DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175285

Association of maternal serum vitamin D level with preeclampsia or eclampsia and its relationship with neonatal outcome and neonatal serum calcium level

Mahija Sahu, Sonali Tripathy, Pallavi Bhuyan

Abstract


Background: Vitamin D deficiency has been associated with various poor maternal and fetal outcome and is proposed to be important in the pathogenesis of preeclampsia. The aim of the study was to evaluate the serum vitamin-D levels in normal pregnant females and pre-eclampsia or eclampsia individuals in the third trimester admitted for termination or in labour and to assess the neonatal outcome and neonatal serum calcium levels of babies born to mother in both the groups.

Methods: This study was a prospective comparative study carried out on the pregnant women in the third trimester admitted for termination or in labour. 100 pregnant females with either pre-eclampsia or eclampsia were compared with equal number of normotensive pregnant females for serum vitamin D. They were followed up until delivery and subsequently neonatal serum calcium level was estimated.

Results: Most pregnant females had vitamin D deficiency pointing towards universal prevalence. Only 10% had suboptimal to optimal vitamin D level while 90% had vitamin deficiency. The hypertensive group had lower mean serum vitamin D level (9.06±5.20 ng/ml) as compared to normotensive group (13.67±7.24 ng/ml). Neonatal outcome was poorer in the hypertensive group. Neonates born to hypertensive mothers had lower mean calcium level (8.30±1.46mg/dl) when compared to those born to normotensive mothers (8.82±0.918mg/dl).

Conclusion: The study findings revealed that there lies a consistent association of maternal serum vitamin D deficiency with the hypertensive disorders of pregnancy and neonatal morbidity. 


Keywords


Calcium, Eclampsia, Neonatal, Preeclampsia, Vitamin D deficiency

Full Text:

PDF

References


Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D: an evidence-based review. J Am Board Fam Med. 2009;22(6):698-706.

Thacher TD, Clarke BL. Vitamin D insufficiency. Mayo Clin Proc. 2011;86:50-60.

Cannell JJ, Hollis BW. Use of vitamin D in clinical practice. Altern Med Review. 2008;13:6-20.

Gallagher JC, Sai AJ. Vitamin D insufficiency, deficiency, and bone health. J Clin Endocrinol Metab. 2010;95:2630-3.

Adams JS, Hewison M. Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab. 2008;4:80-90.

James, Rachael P, Piercy CN. Management of hypertension before, during and after pregnancy. Heart. 2004;90(12):1499-504.

Dutta DC. Text Book of obstetrics, hypertensive disorders of pregnancy. 7th Edn; 2014:220,230.

Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Hypertensive disorders. Williams Obstetrics. 24th edition. McGraw-Hill Eductaion; 2014:728-9.

Robertson SA, Bromfield JJ, Tremellen KP. Seminal priming for protection from preeclampsia-a unifying hypothesis. J Reprod Immunol. 2003;59:253-65.

Fischer D, Schroer A, Ludders D, Cordes T, Bücker B, Reichrath J, et al. Metabolism of vitamin D3 in the placental tissue of normal and preeclampsia complicated pregnancies and premature births. Clin Exp Obstet Gynecol. 2007;34:80-4.

Novakovic B, Sibson M, Ng HK, Manuelpillai U, Rakyan V, Down T, et al. Placenta-specific methylation of the vitamin D 24-hydroxylase gene: implications for feedback autoregulation of active vitamin D levels at the fetomaternal interface. J Biol Chem. 2009;284:14838-48.

Huppertz B. Placental origins of preeclampsia challenging the current hypothesis. Hypertension 2008;51:970-75.

Ullah MI, Koch CA, Tamanna S, Rouf S, Shamsuddin L. Vitamin D deficiency and the risk of preeclampsia and eclampsia in Bangladesh. Horm Metab Res. 2013;45:682-7.

Wamberg L, Cullberg KB, Rejnmark L, Richelsen B, Pedersen SB. Investigations of the anti-inflammatory Effects of Vitamin D in Adipose tissue: results from an in vitro study and a randomized controlled trial. Horm Metab Res. 2013;45:456-62.

Nonn L, Peng L, Feldman D, Peehl DM. Inhibition of p38 by vitamin D reduces interleukin-6 production in normal prostate cells via mitogen activated protein kinase phosphatase 5: implications for prostate cancer prevention by vitamin D. Cancer Res. 2006;66(8):4516-24.

Bednarek-Skublewska A, Smolen A, Jaroszynski A, Załuska W, Ksiazek A. Effects of vitamin D3 on selected biochemical parameters of nutritional status, inflammation, and cardiovascular disease in patients undergoing long-term hemodialysis. Pol Arch Med Wewn. 2010;120:167-74.

Ertek S, Akgül E, Cicero AF, Kütük U, Demirtaş S, Cehreli S, et al. 25-Hydroxy Vitamin D levels and endothelial vasodilator function in normotensive women. Arch Med Sci. 2012;8:47-52.

Powe CE, Seely EW, Rana S, Bhan I, Ecker J, Karumanchi SA, et al. First trimester vitamin D, vitamin D binding protein, and subsequent preeclampsia. Hypertension. 2010;56:758-63.

Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92:3517-22.

Wei SQ, Audibert F, Luo ZC, Nuyt AM, Masse B, Julien P, et al. MIROS study group. Maternal plasma 25-hydroxyvitamin D levels, angiogenic factors, and preeclampsia. Am J Obstet Gynecol. 2013;208:390-e1.

Haugen M, Brantsaeter AL, Trogstad L, Alexander J, Roth C, Magnus P, et al. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiol. 2009;20:720-6.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-30.

Singla R, Gurung P, Aggarwal N, Dutta U, Kochhar R. Relationship between preeclampsia and vitamin D deficiency: a case control study. Arch Gynecol Obstet. 2015;291:1247-51.

Robinson CJ, Alanis MC, Wagner CL. Plasma 25-hydroxyvitamin D Levels in early-onset severe preeclampsia. Am J Obstet Gynecol. 2010;203:366.

Bodnar LM, Simhan HN, Catov JM. Maternal Vitamin D status and the risk of mild and severe preeclampsia. Epidemiol. 2014;25:207-14.

Hypponen E, Cavadino A, Williams D. Vitamin D and pre-eclampsia original data, systematic review and meta-analysis. Ann Nutr Metab.2014;63:331-40.

Bakacak M, Serin S, Ercan O. Comparison of Vitamin D levels in cases with preeclampsia, eclampsia and healthy pregnant women. Int J Clin Exp Med. 2015;8:16280-6.

Gupta T, Wahi S, Gupta N, Arora S, Gupta S, Bhatia P. Correlation of Vitamin D levels in term normotensive and pre-eclamptic patients in labor. J Obstet Gynecol India. 2015;42(3):1-6.

Baker AM, Haeri S, Camargo CA, Stuebe AM, Boggess KA. A nested case-control study of first-trimester maternal vitamin d status and risk for spontaneous preterm birth. Am J Perinatol. 2011;28(9):667-72.

Wetta LA, Biggio JR, Cliver S, Abramovici A, Barnes S, Tita AT. Is midtrimester vitamin D Status associated with spontaneous preterm birth and preeclampsia? Am J Perinatol. 2014;31:541-6.

Gidlof S, Silva AT, Gustafsson S, Lindqvist PG. Vitamin D and the risk of preeclampsia-a nested case-control study. Acta Obstetricia et Gynecologica Scandinavica. 2015;94(8):904-8.

Hall DR, Odendaal HJ, Kirsten GF, Smith J, Grové D. Expectant management of early onset, severe Preeclampsia perinatal outcome. BJOG. 2001;108:1258-64.

Abramovici D, Friedman SA, Sibai BM. Neonatal outcome in severe Preeclampsia at 24 to 36 weeks gestation: Does the HELLP syndrome matter? Am J Obstet Gynecol. 1999;180:220-5.

Teaema FH, Al Ansari K. Nineteen cases of symptomatic neonatal hypocalcemia secondary to vitamin D deficiency: a 2-year study. J Trop Pediatr. 2010;56:108-10.

Mehrotra P, Marwaha RK, Aneja S. Hypovitaminosis D and hypocalcemic seizures in infancy. Indian Pediatr. 2010;47:581-6.

Zeghoud F, Garabedian M, Jardel A, Bernard N, Melchior J. Administration of a single dose of 100,000 U.I. of vitamin D3 in the pregnant woman in winter. The effect on blood calcium level of the newborn infant. J Gynecol S Obstet Biol Reprod. 1988;17:1099-105.