Prevalence of vitamin D deficiency in pregnancy and its relation with adverse pregnancy outcome
Keywords:Maternal serum 25 hydroxy vitamin D, Vitamin D deficiency, Vitamin D insufficiency
Background: Vitamin D deficiency is widely prevalent in all parts of the world. Pregnant women and neonates are highly vulnerable to vitamin D deficiency. Pregnant women receive very less amount of sunlight especially in parts of Southeast Asia due to traditional norms and customs. A strong positive correlation was found between low maternal vitamin D levels with gestational hypertension/preeclampsia, gestational diabetes mellitus, preterm labour, low birth weight, intra uterine growth restriction, neonatal intensive care unit admission and Apgar score. Therefore, the present study was designed to know the prevalence of vitamin D deficiency in pregnant females and to evaluate adverse effects associated with it.
Methods: Total 250 nulliparous pregnant females attending Tirath Ram Shah Hospital for delivery and carrying a viable (>/28 weeks) singleton pregnancy were selected. Women with serum 25-hydroxy vitamin D level <10 ng/ml, 10-20 ng/ml and <20 ng/ml, were diagnosed as vitamin D deficient, insufficient and sufficient groups respectively and the adverse outcomes was correlated.
Results: In this study, out of 250 cases, 159 cases (63.6%) had vitamin D deficiency, 43 cases (17.2%) had insufficiency, and 48 cases (19.2%) had sufficient vitamin D levels (vitamin D ≥20 ng/ml). And, Vitamin D deficiency was associated with preeclampsia, preterm labour and increased risk of caesarean section.
Conclusions: This study indicates that vitamin D deficiency is highly prevalent in pregnant females thus implicating the need of a uniform strategy of vitamin D supplementation to pregnant females.
Mithal A, Wahl DA, Bomjour JP. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20:1807-20.
Balasubramanian K, Rajeshwari J, Gulab, Govil YC, Agarwal AK, Kumar A. Varying role of vitamin D deficiency in rural girls and pregnant women despite abundant sunshine in northern India. Clin Endocrine. 2009;70:680-4.
Sahu M, Bhatia V, Agarwal A, Rawat V, Saxena P, Pandey A. Vitamin D deficiency in rural girls and pregnant women despite adequate sunshine in northern India. Clin Endocrino. 2009;680-684.
Diaz L, Noyola-Martinez N, Barrera D, Hernandez G, Avila E, Halhali A, et al. Calcitriol inhibits TNF-alpha-induced inflammatory cytokines in human trophoblasts. J ReprodImmunol. 2009;81(1):17-24.
Teegarden D, Donkin SS. Vitamin D: emerging new roles in insulin sensitivity. Nutr Res Rev. 2009;22(1):82-92.
Hewison M. Antibacterial effects of vitamin D. Nat Rev Endocrinol. 2011;7(6):337-45.
Karim S, Nusrat U, Aziz S. Vitamin D deficiency in pregnant women and their newborns as seen at a tertiary - care center in Karachi, Pakistan. Int J Gynaecol Obstet. 2011;112:59-62.
Ravinder SS, Deepika C, Padmavathi R, Balakrishnan K, Vijayaraghavan J. Occurrence of vitamin D deficiency in pregnant women in South India - a preliminary study. Int J Pure Appl Biosci. 2015;3:291-6.
Özdemir AA, Ercan Gündemir Y, Küçük M. Vitamin D deficiency in pregnant women and their infants. J Clin Res Pediatr Endocrinol. 2018;10(1):44–50. doi:10.4274/jcrpe.4706F.
Agarwal S, Chaudhary M, Chauhan J, Vacchani A. Assessment of Vitamin D Deficiency in Pregnant Females Attending Antenatal Care Clinic at Tertiary Care Hospital. Int J Sci Stud 2016;4(5):99-101.
Bodnar LM, Catov JM, Roberts JM, Simhan HN. Pre-pregnancy obesity pedicts poor vitamin D status in mothers and their neonates. J Nutr. 2007;137:2437-42.
Aly, Koumi Y, El Rahman MNA, Rehab. Impact of maternal vitamin D status during pregnancy on the prevalence of neonatal vitamin D deficiency. Pediatric Reports. 2013;5:10.4081/4616.
Okonofua F, Menon RK, Houlder S, Thomas M, Robinson D, O’Brien S, et al. Calcium, vitamin D and parathyroid hormone relationships in pregnant caucasian and asian women and their neonates. Ann Clin Biochem. 1987;24(1):22-8.
Bodner LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. Clin J Endocrino Metlab. 2007;92:3517-22.
Farrant HJ, Krishnaveni GV, Hill JC, Boucher BJ, Fisher DJ, Noonan K, et al. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J Clin Nutr. 2009;63(5):646-52.
Bodnar LM, Krohn MA, Simhan HN. Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy. J Nutr. 2009;139(6):1157-61.
Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary caesarean section. J Clin Endocrinol Metab. 2009;94(3):940-5.
Scholl TO, Chen X, Stein P. Maternal vitamin D status and delivery by cesarean. Nutr. 2012;4:319-30.
Khalessi N, Kalani M, Araghi M, Farahani Z. The relationship between maternal vitamin D deficiency and low birth weight neonates. J Family Reprod Health. 2015;9(3):113-7.
Hashemipour S, Ziaee A, Javadi A, Movahed F, Elmizadeh K, Javadi EH, et al. Effect of treatment of vitamin D deficiency and insufficiency during pregnancy on fetal growth indices and maternal weight gain: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2014;172:15-9.