obstetrics and Gynaecology clinics will be approached. Eligible women will be randomised to daily equivalent doses of cholecalciferol, 600 IU or 3000 IU, from 15 to 18 weeks gestation until delivery. Maternal 25(OH)D and chemistries will be assessed at study entry, during the third trimester and at delivery. Neonatal anthropometric variables and 25(OH)D level will be measured at birth, and bone and fat mass assessment by dual-energy X-ray absorptiometry scan at 1 month. A sample size of 280 pregnant women is needed to demonstrate a statistically significant difference in the proportion of women reaching a 25(OH)D level ≥ 50 nmol/L at delivery, and a difference in infant BMC of 6 (10)g, for a 90% power and a 2.5% level of significance. The proportions of women achieving a target 25(OH)D level will be compared between the two arms, using χ(2). An independent t test will be used to compare mean infant BMC between the two arms. The primary analysis is an intention-to-treat analysis of unadjusted results.

ETHICS AND DISSEMINATION

The protocol has been approved by the Institutional Review Board at the American University of Beirut-Lebanon (IM.GEHF.22). The trial results will be published in peer-reviewed medical journals and presented at scientific conferences.

TRIAL REGISTRATION NUMBER

NCT02434380.

Factors Influencing Serum Vitamin D Concentration in Turkish Children Residing in İzmir: A Single-Center Experience

OBJECTIVE

The aim of this study was to examine the vitamin D status of children and to determine the factors influencing serum 25-hydroxyvitamin D [25(OH)D] concentration in Turkish infants living in İzmir.

METHODS

In this study, we examined the serum 25(OH)D levels of 100 infants aged 1 to 24 months and of 22 mothers from İzmir, Turkey. The study also included a questionnaire given to the mothers to acquire data on the demographic characteristics of the infants and their mothers as well as information on vitamin D supplementation, clothing habits, and sunlight exposure.

RESULTS

Vitamin D deficiency was present in 31% of infants and 81.8% of mothers. Twenty-four male (42.9%) and 7 female (15.9%) infants were found to be vitamin D deficient (<20 mg/dL); 9 male (16.1%) and 17 female (38.6%) infants to be vitamin D insufficient (20-30 mg/dL); and 23 male (41.1%) and 20 female (45.5%) infants were vitamin D sufficient (>30 mg/dL). Only 63% of the infants were receiving vitamin D supplementation and 52% were said to be having regular exposure to sunlight. Mean serum vitamin D levels were lower in infants whose mothers were dressed according to the culture of traditional covered clothing (44%) compared to those infants whose mothers' dressing style provided more exposure to sunlight.

CONCLUSION

We conclude that low exposure to sunlight, inadequate use of vitamin D supplementation, and large family size are factors influencing the vitamin D status of Turkish children living in the inner city of İzmir.

Low serum 25(OH)D levels are assocıated to hıgher BMI and metabolic syndrome parameters in adult subjects in Turkey

BACKGROUND

The aim of this study was to investigate the association of 25(OH)D levels with biochemical, anthropometric, and metabolic data obtained from normal and obese people.

METHODS

This study was carried out on 90 individuals between the ages of 18 to 63 that had various body mass indexes. Blood samples and anthropometric measurements were taken.

RESULTS

Waist circumferences, fat mass, LDL cholesterol levels, HDL cholesterol levels, 25(OH)D levels, and triglyceride levels were significantly different according to the body mass index groups of the participants (p<0.05). When compared to the normal body mass index group, both other groups (overweight and obese) had higher waist circumferences, triglyceride levels, LDL cholesterol levels, fasting insulin levels, HOMA-IR ratios, parathyroid hormone levels, and fat mass, and had lower 25(OH)D levels (p<0.05). The overweight group participants had higher 25(OH)D levels than the obese group, and had lower waist circumferences, fat mass, fasting insulin level, HOMA-IR ratios, and HbA1C and PTH levels than those in the obese group (p<0.05).

CONCLUSION

In conclusion, the mean level of 25(OH)D is very low in overweight and obese individuals and low serum 25(OH)D levels appear to be associated with obesity, visceral obesity, hypertriglyceridemia, insulin resistance, and metabolic syndrome in obese patients.

Vitamin D deficiency and placental calcification in low-risk obstetric population: are they related?

OBJECTIVE

We aimed to evaluate the relationship between placental calcification and maternal and cord blood 25-hydroxyvitamin-D3 [25(OH)D] and calcium concentrations in low-risk obstetric population at term and their consequences.

METHODS

Sixty non-complicated pregnant women at term admitted to maternity clinic were included in this prospective case-control study and classified into one of two groups according to grade of placental calcification by defined the Grannum classification: Group 1 (n=30), with Grade 3 placenta and Group 2 (n=30), the control group, no placental calcification noted. Baseline characteristics, maternal serum and umbilical cord 25(OH)D and calcium levels were compared between groups.

RESULTS

The mean age of subjects was 26.4 ± 5.7 years. The mean serum 25(OH)D concentration of women (n=60) was 9.3 ± 3.4 (range 5.59-15.48) ng/mL. The prevalence of vitamin D deficiency [25(OH)D <20 ng/mL] was 100%. Maternal serum and cord blood calcium levels were significantly higher in Group 1 (p=0.036; p=0.037, respectively). In Group 2, maternal serum and cord blood 25(OH)D levels were higher than Group 1 (11.35 ± 6.54 and 10.22 ± 3.59 versus 9.6 ± 4.2 and 9.07 ± 2.43 ng/mL); but the difference is not statistically significant.

CONCLUSIONS

Higher maternal calcium and lower 25(OH)D levels detected in patients with Grade 3 placental calcification indicated the importance of placenta on vitamin D regulation.

Global summary of maternal and newborn vitamin D status - a systematic review

Pregnant women and newborns are at increased risk of vitamin D deficiency. Our objective was to create a global summary of maternal and newborn vitamin D status. We completed a systematic review (1959-2014) and meta-analysis of studies reporting serum 25-hydroxyvitamin D [25(OH)D] concentration in maternal and newborn populations. The 95 identified studies were unevenly distributed by World Health Organization (WHO) region: Americas (24), European (33), Eastern Mediterranean (13), South-East Asian (7), Western Pacific (16) and African (2). Average maternal 25(OH)D concentrations (nmol L(-1) ) by region were 47-65 (Americas), 15-72 (European), 13-60 (Eastern Mediterranean), 20-52 (South-East Asian), 42-72 (Western Pacific) and 92 (African). Average newborn 25(OH)D concentrations (nmol L(-1) ) were 35-77 (Americas), 20-50 (European), 5-50 (Eastern Mediterranean), 20-22 (South-East Asian), 32-67 (Western Pacific) and 27-35 (African). The prevalences of 25(OH)D <50 and <25 nmol L(-1) by WHO region in pregnant women were: Americas (64%, 9%), European (57%, 23%), Eastern Mediterranean (46%, 79%), South-East Asian (87%, not available) and Western Pacific (83%, 13%). Among newborns these values were: Americas (30%, 14%), European (73%, 39%), Eastern Mediterranean (60%, not available), South-East Asian (96%, 45%) and Western Pacific (54%, 14%). By global region, average 25(OH)D concentration varies threefold in pregnant women and newborns, and prevalence of 25(OH)D <25 nmol L(-1) varies eightfold in pregnant women and threefold in newborns. Maternal and newborn 25(OH)D concentrations are highly correlated. Addressing vitamin D deficiency in pregnant women and newborns should be a global priority. To protect children from the adverse effects of vitamin D deficiency requires appropriate interventions during both pregnancy and childhood.

Comparison of cord blood vitamin D levels in newborns of vitamin D supplemented and unsupplemented pregnant women: a prospective, comparative study

OBJECTIVE

To screen pregnant women for deficiency of 25-hydroxyvitamin D (25(OH)D) and supplement selected vitamin D deficient pregnant women with vitamin D and to compare 25(OH)D levels in cord blood between them.

METHOD

Sixty pregnant women were selected as cases (vitamin D levels <30 ng/ml) and 60 unscreened pregnant women were taken as controls. Cases were supplemented with available 60,000 IU vitamin D every two weeks for eight doses or till delivery, whichever was earlier. In both the cases and controls, cord blood was collected at the time of delivery and tested for 25(OH)D levels using Biomerieux miniVIDAS.

RESULT

Maximum (66.7%) pregnant women who received vitamin D supplementation had cord blood vitamin D level >30 ng/ml, while only 3.3% unsupplemented pregnant women had cord blood vitamin D level >30 ng/ml. The median cord blood vitamin D level was 36.5 ng/ml in vitamin D supplemented and 11.35 ng/ml in unsupplemented women. The mean birth weight and mean crown heel length were 3.1 ± 0.485 kg versus 2.8 ± 0.705 kg and 49.35 ± 1.36 cm versus 48.67 ± 2.12 cm, respectively.

CONCLUSION

Vitamin D supplemented women had sufficient levels of 25(OH)D in cord blood at birth in maximum cases and neonates had higher birth weights and increased crown heel length.

Association of antepartum vitamin D levels with postpartum pelvic floor muscle strength and symptoms

INTRODUCTION AND HYPOTHESIS

Vitamin D affects skeletal muscle strength and functions via various mechanisms. Strength and/or functional dysfunctions of the pelvic floor muscles may be associated with the distortion of pelvic floor functions. We hypothesized that vitamin D deficiency may contribute to pelvic floor dysfunction (PFD) by affecting pelvic floor muscle strength (PFMS). The aim of this study was to assess the effect of vitamin D deficiency during pregnancy on postpartum PFMS.

METHODS

This cross-sectional study was conducted in a university hospital. One hundred and eighty pregnant women were admitted to our hospital in their third trimester and compared with 156 healthy nulliparous women. Venous blood samples for examining vitamin D levels were taken from each participant and stored at -80 °C. At 8-10 weeks postpartum, patients were invited to the hospital, asked about their PFD symptoms, and PFMS was measured using a perineometer.

RESULTS

There was no statistical significance among groups regarding mean age, maternal age, and weight at delivery. Postpartum PFMS and duration in vitamin D-deficient women were significantly lower than those without the deficiency. Vitamin D-deficient vaginal delivery cases (group I) had a postpartum PFMS average of 21.96 ± 7.91 cm-H₂O, nonvitamin D-deficient normal delivery cases (group III) had a PFMS of 29.66 ± 10.3 cm-H₂O (p = 0.001). In the cesarean delivery groups, vitamin D-deficient (group II) and nonvitamin D-deficient (group IV) cases had PFMS values of 32.23 ± 9.66 and 35.53 ± 15.58 cm-H₂O respectively (p = 0.258).

CONCLUSIONS

Lower vitamin D levels in the third trimester correlates with decreased PFMS.

Evaluation of vitamin D supplementation doses during pregnancy in a population at high risk for deficiency

AIM/BACKGROUND

Vitamin D supplementation during pregnancy is a well-accepted recommendation worldwide; however, the debate about the correct dose is ongoing. We aimed to compare daily doses of 600, 1,200, and 2,000 IU in this randomized, controlled study.

METHODS

The study group consisted of 91 pregnant women aged 16-42 years admitted to Kocaeli Maternity and Children Hospital between April 2011 and April 2012. The participants were randomly divided into 3 groups. 600, 1,200, and 2,000 IU/day of vitamin D was supplemented to group 1 (control group, n = 31), group 2 (n = 31), and group 3 (n = 32), respectively. Serum calcium, 25-hydroxyvitamin D (25OHD), and the calcium/creatinine ratio in spot urine samples were measured in the follow-up period. The serum calcium and 25OHD levels of the mothers' infants were measured as well.

RESULTS

The frequency of vitamin D sufficiency after supplementation was 80% in group 3 and it was significantly higher than in groups 1 (42%) and 2 (39%) (p = 0.03). The frequency of vitamin D sufficiency in the infants of the participants was 91% in group 3 and it was significantly higher than in groups 1 (36%) and 2 (52%) (p = 0.006).

CONCLUSIONS

At least 2,000 IU/day of vitamin D is needed to ensure adequate vitamin D status in pregnancy and early infancy.

Markers of subclinical atherosclerosis in premenopausal women with vitamin D deficiency and effect of vitamin D replacement

BACKGROUND

Recent studies have revealed a relationship between vitamin D deficiency and atherosclerosis. This study aims to investigate the impact of vitamin D deficiency and replacement on markers of subclinical atherosclerosis in young premenopausal women in whom vitamin D deficiency is prevalent.

METHODS

Thirty-one premenopausal vitamin D deficient women and 27 age and gender-matched control subjects were enrolled in this study. Markers of subclinical atherosclerosis including carotid intima-media thickness (cIMT), flow-mediated dilatation (FMD), endothelial progenitor cell (EPC) count and cytokine levels were determined at baseline. All measurements were repeated at 6-month follow-up in vitamin D-deficient subjects after vitamin D replacement.

RESULTS

Vitamin D deficient premenopausal women had lower FMD (9.9 ± 1.3 vs. 13.8 ± 1.7%, p < 0.001) and EPC counts at baseline. This population also had lower IL-10 and higher IL-17 levels. A 6-month vitamin D replacement therapy resulted in a significant increase in FMD (9.9 ± 1.3 vs. 11.4 ± 1.4%, p < 0.001) and EPC counts. Furthermore, cytokine profile shifted toward a more anti-inflammatory phenotype including elevated IL-10 and decreased IL-17 levels. cIMT was not different between patient and control groups and did not change following vitamin D replacement. Change in 25(OH)D and IL-17 levels were independent predictors of the change in FMD measurements following vitamin D replacement.

CONCLUSION

This study demonstrates that endothelial function is impaired in otherwise healthy vitamin D deficient young premenopausal women and improves with 6-month replacement therapy. Immune-modulatory effects of vitamin D may, at least partly, be responsible for its beneficial effects on vascular health.

High prevalence of vitamin D deficiency among pregnant women in a Turkish population and impact on perinatal outcomes

OBJECTIVE

Maternal vitamin D deficiency is a major public health problem. The aim of this study is to investigate the influence of vitamin D deficiency on perinatal results in primigravida.

METHODS

One-hundred fifty-two healthy nullipar women were included in the study. Pregnant women with serum vitamin D levels <15ng/ml were defined as Group I and ≥15 ng/dl were defined as Group II; data were evaluated retrospectively. Type of delivery, gestational age at birth, birth weight, intensive care of the newborn, peri-and postpartum complications were recorded. Statistical analyses were performed with SPSS for Windows (version 16.0 ). Categorical variables were assessed using chi-squared test. The numeric variables were analyzed using Student's t-test and one-way ANOVA.

RESULTS

44.6% of pregnant women were found to have vitamin D deficiency. The mean serum vitamin D levels for Groups I and II were 10.8 ± 3.8 and 23.8 ± 13.3 ng/ml, respectively. SGA deliveries were detected in 16.66% and 4.87% of the primigravidas with and without vitamin D deficiency, respectively.

CONCLUSIONS

This study has shown that maternal vitamin D deficiency is related with an increased risk of SGA delivery. Further studies are needed to explain the relationship with vitamin D deficiency and poor perinatal outcomes.

The effect of place of residence and lifestyle on vitamin D deficiency in pregnancy: Comparison of eastern and western parts of Turkey

OBJECTIVE

The aim of this study was to determine the prevalence and the predictive factors of vitamin D deficiency in pregnancy and the compliance with "The National Vitamin D Support Program" at Turkey's easternmost and westernmost provinces.

MATERIAL AND METHODS

Lifestyles of women at 24-28 weeks of pregnancy were assessed using a questionnaire form, and serum 25-hydroxyvitamin D3 (25(OH)D3) levels were measured.

RESULTS

Vitamin D deficiency (≤20 ng/mL) in pregnant women had a prevalence of 27.8% in İzmir and 76.3% in Erzurum. The compliance of "The National Vitamin D Support Program" was 8% in İzmir and 32.6% in Erzurum. Clothing style, fish consumption, seaside holiday duration, and 1200 IU/day vitamin D replacement had an effect on 25(OH)D3 levels in pregnant subjects in İzmir, whereas only holiday duration and 1200 IU/day vitamin D replacement affected 25(OH)D3 levels in Erzurum. However, when a threshold for 25(OH)D3 level was considered ≥32 ng/mL, lifestyles did not affect 25(OH)D3 level.

CONCLUSION

The effect of lifestyle on 25(OH)D3 level in pregnancy is limited, especially in cold regions. We recommended increasing the compliance with "The National Vitamin D Support Program" at the follow-up of all pregnant women, irrespective of region and season.

Metabolic bone disease of prematurity: report of four cases

Osteopenia of prematurity has become a common problem recently because of improved survival rates of infants with very low birth weight (VLBW). The incidence of neonatal osteopenia is inversely correlated with gestational age and birth weight. Herein, we present four cases of preterm osteopenia that were referred to the pediatric endocrinology outpatient clinic with diverse clinical and laboratory findings and we discuss the clinical course of these infants with regard to bone disease after discharge from the neonatal intensive care unit (NICU). This report highlights the importance of enteral calcium, phosphorus and vitamin D support at adequate doses following discharge from NICU for preterm infants with VLBW who are at risk of metabolic bone disease.

Severe vitamin D deficiency among pregnant women and their newborns in Turkey

OBJECTIVES

Vitamin D deficiency is an important health problem in pregnant women and their infants in sunny countries. Low socio-economic status (LSES), covered dressing style, pregnancies in winter season and having dark skin are the major risk factors for vitamin D deficiency. The present study evaluated serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations in pregnant women and in their newborns and determined the risk factors in LSES cities in Turkey.

METHODS

Ninety-seven pregnant women and their newborns were included in the study between December 2012 and February 2013. All of the pregnant women had irregular follow-up or had received no antenatal care, were pregnant during summer, had presented to the hospital after 37 weeks of gestation (WG) and had received no vitamin D supplementation. A detailed history was obtained, which included mothers' age, number of births and dressing sytle. Maternal and cord blood samples were taken to measure 25(OH)D3 levels.

RESULTS

All of the pregnant women were predominantly LSES, had covered dressing style and none of them had received vit D3 supplementation during pregnancy. The mean serum 25(OH)D3 level and mean cord blood level of of 97 mothers were 4.97 ± 3.27 ng/ml and 4.29 ± 2.44 ng/ml, respectively. There was a strong positive correlation between maternal serum and umbilical cord 25(OH)D3 levels (r: 0.735, p < 0.05). Ninety-five mothers had serum 25(OH)D3 below 20 ng/ml and all cord blood serum 25(OH)D3 levels were below 20 ng/ml. Level of 25(OH)D3 was not correlated with mother age, WG or newborn weight. Serum 25(OH)D3 concentrations in primigravida and multigravida were 3.71 ± 1.88 and 5.2 ± 3.4 ng/ml, respectively, with a significant difference between them (p < 0.05).

CONCLUSION

Severe vitamin D deficiency is common in reproductive women and their newborns in LSES cities of Turkey. Covered dressing style, not receiving any vitamin D supplementation and primigravida women are at greatest risk. Vitamin D supplementation campaigns which should cover pregnant women and the newborn to prevent maternal and perinatal vitamin D deficiency should be implemented especially in risk areas.

The impact of Vitamin D Replacement on Glucose Metabolism

OBJECTIVE

We investigated the impact of vitamin D supplementation on glucose metabolism in Vitamin D-deficient patients with prediabetes.

METHODS

A total of 66 subjects with the mean ages 52.2±9.9 years were included in this prospective and a 6-month follow-up study between 2008-2010. Vitamin D deficient patients (<25ng/ml) were supplemented with oral Vitamin D.

RESULTS

Vitamin D deficiency (<25ng/ml) was found in 93.9% of the patients. Post replacement Vitamin D levels increased significantly and insulin, HbA1c, and HOMA-IR decreased significantly following Vitamin D replacement. Conclusion : We found Vitamin D deficiency was very common in our study population. In Vitamin D deficient patients, supplementation treatment improved insulin resistance and glycemic parameters. Vitamin D replacement may be a promising intervention for the primary prevention of insulin resistance syndromes.

The association between severity of vitamin D deficiency and Hashimoto's thyroiditis

OBJECTIVE

The relation between vitamin D and autoimmune disorders has long been investigated regarding the important roles of this hormone in immune regulation. We evaluated 25-hydroxyvitamin D (25OHD) status in subjects with Hashimoto's thyroiditis (HT) and healthy controls.

METHODS

Group-1 included 180 euthyroid patients (123 females/57 males) with HT who were on a stable dose of L-thyroxine (LT). A total of 180 sex-, age-, and body mass index (BMI)-matched euthyroid subjects with newly diagnosed HT were considered as Group-2, and 180 healthy volunteers were enrolled as controls (Group-3). All 540 subjects underwent thyroid ultrasound and were evaluated for serum 25OHD, anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-TG) levels.

RESULTS

Group-1 had the lowest 25OHD levels (11.4 ± 5.2 ng/mL) compared to newly diagnosed HT subjects (Group-2) (13.1 ± 5.9 ng/mL, P = .002) and to control subjects (15.4 ± 6.8 ng/mL, P<.001). Serum 25OHD levels directly correlated with thyroid volume (r = 0.145, P<.001) and inversely correlated with anti-TPO (r = -0.361, P<.001) and anti-TG levels (r = -0.335, P<.001). We determined that 48.3% of Group-1, 35% of Group-2, and 20.5% of controls had severe 25OHD deficiency (<10 ng/mL). Female chronic HT patients had the lowest serum 25OHD levels (10.3 ± 4.58 ng/mL), and male control subjects had the highest (19.3 ± 5.9 ng/mL, P<.001).

CONCLUSIONS

We demonstrated that serum 25OHD levels of HT patients were significantly lower than controls, and 25OHD deficiency severity correlated with duration of HT, thyroid volume, and antibody levels. These findings may suggest a potential role of 25OHD in development of HT and/or its progression to hypothyroidism.

Comparison between daily supplementation doses of 200 versus 400 IU of vitamin D in infants

The daily supplementation of vitamin D is mandatory for infants. However, there are still conflicting opinions about the exact daily dose. Thus, we aimed to evaluate a daily supplementation dose of 200 IU is sufficient and compared the supplementation doses of 200 and 400 IU per day. One hundred and sixty-nine infants were randomly assigned to two groups (group 1, 200 IU/day; group 2, 400 IU/day) and there were 75 infants in group 1 and 64 were in group 2 with a total number of 139. The median levels of 25-hydroxyvitamin D3 were significantly increased in group 2 at the age of 4 months (group 1, 39.60 mcg/L; group 2, 56.55 mcg/L; p < 0.0001). We clearly demonstrated that at the age of 4 months, none of the infants on the group 2 had a serum level of 25-hydroxyvitamin D3 less than 30 mcg/L. However, 21.3% of the infants in group 1 had a level below 30 mcg/L. Thus, in order to avoid vitamin D deficiency and rickets, we recommend supplementation dose of vitamin D at 400 IU/day as a safe and effective dose.

Determinants of hypovitaminosis d in pregnant women and their newborns in a sunny region

Introduction. This study aims to assess the factors associated with 25-hydroxy vitamin D (25(OH)D) levels in pregnant women and their newborns in a sunny region. Materials and Methods. This cross-sectional study was conducted in 2012 in Isfahan, Iran. It comprised 100 nulliparous singleton pregnant women, selected by random cluster sampling. Laboratory tests were assessed before delivery in mothers and after delivery in their infants' umbilical cord blood. The P for trend of variables was assessed across the air quality index (AQI) quartiles. The associations of AQI and 25(OH)D were assessed by multiple linear regression after adjustment for age, body mass index, and dietary intake. Results. Sera of 98 mothers and an equal number of newborns were analyzed. The median (interquartile range, IQR) of serum 25(OH)D of mothers and neonates was 15.1(12.6, 18.2) ng/mL in mothers and 15.7(12.0, 18.1) ng/mL in neonates, respectively. AQI had an inverse association with serum 25(OH)D (Beta = -0.58, P = 0.04). The corresponding figure was also inverse and significant for newborns (Beta (SE)= -0.51(0.04), P = 0.01). Conclusion. The independent inverse association of 25(OH)D with air quality can explain the high prevalence of hypovitaminosis D in pregnant women living in this sunny region.

Relation of obesity with serum 25 hydroxy vitamin D3 levels in type 2 diabetic patients

BACKGROUND

Hypovitaminosis D is associated with diabetes mellitus (DM). Aim of our study was to determine the relation of obesity with vitamin D levels in type 2 diabetic patients.

MATERIALS AND METHODS

We examined 101 type 2 diabetic patients and made a correlation analysis in all parameters. Then we classified our diabetics according to their body-mass indices and compared their 25 hdroxy vitamin D3 levels.

RESULTS

We found negative correlation between 25O HD and body mass index (BMI) (P: <0.001, r: -0.23). When we classified our diabetics according to their body mass indices as normal, overweight and obese, and compared their 25 hydroxy vitamin D3 levels, we determined that in every BMI group 25 hydroxy vitamin D levels were not found to be significantly different.

CONCLUSION

These results suggest that at least in a Turkish population with type 2 DM vitamin D levels are low and correlate with BMI, but when vitamin D levels are so low, as obesity worsens vitamin D levels does not lessen.

Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey

OBJECTIVE

To investigate the frequency of vitamin D deficiency in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters in adult out-patients.

DESIGN

Descriptive, retrospective study concerning evaluation of the initial 25-hydroxyvitamin D (25(OH)D) levels determined at admission in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters. 25(OH)D levels ,20 ng/ml were classified as deficiency, 20–30 ng/ml as insufficiency and .30 ng/ml as sufficiency.

SETTING

Out-patient clinics at a tertiary care centre.

SUBJECTS

A total of 2488 adult patients (mean age: 53?3 (SD 15?2) years; 85?2% were females) admitted to out-patient clinics at Baskent University Istanbul Hospital were included.

RESULTS

Mean level of 25(OH)D in the overall population was 17?4 (SD 11?5) ng/ml while insufficiency and deficiency were evident in 24% and 66% of patients, respectively. Mean 25(OH)D levels in males .45 years old were higher than in their female counterparts (19?4 (SD 11?3) ng/ml v. 17?8 (SD 12?2) ng/ml; P,0?05). Mean 25(OH)D levels obtained in summer (18?6 (SD 11?1) ng/ml) and autumn (23?3 (SD 13?6) ng/ml) were significantly higher than levels in spring (16?1 (SD 10?3) ng/ml) and winter (14?6 (SD 10?2) ng/ml; P,0?01). Mean 25(OH)D levels were determined to be significantly lower in obese patients compared with non-obese patients (15?6 (SD 10?4) ng/ml v. 17?6 (SD 11?6) ng/ml; P,0?05). Levels of 25(OH)D were significantly negatively correlated with serum parathyroid hormone levels (r520?194; P,0?001) while significantly positively correlated with phosphorus (r50?059; P,0?01) and HDL cholesterol (r50?070; P,0?01) levels.

CONCLUSIONS

Our findings indicate that vitamin D deficiency is very common among out-patients in Turkey, regardless of gender and age, especially among obese people and during winter and spring.

Nutritional rickets

Nutritional rickets (NR) is still the most common form of growing bone disease despite the efforts of health care providers to reduce the incidence of the disease. Today, it is well known that the etiology of NR ranges from isolated vitamin D deficiency (VDD) to isolated calcium deficiency. In Turkey, almost all NR cases result from VDD. Recent evidence suggests that in addition to its short- or long-term effects on skeletal development, VDD during infancy may predispose the patient to diseases such as diabetes mellitus, cancer and multiple sclerosis. Among the factors responsible for the high prevalence of VDD in developing countries and its resurgence in developed countries is limited sunshine exposure due to individuals' spending more time indoors (watching television and working on computer) or avoiding sun exposure intentionally for fear of skin cancer. Traditional clothing (covering the entire body except the face and hands) further limits the exposure time to sunlight and, thus, decreases the endogenous synthesis of vitamin D. In Turkey, maternal VDD and exclusive breastfeeding without supplementation were reported to be the most prominent reasons leading to NR. The diagnosis of NR is established by a thorough history and physical examination and confirmed by laboratory evaluation. Recent reports draw attention to the supplemental doses of vitamin D required to achieve a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/l) - the serum concentration that is needed to optimize absorption of dietary calcium and to suppress excessive secretion of parathyroid hormone. This type of prevention will also reduce fracture risk as well as prevent long-term negative effect of vitamin D insufficiency.