Role of vitamin D in prevention of adverse maternal and perinatal outcome: a randomized controlled trial

Authors

  • Sujatha M. S. Department of Obstetrics and Gynecology, JSS Medical College and Hospital, Mysuru, Karnataka, India
  • Shruthi K. R. Department of Obstetrics and Gynecology, JSS Medical College and Hospital, Mysuru, Karnataka, India
  • Neelaharika . Department of Obstetrics and Gynecology, JSS Medical College and Hospital, Mysuru, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20192428

Keywords:

Birth weight, Gestational diabetes mellitus, Primary caesarean delivery, Preecampsia, Vitamin D

Abstract

Background: Vitamin  D  deficiency  is  thought  to  be   common among  pregnant  women  and  is  associated  with  adverse  maternal  and  perinatal  outcome. Maternal  and foetal  outcome  in  pregnant  women  with  standard  obstetric  care  was compared with   women with  additional  vitamin D  supplementation.

Methods: A randomized comparative  study  was  conducted  on  100  patients attending  the  antenatal  clinic at JSS Medical College and Hospital, Mysuru, Karnataka, India   who were randomly  grouped   into  group A (50 patients) who  received  standard  obstetric care  (500 mg calcium+200 IU vitamin D)  and  group  B (50 patients)  who  received  in  addition  to  standard  obstetric  care   supplementation  of   Vitamin  D  1000 IU/day starting  from  14  weeks  of  gestation  till  delivery.  Vitamin  D  levels  were assessed  in  both  the  groups  with  onset  of  labour  by  chemiluminescence immunoassay  and  obstetric  and  neonatal  outcomes  in  both  groups  were compared.

Results: High  incidence  of vitamin  D  deficiency  (96%)  in  standard  care  group  compared  to  vitamin  D supplemented  group  ( p= <0.0001)  was  noted. The  study  showed  significant  reduction  in  risk  of  Preeclampsia (P=0.004),  GDM  (P= 0.02)  and  primary  caesarean  delivery  (0.008)  in  Vitamin  D  supplemented  group. Significantly  high  birth  weight  in  vitamin  D supplemented   group,  an  increase  in  320 grams  in  birth  weight  was  noted  (P <0.0001).

Conclusions: There is a high incidence of subnormal vitamin D levels in antenatal women and is associated with maternal and neonatal adverse effects. Measuring Vitamin D levels and appropriate supplementation of higher dose of vitamin D is an effective strategy in prevention of adverse maternal and neonatal outcomes.

References

Van Schoor NM, Lips P. Worldwide Vitamin D Status. Best Pract Res Clin Endocrinol Metab. 2011;25:671-80.

Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20:1807-20.

Vander Meer IM, Middelkoop BJ, Boeke AJ, Lips P. Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: An overview. Osteoporos Int. 2011;22:1009-21.

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

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

Abrams SA. In utero physiology: Role in nutrient delivery and fetal development for calcium, phosphorus, and vitamin D. Am J Clin Nutr. 2007;85:S604-7.

Holick MF, Biancuzzo RM, Chen TC, Klein EK, Young A, Bibuld D, et al. Is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab. 2008;93:677-81.

Scholl TO, Chen X. Vitamin D intake during pregnancy: Association with maternal characteristics and infant birth weight. Early Hum Dev. 2009;85:231-4.

McCarty CA. Sunlight exposure assessment: Can we accurately assess vitamin D exposure from sunlight questionnaires? Am J Clin Nutr. 2008;87:S1097-101.

Maghbooli Z, Hossein-Nezhad A, Shafaei AR, Karimi F, Madani FS, Larijani B. Vitamin D status in mothers and their newborns in Iran. BMC Pregnancy Childbirth. 2007;7:1.

Bhalala U, Desai M, Parekh P, Mokal R, Chheda B. Subclinical hypovitaminosis D among exclusively breastfed young infants. Indian Pediatr. 2007;44:897-901.

Ginde AA, Sullivan AF, Mansbach JM, Camargo CA Jr. Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the United States. Am J Obstet Gynecol. 2010;202(5):436-8.

Alemu E, Varnam R. Awareness of vitamin D deficiency among at-risk patients. BMC Research Notes. 2012;5(1):17.

Sayers A, Tilling K, Boucher BJ, Noonan K, Tobias, JH. Predicting ambient ultraviolet from routine meteorological data; its potential use as an instrumental variable for vitamin D status in pregnancy in a longitudinal birth cohort in the UK. Int J Epidemiol. 2009;38:1681-8.

Bodnar LM, Simhan HN, Powers RW, Frank MP, Cooperstein E, Roberts JM. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr. 2007;137:447-52.

Kalra P, Das V, Agarwal A, Kumar M, Ramesh V, Bhatia E, et al. Effect of vitamin D supplementation during pregnancy on neonatal mineral homeostasis and anthropometry of the new born and infant. Br J Nutr. 2012;108:1052-8.

Sahu M, Das V, Aggarwal A, Rawat V, Saxena P, Bhatia V. Vitamin D replacement in pregnant women in rural north India: a pilot study. Eu J Clin Nutr. 2009;63:1157-9.

Meer VIM, Middelkoop BJ, Boeke AJ, Lips P. Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: An overview. Osteoporos Int. 2011;22:1009-21.

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.

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.

Mojibian M, Soheilykhah S, Fallah Zadeh MA, Moghadam MJ. The effects of vitamin D supplementation on maternal and neonatal outcome: A randomized clinical trial: Iran J Reprod Med. 2015;13(11):687-96.

Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009;94(3):940-5.

Loy SL, Lek N, Yap F, Soh SE, Padmapriya N, Tan KH, et al. Association of maternal Vitamin D status with glucose tolerance and caesarean section in a multi-ethnic asian cohort: the growing up in singapore towards healthy outcomes study. PLoS ONE. 2015;10(11):e01.

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

Thorp JM, Camargo CA, McGee PL, Harper M, Klebanoff MA, Sorokin Y, et al. Vitamin D status and recurrent preterm birth: a nested case-control study in high-risk women. BJOG. 2012;119:1617.

Bodnar LM, Rouse DJ, Momirova V, Peaceman AM, Sciscione A, Spong CY, et al. Maternal 25-hydroxyvitamin D and preterm birth in twin gestations. Obstet Gynecol. 2013;122:91-8.

Thota C, Menon R, Fortunato SJ, Brou L, Lee JE, Al-Hendy A. 1,25-Dihydroxyvitamin D deficiency is associated with preterm birth in African American and Caucasian women. Reprod Sci. 2014;21:244-50.

Mannion CA, Gray-Donald K, Koski KG. Association of low intake of milk and vitamin D during pregnancy with decreased birth weight. CMAJ. 2006;174:1273-7.

Tustin K, Gross J, Hayne H. Maternal exposure to first-trimester sunshine is associated with increased birth weight in human infants. Developmental Psychobiol. 2004;45(4):221-30.

Morley R, Carlin JB, Pasco JA, Wark JD, Ponsonby AL. Maternal 25-hydroxyvitamin D concentration and offspring birth size: effect modification by infant VDR genotype. Eur J Clin Nutr. 2009;63:802-4.

Leffelaar ER, Vrijkotte TGM, 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. Br J Nutri. 2010;104(01):108-17.

Scholl TO, Chen X. Vitamin D intake during pregnancy: Association with maternal characteristics and infant birth weight. Early Him Dev. 2009;85(4):231-4.

Downloads

Published

2019-05-28

Issue

Section

Original Research Articles