DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20191221

A study to evaluate serum 25-hydroxy vitamin D3 and calcium levels in maternal and cord blood and their effect on pregnancy outcome

Radha B. P. Thangappah, Ursula Sampson, Amrin Azad, Rathna Arumugam, Smriti Anand, Ponnalagan Karunakaran

Abstract


Background: To determine the prevalence of vitamin D deficiency among pregnant mothers and their neonates and to study the effect of vitamin D deficiency on maternal and perinatal outcome.

Methods: This prospective cohort study conducted in a teaching hospital included 223 pregnant mothers and their offspring born in 2017. Detailed history was taken to ascertain the causes of vitamin D deficiency.   vitamin D3 and calcium levels were estimated in maternal and cord blood samples. To study the association between the vitamin D status and the various maternal and neonatal parameters.

Results: 91.9 % of women were house wives involved in indoor activities. Pre-eclampsia and GDM were seen in 4.5% of cases each. 5.41% were obese and 84%  were of medium complexion,  and 8% were  dark. 93.7% were non- vegetarians,  and fish, egg and milk consumption was adequate in 61.3% , 64% and 71% respectively. Only 5.40% of women had adequate exposure to sunlight.  The mean birth weight was 3.08± 0.36 Kg. and 14 babies were admitted to NICU for neonatal asphyxia.77.40% had deficient levels of vitamin D  <20 ng/ml. Only four pregnant mothers (1.8%) had sufficient levels vitamin D. There was no statistically significant association between vitamin D deficiency and various maternal and neonatal parameters.

Conclusions: This study has shown that the prevalence of vitamin D deficiency among south Indian pregnant mothers and their newborn is very high and the ways to improve the vitamin D status among pregnant mothers should be looked at.


Keywords


Calcium, Maternal and perinatal outcome, Vitamin D deficiency

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References


Hyppönen E, Power C. Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clinic Nutri. 2007;85(3):860-8.

Yu CK, Sykes L, Sethi M, Teoh TG, Robinson S. Vitamin D deficiency and supplementation during pregnancy. Clinic Endocrinol. 2009;70(5):685-90.

Scientific Impact Paper No. 43. © Royal College of Obstetricians and Gynaecologists 2014;Vitamin D in pregnancy.

Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V. High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clinic Nutrit. 2005;81(5):1060-4.

Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O’Beirne M, Rabi DM. 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.

Mehrotra P, Marwaha RK, Aneja S, Seth A, Singla BM, Ashraf G, Sharma B, Sastry A, Tandon N. Hypovitaminosis d and hypocalcemic seizures in infancy. Ind Pediat. 2010;47(7):581-6.

Ritu G, Gupta A. Vitamin D Deficiency in India: Prevalence, Causalities and Interventions. Nutrients 2014;6(2):729-75.

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(8):e43868.

De-Regil LM, Palacios C, Ansary A, Kulier R, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Pregnancy and Childbirth Group. 2012 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.

Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clinic Nutri. 2004;80(6):1678S-88S.

Bodnar LM, Catov JM, Roberts JM, Simhan HN. Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates. J Nutrit. 2007;137(11):2437-42.

Wei SQ, Qi HP, Luo ZC, Fraser WD. Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Maternal-Fetal Neonat Med. 2013 ;26(9):889-99.

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. 2016;66(3):154-9.

Baker AM, Haeri S, Camargo Jr CA, Espinola JA, Stuebe AM. A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia. J Clinic Endocrinol Metabol. 2010;95(11):5105-9.

Robinson CJ, Alanis MC, Wagner CL, Hollis BW, Johnson DD. Plasma 25-hydroxyvitamin D levels in early-onset severe preeclampsia. Am J Obstet Gynecol. 2010;203(4):366-e1.

Shand AW, Nassar N, Von Dadelszen P, Innis SM, Green TJ. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for pre‐eclampsia. BJOG: Int J Obstet Gynaecol. 2010;117(13):1593-8.

Powe CE, Seely EW, Rana S, Bhan I, Ecker J, Karumanchi SA, Thadhani R. First trimester vitamin D, vitamin D binding protein, and subsequent preeclampsia. Hypertens. 2010;56(4):758-63.

Zhang C, Qiu C, Hu FB, David RM, Van Dam RM, Bralley A, Williams MA. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PloS one. 2008;3(11):e3753.

Makgoba M, Nelson SM, Savvidou M, Messow CM, Nicolaides K, Sattar N. First-trimester circulating 25-hydroxyvitamin D levels and development of gestational diabetes mellitus. Diabetes Care. 2011;34(5):1091-3.

Farrant HJ, Krishnaveni GV, Hill JC, Boucher BJ, Fisher DJ, Noonan K, Osmond C, Veena SR, Fall CH. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Europe J Clinic Nutri. 2009;63(5):646.

Leffelaar ER, Vrijkotte TG, van Eijsden M. Maternal early pregnancy vitamin D status in relation to fetal and neonatal growth: results of the multi-ethnic Amsterdam Born Children and their Development cohort. British J Nutri. 2010;104(1):108-17.

Bodnar LM, Catov JM, Zmuda JM, Cooper ME, Parrott MS, Roberts JM, Marazita ML, Simhan HN. Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. J Nutri. 2010;140(5):999-1006.

Morley R, Carlin JB, Pasco JA, Wark JD. Maternal 25-hydroxyvitamin D and parathyroid hormone concentrations and offspring birth size. J Clinic Endocrinol Metabol. 2006 Mar 1;91(3):906-12.

Nasrin Khalessi, Majid Kalani, Mehdi Araghi, and Zahra Farahani, The Relationship between Maternal Vitamin D Deficiency and Low Birth Weight Neonates. J Family Reprod Health. 2015;9(3):113-7.

Rodriguez A, García‐Esteban R, Basterretxea M, Lertxundi A, Rodríguez‐Bernal C, Iniguez C et al. Associations of maternal circulating 25‐hydroxyvitamin D3 concentration with pregnancy and birth outcomes. BJOG: Int J Obstet Gynaecol. 2015;122(12):1695-704.

Do HJ, Park JS, Seo JH, Lee ES, Park CH, Woo HO, Youn HS. Neonatal late-onset hypocalcemia: is there any relationship with maternal hypovitaminosis D?. Pediatric Gastroenterol, Hepatol Nutrition. 2014;17(1):47-51.

Khadilkar A, Khadilkar V, Chinnappa J, Rathi N, Khadgawat R, Balasubramanian S, Parekh B, Jog P. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) Guidelines. Indian Pediat. 2017;54(7):567-73.

Institute of Medicine of the National Academies (US). Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academy Press; 2010.