Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Laboratory Analysis
2.3. Statistical Analysis
3. Results
3.1. Participant Characteristics
3.2. Vitamin D Deficiency
3.3. Change in Vitamin D Status during Pregnancy
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
- Bergström, I.; Blanck, A.; Sävendahl, L. Vitamin D Levels in Children Born to Vitamin D-Deficient Mothers. Horm. Res. Paediatr. 2013, 80, 6–10. [Google Scholar] [CrossRef] [PubMed]
- Harvey, N.C.; Moon, R.J.; Sayer, A.A.; Ntani, G.; Davies, J.H.; Javaid, M.K.; Robinson, S.M.; Godfrey, K.M.; Inskip, H.M.; Cooper, C. Maternal antenatal vitamin D status and offspring muscle development: Findings from the Southampton women’s survey. J. Clin. Endocrinol. Metab. 2014, 99, 330–337. [Google Scholar] [CrossRef] [PubMed]
- Wei, S.Q.; Audibert, F.; Hidiroglou, N.; Sarafin, K.; Julien, P.; Wu, Y.; Lou, Z.C.; Fraser, W.D. Longitudinal vitamin D status in pregnancy and the risk of pre-eclampsia. BJOG 2012, 119, 832–839. [Google Scholar] [CrossRef] [PubMed]
- 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]
- Schneuer, F.J.; Roberts, C.L.; Guilbert, C.; Simpson, J.M.; Algert, C.S.; Khambalia, A.Z.; Tasevski, V.; Ashton, A.W.; Morris, J.M.; Nassar, N. Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am. J. Clin. Nutr. 2014, 99, 287–295. [Google Scholar] [CrossRef] [PubMed]
- Socialstyrelsen. 2013. Available online: http://www.socialstyrelsen.se/statistik/statistikdatabas/graviditeter-forlossningarochnyfodda (accessed on 11 September 2015).
- Socialstyrelsen. Pregnancies, Deliveries and Newborn Infants: The Swedish Medical Birth Register 1973–2012; Report No.: 1400-3511; Official Statistics of Sweden: Stockholm, Sweden, 2013. [Google Scholar]
- Barebring, L.; Bullarbo, M.; Glantz, A.; Leu Agelii, M.; Jagner, A.; Ellis, J.; Hulthén, L.; Schoenmakers, I.; Augustin, H. Preeclampsia and Blood Pressure Trajectory during Pregnancy in Relation to Vitamin D Status. PLoS ONE 2016, 11, e0152198. [Google Scholar] [CrossRef] [PubMed]
- Zhang, J.Y.; Lucey, A.J.; Horgan, R.; Kenny, L.C.; Kiely, M. Impact of pregnancy on vitamin D status: A longitudinal study. Br. J. Nutr. 2014, 112, 1081–1087. [Google Scholar] [CrossRef] [PubMed]
- More, C.; Bhattoa, H.P.; Bettembuk, P.; Balogh, A. The effects of pregnancy and lactation on hormonal status and biochemical markers of bone turnover. Eur. J. Obstet. Gynecol. Reprod. Biol. 2003, 106, 209–213. [Google Scholar] [CrossRef]
- Lundqvist, A.; Sandström, H.; Stenlund, H.; Johansson, I.; Hultdin, J. Vitamin D status during pregnancy: A longitudinal study in Swedish women from early pregnancy to seven months postpartum. PLoS ONE 2016, 11, e0150385. [Google Scholar] [CrossRef] [PubMed]
- Moon, R.J.; Crozier, S.R.; Dennison, E.M.; Davies, J.H.; Robinson, S.M.; Inskip, H.M.; Godfrey, K.M.; Cooper, C.; Harvey, N.C. Tracking of 25-hydroxyVitamin D status during pregnancy: The importance of Vitamin D supplementation. Am. J. Clin. Nutr. 2015, 102, 1081–1087. [Google Scholar] [CrossRef] [PubMed]
- Brembeck, P.; Winkvist, A.; Olausson, H. Determinants of vitamin D status in pregnant fair-skinned women in Sweden. Br. J. Nutr. 2013, 110, 856–864. [Google Scholar] [CrossRef] [PubMed]
- Dahlman, I.; Gerdhem, P.; Bergström, I. Vitamin D status and bone health in immigrant versus Swedish women during pregnancy and the post-partum period. J. Musculoskelet. Neuronal Interact. 2013, 13, 464–469. [Google Scholar] [PubMed]
- Kalliokoski, P.; Bergqvist, Y.; Löfvander, M. Physical performance and 25-hydroxyvitamin D: A cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers. BMC Pregnancy Childbirth 2013, 13. [Google Scholar] [CrossRef] [PubMed]
- Andersen, L.B.; Abrahamsen, B.; Dalgard, C.; Kyhl, H.B.; Beck-Nielsen, S.S.; Frost-Nielsen, M.; Jorgensen, J.S.; Barington, T.; Christesen, H.T. Parity and tanned white skin as novel predictors of vitamin D status in early pregnancy: A population-based cohort study. Clin. Endocrinol. 2013, 79, 333–341. [Google Scholar] [CrossRef] [PubMed]
- Bjørn Jensen, C.; Thorne-Lyman, A.L.; Vadgård Hansen, L.; Strøm, M.; Odgaard Nielsen, N.; Cohen, A.; Olsen, S.F. Development and Validation of a Vitamin D Status Prediction Model in Danish Pregnant Women: A Study of the Danish National Birth Cohort. PLoS ONE 2013, 8, e53059. [Google Scholar] [CrossRef] [PubMed]
- Petersen, S.B.; Olsen, S.F.; Molgaard, C.; Granstrom, C.; Cohen, A.; Vestergaard, P.; Strom, M. Maternal vitamin D status and offspring bone fractures: Prospective study over two decades in Aarhus City, Denmark. PLoS ONE 2014, 9, e114334. [Google Scholar] [CrossRef] [PubMed]
- Crozier, S.R.; Harvey, N.C.; Inskip, H.M.; Godfrey, K.M.; Cooper, C.; Robinson, S.M. Maternal vitamin D status in pregnancy is associated with adiposity in the offspring: Findings from the Southampton Women’s Survey. Am. J. Clin. Nutr. 2012, 96, 57–63. [Google Scholar] [CrossRef] [PubMed]
- Haggarty, P.; Campbell, D.M.; Knox, S.; Horgan, G.W.; Hoad, G.; Boulton, E.; McNeill, G.; Wallace, A.M. Vitamin D in pregnancy at high latitude in Scotland. Br. J. Nutr. 2013, 109, 898–905. [Google Scholar] [CrossRef] [PubMed]
- Vandevijvere, S.; Amsalkhir, S.; van Oyen, H.; Moreno-Reyes, R. High prevalence of vitamin D deficiency in pregnant women: A national cross-sectional survey. PLoS ONE 2012, 7, e43868. [Google Scholar] [CrossRef] [PubMed]
- Hedlund, L.; Brekke, H.K.; Brembeck, P.; Augustin, H. A Short Questionnaire for Assessment of Dietary Vitamin D Intake. Eur. J. Nutr. Food Saf. 2014, 4, 150–156. [Google Scholar] [CrossRef]
- Livsmedelsverkets Föreskrifter om Berikning av Vissa Livsmedel. Available online: http://www.livsmedelsverket.se/globalassets/om-oss/remisser---aktuella/2015---utgangna/foreskriftsforslag-remiss-dnr-2763-2013-berikning.pdf (accessed on 4 March 2016).
- Wielders, J.P.M.; Wijnberg, F.A. Preanalytical stability of 25(OH)-vitamin D3 in human blood or serum at room temperature: Solid as a rock. Clin. Chem. 2009, 55, 1584–1585. [Google Scholar] [CrossRef] [PubMed]
- Metodbeskrivning S-25-OH Vitamin D3, S-25-OH Vitamin D2, Malmö [Internet]. 2014. Available online: http://www.skane.se/Upload/Webbplatser/Labmedicin/Verksamhetsomr%C3%A5den/Klinisk%20kemi/Analyser/Malmo/S-25-OH%20Vitamin%20D3,%20S-25-OH%20Vitamin%20D2,%20Malm%C3%B6.pdf (accessed on 6 November 2014).
- Ross, A.C.; Manson, J.E.; Abrams, S.A.; Aloia, J.F.; Brannon, P.M.; Clinton, S.K.; Durazo-Arvizu, R.A.; Gallagher, J.C.; Gallo, R.L.; Jones, G.; et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: What clinicians need to know. J. Clin. Endocrinol. Metab. 2011, 96, 53–58. [Google Scholar] [CrossRef] [PubMed]
- Kimlin, M.G.; Lucas, R.M.; Harrison, S.L.; van der Mei, I.; Armstrong, B.K.; Whiteman, D.C.; Kricker, A.; Nowak, M.; Brodie, A.M.; Sun, J. The contributions of solar ultraviolet radiation exposure and other determinants to serum 25-hydroxyvitamin D concentrations in Australian adults: The AusD Study. Am. J. Epidemiol. 2014, 179, 864–874. [Google Scholar] [CrossRef] [PubMed]
- Jones, K.S.; Assar, S.; Prentice, A.; Schoenmakers, I. Vitamin D expenditure is not altered in pregnancy and lactation despite changes in Vitamin D metabolite concentrations. Sci. Rep. 2016, 6. [Google Scholar] [CrossRef] [PubMed]
- Hedlund, L.; Brembeck, P.; Olausson, H. Determinants of Vitamin D Status in Fair-Skinned Women of Childbearing Age at Northern Latitudes. PLoS ONE 2013, 8, e60864. [Google Scholar] [CrossRef] [PubMed]
- Zerwekh, J.E. Blood biomarkers of vitamin D status. Am. J. Clin. Nutr. 2008, 87, 1087s–1091s. [Google Scholar] [PubMed]
Mean | SD | |
---|---|---|
Age (years) | 31.3 | 4.9 |
Height (cm) | 166.8 | 6.3 |
Weight T1 (kg) | 68.1 | 12.6 |
BMI T1 (kg/m2) | 24.5 | 4.2 |
Gestational age T1 (weeks) | 10.8 | 2.0 |
Gestational age T3 (weeks) | 33.4 | 1.9 |
25(OH)D T1 (nmol/L) | 64.5 | 24.5 |
25(OH)D T3(nmol/L) | 74.7 | 34.4 |
Season-corrected 25(OH)D T1 (nmol/L) | 63.6 | 23.9 |
Season-corrected 25(OH)D T3 (nmol/L) | 74.7 | 31.3 |
Vitamin D dietary intake T1 2 (µg/day) | 2.4 | 1.6 |
Vitamin D dietary intake T3 3 (µg/day) | 3.3 | 1.7 |
Gestational weight gain 4 (kg) | 13.5 | 5.1 |
N(%) | ||
25(OH)D <30 nmol/L, T1 | 201 (10) | |
25(OH)D <50 nmol/L, T1 | 498 (25) | |
Born in Sweden | 1479 (74) | |
Overweight (BMI 25–29.9) T1 (kg/m2) | 489 (25) | |
Obese (BMI ≥ 30) T1 (kg/m2) | 203 (10) | |
Vitamin D supplement use T1 (any) | 868 (43) | |
Vitamin D supplement use T3 (any) | 842 (42) | |
Recently travelled <35° N T1 1 | 516 (26) | |
Recently travelled <35° N T3 1 | 347 (17) | |
Tobacco use at T1 (any) | 89 (4) | |
University education level T1 (any) | 1190 (60) | |
Employment T1 (any) | 1501 (75) | |
Nulliparity T1 | 836 (42) |
All Women 1 | Women Born in Africa and Asia 1 | |||||
---|---|---|---|---|---|---|
95% CI | 95% CI | |||||
OR | Lower | Upper | OR | Lower | Upper | |
Origin (continent of birth) | ||||||
North Europe (ref) | ||||||
America | 5.13 * | 1.01 | 26.15 | |||
Continental Europe | 4.55 *** | 2.16 | 9.57 | |||
Asia | 22.09 *** | 11.51 | 42.42 | |||
Africa | 9.74 *** | 4.09 | 23.18 | |||
Season T1 | ||||||
September–November (ref) | ||||||
March–May | 2.17 ** | 1.35 | 3.49 | 1.22 | 0.62 | 2.41 |
December–February | 1.91 | 0.29 | 12.38 | 10.01 | 0.63 | 160.02 |
June–August | 0.59 | 0.13 | 2.63 | 0.22 | 0.03 | 1.72 |
Vitamin D dietary intake T1 | 0.82 ** | 0.71 | 0.95 | 0.84 | 0.70 | 1.01 |
Sun-seeking behaviour | ||||||
Prefer sun (ref) | ||||||
Prefer both sun and shade | 0.91 | 0.48 | 1.74 | 0.78 | 0.33 | 1.89 |
Prefer shade | 0.64 | 0.23 | 1.82 | 0.47 | 0.14 | 1.64 |
Clothing when sunny | ||||||
Often expose skin (ref) | ||||||
Seldom expose skin | 1.68 | 0.88 | 3.21 | 1.44 | 0.56 | 3.72 |
Never expose skin | 6.04 *** | 2.80 | 13.02 | 6.52 *** | 2.56 | 16.60 |
Vitamin D supplement T1 | ||||||
No (ref) | ||||||
Yes | 0.09 *** | 0.05 | 0.17 | 0.04 *** | 0.02 | 0.12 |
Travel <35° N before T1 | ||||||
No (ref) | ||||||
Yes | 0.70 | 0.40 | 1.22 | 0.97 | 0.47 | 1.98 |
BMI T1 | 1.02 | 0.97 | 1.07 | 1.01 | 0.93 | 1.09 |
Age | 0.88 *** | 0.83 | 0.93 | 0.89 ** | 0.82 | 0.96 |
Tobacco use T1 | ||||||
No (ref) | ||||||
Yes | 2.18 | 0.88 | 5.39 | 4.71 | 0.42 | 52.74 |
All Women 1 | Women Born in Africa And Asia 1 | |||||
---|---|---|---|---|---|---|
Adjusted R2 = 0.186 | Adjusted R2 = 0.115 | |||||
Unstandardized Coefficients | P | Unstandardized Coefficients | P | |||
B | Std. Error | B | Std. Error | |||
Origin (continent of birth) | ||||||
North Europe (ref) | ||||||
America | −4.61 | 3.81 | 0.227 | |||
Continental Europe | −4.75 | 2.01 | 0.018 | |||
Africa | −10.95 | 2.92 | <0.001 | |||
Asia | −16.99 | 2.10 | <0.001 | |||
Sun-seeking behaviour | ||||||
Prefer sun (ref) | ||||||
Prefer both sun and shade | −3.18 | 1.39 | 0.022 | −2.56 | 3.29 | 0.437 |
Prefer shade | −1.13 | 3.12 | 0.718 | −4.60 | 4.89 | 0.348 |
Clothing when sunny | ||||||
Often expose skin (ref) | ||||||
Seldom expose skin | −4.69 | 1.57 | 0.003 | −5.85 | 3.39 | 0.085 |
Never expose skin | −7.54 | 2.80 | 0.007 | −5.37 | 3.30 | 0.105 |
Vitamin D dietary intake T3 (µg) | 0.99 | 0.31 | 0.002 | 1.07 | 0.69 | 0.119 |
Vitamin D supplement T3 | ||||||
No (ref) | ||||||
Yes | 16.68 | 1.08 | <0.001 | 13.67 | 2.82 | <0.001 |
Travel <35° N before T3 | ||||||
No (ref) | ||||||
Yes | 3.57 | 1.31 | 0.006 | −0.92 | 3.28 | 0.780 |
BMI T1 (kg/m2) | −0.09 | 0.13 | 0.489 | 0.30 | 0.38 | 0.301 |
Age T1 (years) | 0.22 | 0.12 | 0.082 | 0.27 | 0.90 | 0.271 |
Gestational weight gain (kg) | −0.15 | 0.10 | 0.126 | 0.06 | 0.25 | 0.805 |
25(OH)D T1 | 25(OH)D T3 | |||||
---|---|---|---|---|---|---|
Season | N | Mean nmol/L | SD | N | Mean nmol/L | SD |
December–February | 43 | 64 | 27 | 344 | 62 | 28 |
March–May | 825 | 58 * | 25 | 633 | 63 * | 28 |
June–August | 77 | 70 * | 21 | 280 | 99 * | 37 |
September–November | 1040 | 69 * | 24 | 579 | 83 * | 34 |
Overall | 1985 | 65 | 25 | 1836 | 75 | 34 |
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Bärebring, L.; Schoenmakers, I.; Glantz, A.; Hulthén, L.; Jagner, Å.; Ellis, J.; Bärebring, M.; Bullarbo, M.; Augustin, H. Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort. Nutrients 2016, 8, 655. https://doi.org/10.3390/nu8100655
Bärebring L, Schoenmakers I, Glantz A, Hulthén L, Jagner Å, Ellis J, Bärebring M, Bullarbo M, Augustin H. Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort. Nutrients. 2016; 8(10):655. https://doi.org/10.3390/nu8100655
Chicago/Turabian StyleBärebring, Linnea, Inez Schoenmakers, Anna Glantz, Lena Hulthén, Åse Jagner, Joy Ellis, Mattias Bärebring, Maria Bullarbo, and Hanna Augustin. 2016. "Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort" Nutrients 8, no. 10: 655. https://doi.org/10.3390/nu8100655
APA StyleBärebring, L., Schoenmakers, I., Glantz, A., Hulthén, L., Jagner, Å., Ellis, J., Bärebring, M., Bullarbo, M., & Augustin, H. (2016). Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort. Nutrients, 8(10), 655. https://doi.org/10.3390/nu8100655