Is First Trimester Maternal 25-Hydroxyvitamin D Level Related to Adverse Maternal and Neonatal Pregnancy Outcomes? A Prospective Cohort Study among Malaysian Women
Abstract
:1. Introduction
2. Materials and Methods
2.1. Measurement of Maternal Serum 25(OH)D
2.2. Statistical Analysis
3. Results
3.1. Serum 25(OH)D Level and Vitamin D Status According to Subjects’ Characteristics
3.2. Serum 25(OH)D Level and Vitamin D Status According to Pregnancy and Neonatal Outcome.
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Vanchinathan, V.; Lim, H.W. A dermatologist’s perspective on Vitamin D. Mayo Clin. Proc. 2012, 87, 372–380. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Woon, F.C.; Chin, Y.S.; Ismail, I.H.; Batterham, M.; Abdul Latiff, A.H.; Gan, W.Y.; Appannah, G.; Mohammed Hussien, S.H.; Edi, M.; Tan, M.L.; et al. Vitamin D deficiency during pregnancy and its associated factors among third trimester malaysian pregnant women. PLoS ONE 2019, 14, e0216439. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Christakos, S.; Ajibade, D.V.; Dhawan, P.; Fechner, A.J.; Mady, L.J. Vitamin D: Metabolism. Endocrinol. Metab. Clin. N. Am. 2010, 39, 243–253. [Google Scholar] [CrossRef] [PubMed]
- Zerwekh, J.E. Blood biomarkers of Vitamin D status. Am. J. Clin. Nutr. 2008, 87, 1087S–1091S. [Google Scholar] [CrossRef] [Green Version]
- De-Regil, L.M.; Palacios, C.; Lombardo, L.K.; Peña-Rosas, J.P. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst. Rev. 2016, Cd008873. [Google Scholar] [CrossRef] [Green Version]
- Holick, M.F. The Vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev. Endocr. Metab. Disord. 2017, 18, 153–165. [Google Scholar] [CrossRef]
- Institute of medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D; Ross, A.C., Taylor, C.L., Yaktine, A.L., Del Valle, H.B., Eds.; National Academies Press: Washington, DC, USA, 2011.
- Hossein-nezhad, A.; Holick, M.F. Vitamin D for health: A global perspective. Mayo Clin. Proc. 2013, 88, 720–755. [Google Scholar] [CrossRef] [Green Version]
- Aji, A.S.; Erwinda, E.; Yusrawati, Y.; Malik, S.G.; Lipoeto, N.I. Vitamin D deficiency status and its related risk factors during early pregnancy: A cross-sectional study of pregnant minangkabau women, indonesia. BMC Pregnancy Childbirth 2019, 19, 183. [Google Scholar] [CrossRef]
- Lee, C.L.; Ng, B.K.; Wu, L.L.; Cheah, F.C.; Othman, H.; Ismail, N.A.M. Vitamin D deficiency in pregnancy at term: Risk factors and pregnancy outcomes. Horm. Mol. Biol. Clin. Investig. 2017, 31, 20170005. [Google Scholar] [CrossRef]
- Olmos-Ortiz, A.; Avila, E.; Durand-Carbajal, M.; Díaz, L. Regulation of calcitriol biosynthesis and activity: Focus on gestational Vitamin D deficiency and adverse pregnancy outcomes. Nutrients 2015, 7, 443–480. [Google Scholar] [CrossRef] [Green Version]
- Wei, S.Q. Vitamin D and pregnancy outcomes. Curr. Opin. Obstet. Gynecol. 2014, 26, 438–447. [Google Scholar] [CrossRef] [PubMed]
- Hollis, B.W.; Wagner, C.L. Vitamin D supplementation during pregnancy: Improvements in birth outcomes and complications through direct genomic alteration. Mol. Cell. Endocrinol. 2017, 453, 113–130. [Google Scholar] [CrossRef]
- Chan, S.Y.; Susarla, R.; Canovas, D.; Vasilopoulou, E.; Ohizua, O.; McCabe, C.J.; Hewison, M.; Kilby, M.D. Vitamin D promotes human extravillous trophoblast invasion in vitro. Placenta 2015, 36, 403–409. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ma, S.L.; Tian, X.Y.; Wang, Y.Q.; Zhang, H.F.; Zhang, L. Vitamin D supplementation prevents placental ischemia induced endothelial dysfunction by downregulating placental soluble fms-like tyrosine kinase-1. DNA Cell Biol. 2017, 36, 1134–1141. [Google Scholar] [CrossRef] [PubMed]
- Tamblyn, J.A.; Hewison, M.; Wagner, C.L.; Bulmer, J.N.; Kilby, M.D. Immunological role of Vitamin D at the maternal–fetal interface. J. Endocrinol. 2015, 224, R107. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Curtis, E.M.; Moon, R.J.; Harvey, N.C.; Cooper, C. Maternal Vitamin D supplementation during pregnancy. Br. Med. Bull. 2018, 126, 57–77. [Google Scholar] [CrossRef] [Green Version]
- Wagner, C.L.; Hollis, B.W. The implications of Vitamin D status during pregnancy on mother and her developing child. Front. Endocrinol. (Lausanne) 2018, 9, 500. [Google Scholar] [CrossRef] [Green Version]
- Ariffin, M.A.S.M.; Fazil, F.N.; Yassin, N.M.; Junaida, N.S.; Gan, P.V.; Rahman, R.A.; Chin, K.-Y.; Aziz, N.H.A. Prevalence of Vitamin D deficiency and its associated risk factors during early pregnancy in a tropical country: A pilot study. J. Clin. Diagn Res. 2018, 12, QC18–QC22. [Google Scholar] [CrossRef]
- Bukhary, N.B.I.; Isa, Z.M.; Shamsuddin, K.; Lin, K.G.; Mahdy, Z.A.; Hassan, H.; Yeop, N.S.H. Risk factors for antenatal hypovitaminosis d in an urban district in malaysia. BMC Pregnancy Childbirth 2016, 16, 156. [Google Scholar] [CrossRef] [Green Version]
- Pourhoseingholi, M.A.; Vahedi, M.; Rahimzadeh, M. Sample size calculation in medical studies. Gastroenterol. Hepatol. Bed Bench 2013, 6, 14–17. [Google Scholar]
- Kent, S.; Fusco, F.; Gray, A.; Jebb, S.A.; Cairns, B.J.; Mihaylova, B. Body mass index and healthcare costs: A systematic literature review of individual participant data studies. Obes. Rev. 2017, 18, 869–879. [Google Scholar] [CrossRef] [PubMed]
- Shibata, M.; Suzuki, A.; Sekiya, T.; Sekiguchi, S.; Asano, S.; Udagawa, Y.; Itoh, M. High prevalence of hypovitaminosis d in pregnant japanese women with threatened premature delivery. J. Bone Miner. Metab. 2011, 29, 615–620. [Google Scholar] [CrossRef] [PubMed]
- Bener, A.; Al-Hamaq, A.O.; Saleh, N.M. Association between Vitamin D insufficiency and adverse pregnancy outcome: Global comparisons. Int. J. Women’s Health 2013, 5, 523–531. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shafinaz, I.S.; Moy, F.M. Vitamin D level and its association with adiposity among multi-ethnic adults in kuala lumpur, malaysia: A cross sectional study. BMC Public Health 2016, 16, 232. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jamil, N.A.; Yew, M.H.; Noor Hafizah, Y.; Gray, S.R.; Poh, B.K.; Macdonald, H.M. Estimated Vitamin D synthesis and dietary Vitamin D intake among asians in two distinct geographical locations (kuala lumpur, 3 degrees n v. Aberdeen, 57 degrees n) and climates. Public Health Nutr. 2018, 21, 3118–3124. [Google Scholar] [CrossRef] [Green Version]
- Bodnar, L.M.; Simhan, H.N.; Catov, J.M.; Roberts, J.M.; Platt, R.W.; Diesel, J.C.; Klebanoff, M.A. Maternal Vitamin D status and the risk of mild and severe preeclampsia. Epidemiol. (Camb. Mass.) 2014, 25, 207–214. [Google Scholar] [CrossRef]
- Halhali, A.; Tovar, A.R.; Torres, N.; Bourges, H.; Garabedian, M.; Larrea, F. Preeclampsia is associated with low circulating levels of insulin-like growth factor i and 1,25-dihydroxyVitamin D in maternal and umbilical cord compartments. J. Clin. Endocrinol. Metab. 2000, 85, 1828–1833. [Google Scholar] [CrossRef] [Green Version]
- Aghajafari, F.; Nagulesapillai, T.; Ronksley, P.E.; Tough, S.C.; O’Beirne, M.; Rabi, D.M. Association between maternal serum 25-hydroxyVitamin D level and pregnancy and neonatal outcomes: Systematic review and meta-analysis of observational studies. BMJ 2013, 346, f1169. [Google Scholar] [CrossRef] [Green Version]
- Ainy, E.; Ghazi, A.A.; Azizi, F. Changes in calcium, 25(oh) Vitamin D3 and other biochemical factors during pregnancy. J. Endocrinol. Investig. 2006, 29, 303–307. [Google Scholar] [CrossRef]
- Choi, R.; Kim, S.; Yoo, H.; Cho, Y.Y.; Kim, S.W.; Chung, J.H.; Oh, S.-Y.; Lee, S.-Y. High prevalence of Vitamin D deficiency in pregnant korean women: The first trimester and the winter season as risk factors for Vitamin D deficiency. Nutrients 2015, 7, 3427–3448. [Google Scholar] [CrossRef]
- Mumtaz, M. Gestational diabetes mellitus. Malays. J. Med. Sci. 2000, 7, 4–9. [Google Scholar] [PubMed]
- Weissgerber, T.L.; Mudd, L.M. Preeclampsia and diabetes. Curr. Diab. Rep. 2015, 15, 9. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Arnold, D.L.; Enquobahrie, D.A.; Qiu, C.; Huang, J.; Grote, N.; VanderStoep, A.; Williams, M.A. Early pregnancy maternal Vitamin D concentrations and risk of gestational diabetes mellitus. Paediatr. Perinat. Epidemiol. 2015, 29, 200–210. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Eggemoen, Å.R.; Waage, C.W.; Sletner, L.; Gulseth, H.L.; Birkeland, K.I.; Jenum, A.K. Vitamin D, gestational diabetes, and measures of glucose metabolism in a population-based multiethnic cohort. J. Diabetes Res. 2018, 2018, 8939235. [Google Scholar] [CrossRef] [Green Version]
- De-Regil, L.M.; Palacios, C.; Ansary, A.; Kulier, R.; Peña-Rosas, J.P. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst. Rev. 2012, 2, Cd008873. [Google Scholar] [CrossRef] [Green Version]
- Bodnar, L.M.; Platt, R.W.; Simhan, H.N. Early-pregnancy Vitamin D deficiency and risk of preterm birth subtypes. Obstet. Gynecol. 2015, 125, 439–447. [Google Scholar] [CrossRef] [PubMed]
- Zhou, J.; Su, L.; Liu, M.; Liu, Y.; Cao, X.; Wang, Z.; Xiao, H. Associations between 25-hydroxyvitamin D levels and pregnancy outcomes: A prospective observational study in southern china. Eur. J. Clin. Nutr. 2014, 68, 925–930. [Google Scholar] [CrossRef] [Green Version]
- Pérez-López, F.R.; Pasupuleti, V.; Mezones-Holguin, E.; Benites-Zapata, V.A.; Thota, P.; Deshpande, A.; Hernandez, A.V. Effect of Vitamin D supplementation during pregnancy on maternal and neonatal outcomes: A systematic review and meta-analysis of randomized controlled trials. Fertil. Steril. 2015, 103, 1278–1288. [Google Scholar] [CrossRef]
- Von Websky, K.; Hasan, A.A.; 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. [Google Scholar] [CrossRef]
- Dutra, L.V.; Affonso-Kaufman, F.A.; Cafeo, F.R.; Kassai, M.S.; Barbosa, C.P.; Santos Figueiredo, F.W.; Suano-Souza, F.I.; Bianco, B. Association between Vitamin D plasma concentrations and vdr gene variants and the risk of premature birth. BMC Pregnancy Childbirth 2019, 20, 3. [Google Scholar] [CrossRef]
- Zhu, B.; Huang, K.; Yan, S.; Hao, J.; Zhu, P.; Chen, Y.; Ye, A.; Tao, F. Vdr variants rather than early pregnancy Vitamin D concentrations are associated with the risk of gestational diabetes: The ma’anshan birth cohort (mabc) study. J. Diabetes Res. 2019, 2019, 8313901. [Google Scholar] [CrossRef] [PubMed]
- Knabl, J.; Vattai, A.; Ye, Y.; Jueckstock, J.; Hutter, S.; Kainer, F.; Mahner, S.; Jeschke, U. Role of placental vdr expression and function in common late pregnancy disorders. Int. J. Mol. Sci. 2017, 18, 2340. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kaushal, M.; Magon, N. Vitamin D in pregnancy: A metabolic outlook. Indian J. Endocrinol. Metab. 2013, 17, 76–82. [Google Scholar] [CrossRef] [PubMed]
- Hollis, B.W.; Johnson, D.; Hulsey, T.C.; Ebeling, M.; Wagner, C.L. Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. J. Bone Miner. Res. 2011, 26, 2341–2357. [Google Scholar] [CrossRef] [Green Version]
- Ardawi, M.S.; Nasrat, H.A.; HS, B.A.A. Calcium-regulating hormones and parathyroid hormone-related peptide in normal human pregnancy and postpartum: A longitudinal study. Eur. J. Endocrinol. 1997, 137, 402–409. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Marwaha, R.K.; Tandon, N.; Chopra, S.; Agarwal, N.; Garg, M.K.; Sharma, B.; Kanwar, R.S.; Bhadra, K.; Singh, S.; Mani, K.; et al. Vitamin D status in pregnant indian women across trimesters and different seasons and its correlation with neonatal serum 25-hydroxyVitamin D levels. Br. J. Nutr. 2011, 106, 1383–1389. [Google Scholar] [CrossRef] [Green Version]
- Orvik, A.B.; Andersen, M.R.; Bratholm, P.S.; Hedengran, K.K.; Ritz, C.; Stender, S.; Szecsi, P.B. Variation in plasma 25-hydroxyvitamin D2 and D3 in normal pregnancy with gestational age, sampling season, and complications: A longitudinal cohort study. PLoS ONE 2020, 15, e0231657. [Google Scholar] [CrossRef]
- Cross, N.A.; Hillman, L.S.; Allen, S.H.; Krause, G.F.; Vieira, N.E. Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: A longitudinal study. Am. J. Clin. Nutr. 1995, 61, 514–523. [Google Scholar] [CrossRef]
- Dovnik, A.; Mujezinović, F. The association of Vitamin D levels with common pregnancy complications. Nutrients 2018, 10, 867. [Google Scholar] [CrossRef] [Green Version]
- Mulligan, M.L.; Felton, S.K.; Riek, A.E.; Bernal-Mizrachi, C. Implications of Vitamin D deficiency in pregnancy and lactation. Am. J. Obs. Gynecol. 2010, 202, e421–e429. [Google Scholar] [CrossRef] [Green Version]
- Ganguly, A.; Tamblyn, J.A.; Finn-Sell, S.; Chan, S.Y.; Westwood, M.; Gupta, J.; Kilby, M.D.; Gross, S.R.; Hewison, M. Vitamin D, the placenta and early pregnancy: Effects on trophoblast function. J. Endocrinol. 2018, 236, R93–R103. [Google Scholar] [CrossRef] [PubMed]
- Malaysian Meteorological Department. Iklim Malaysia. Available online: http://www.met.gov.my/pendidikan/iklim/iklimmalaysia?lang=en (accessed on 19 April 2020).
Characteristics | n (%) |
---|---|
Ethnicity | |
Malay | 52 (87) |
Chinese | 4 (7) |
Indian | 3 (5) |
Aborigines | 1 (2) |
Parity | |
Nulliparous | 13 (22) |
Multiparous | 47 (78) |
Previous miscarriage | |
No | 34 (57) |
Yes | 26 (43) |
Working status | |
Yes | 51 (85) |
No | 9 (15) |
Pre-pregnancy body mass index status | |
Underweight (<18 kg/m2) | 1 (2) |
Normal (18–24.9 kg/m2) | 25 (42) |
Overweight (25–29.9 kg/m2) | 17 (28) |
Obese (>30 kg/m2) | 17 (28) |
Vitamin D status | |
Deficiency (<30 nmol/L) | 6 (10) |
Insufficiency (30–50 nmol/L) | 34 (57) |
Sufficiency (>50 nmol/L) | 20 (33) |
Characteristics | Mean ± SD (range) |
Age (years) | 34 ± 4 (25–42) |
Pre-pregnancy body mass index (kg/m2) | 26.6 ± 4.9 (17.5–37.3) |
Serum 25-hydroxyvitamin D (nmol/L) | 34.5 ± 14.1 (13.9–76.7) |
Characteristic | 25-hydroxyvitamin D (nmol/L) | p | Vitamin D Status | p | |
---|---|---|---|---|---|
Mean ± SD | Sufficient | Insufficient | |||
Ethnicity | 0.049 | 0.55 | |||
Malay and aborigines (n = 53) | 35.4 ± 13.7 * | 5 | 48 | ||
Chinese (n = 4) | 53.0 ± 15.9 * | 1 | 3 | ||
Indian (n = 3) | 33.2 ± 5.7 | 0 | 3 | ||
Parity | 0.55 | 0.75 | |||
nulliparous (n = 13) | 34.4 ± 9.8 | 1 | 12 | ||
multiparous (n = 47) | 37.1 ± 15.2 | 5 | 42 | ||
Previous miscarriage | 0.52 | 0.73 | |||
No (n = 34) | 35.4 ± 13.7 | 3 | 31 | ||
Yes (n = 26) | 37.8 ± 14.8 | 3 | 23 | ||
Pre-pregnancybody mass index | 0.24 | 0.11 | |||
<25 kg/m2 (n = 26) | 34.5 ± 12.8 | 1 | 25 | ||
25–29.9 kg/m2 (n = 17) | 34.6 ± 14.3 | 1 | 16 | ||
>30 kg/m2 (n = 17) | 41.4 ± 15.5 | 4 | 13 | ||
Working status | 0.22 | 1.00 | |||
No (n = 9) | 41.8 ± 12.0 | 1 | 8 | ||
Yes (n = 51) | 35.5 ± 14.4 | 5 | 46 | ||
Existing comorbidities | 0.24 | 0.35 | |||
No (n = 42) | 35.1 ± 13.3 | 3 | 39 | ||
Yes (n = 18) | 39.7 ± 15.9 | 3 | 15 |
Characteristic | 25-hydroxyvitamin D (nmol/L) | p | Vitamin D Status | p | |
---|---|---|---|---|---|
Mean ± SD | Sufficient | Insufficient | |||
Antenatal complications | 0.37 | 0.98 | |||
No (n = 41) | 36.7 ± 14.8 | 5 | 27 | ||
Gestational diabetes mellitus (n = 13) | 39.1 ± 13.4 | 1 | 9 | ||
Others (n = 6) | 29.3 ± 10.0 | 0 | 4 | ||
Vaginal infection | 0.96 | 0.68 | |||
No (n = 50) | 36.8 ± 14.1 | 4 | 45 | ||
Yes (n = 5) | 37.2 ± 18.2 | 1 | 4 | ||
Gestation at birth | 0.23 | 0.31 | |||
Term (≥37 weeks) (n = 43) | 34.5 ± 14.5 | 3 | 40 | ||
Preterm (24–36+6 weeks) (n = 13) | 42.1 ± 13.5 | 2 | 11 | ||
Miscarriage (<24 weeks) (n = 4) | 39.3 ± 8.8 | 1 | 3 | ||
Mode of delivery | 0.43 | 1.00 | |||
Vaginal or instrumental (n = 34) | 35.0 ± 15.2 | 3 | 31 | ||
Caesarean (n = 22) | 38.2 ± 13.4 | 2 | 20 | ||
Type of labor | 0.11 | 0.406 | |||
Spontaneous (n = 51) | 37.3 ± 14.7 | 5 | 46 | ||
Induced (n = 5) | 26.4 ± 6.2 | 1 | 3 | ||
Neonatal intensive care unit (NICU) admission | 0.09 | 0.50 | |||
No (n = 49) | 35.0 ± 14.7 | 4 | 45 | ||
Yes (n = 7) | 44.9 ± 9.5 | 1 | 6 | ||
Neonatal complications | 0.28 | 0.38 | |||
No (n = 51) | 35.6 ± 14.6 | 4 | 47 | ||
Yes (n = 5) | 43.0 ± 12.7 | 1 | 4 | ||
Apgar score at the 5th minutes | 0.31 | 0.17 | |||
<7 (n = 2) | 46.7 ± 23.6 | 4 | 50 | ||
≥7 (n = 54) | 35.9 ± 14.3 | 1 | 1 | ||
Small for gestational age | 0.80 | 1.00 | |||
No (n = 53) | 36.4 ± 14.7 | 5 | 48 | ||
Yes (n = 3) | 34.1 ± 11.5 | 0 | 3 |
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Abd Aziz, N.H.; Yazid, N.A.; Abd Rahman, R.; Abd Rashid, N.; Wong, S.K.; Mohamad, N.V.; Lim, P.S.; Chin, K.-Y. Is First Trimester Maternal 25-Hydroxyvitamin D Level Related to Adverse Maternal and Neonatal Pregnancy Outcomes? A Prospective Cohort Study among Malaysian Women. Int. J. Environ. Res. Public Health 2020, 17, 3291. https://doi.org/10.3390/ijerph17093291
Abd Aziz NH, Yazid NA, Abd Rahman R, Abd Rashid N, Wong SK, Mohamad NV, Lim PS, Chin K-Y. Is First Trimester Maternal 25-Hydroxyvitamin D Level Related to Adverse Maternal and Neonatal Pregnancy Outcomes? A Prospective Cohort Study among Malaysian Women. International Journal of Environmental Research and Public Health. 2020; 17(9):3291. https://doi.org/10.3390/ijerph17093291
Chicago/Turabian StyleAbd Aziz, Nor Haslinda, Noor Azyani Yazid, Rahana Abd Rahman, Norhashima Abd Rashid, Sok Kuan Wong, Nur Vaizura Mohamad, Pei Shan Lim, and Kok-Yong Chin. 2020. "Is First Trimester Maternal 25-Hydroxyvitamin D Level Related to Adverse Maternal and Neonatal Pregnancy Outcomes? A Prospective Cohort Study among Malaysian Women" International Journal of Environmental Research and Public Health 17, no. 9: 3291. https://doi.org/10.3390/ijerph17093291