http://informahealthcare.com/jmf ISSN: 1476-7058 (print), 1476-4954 (electronic) J Matern Fetal Neonatal Med, Early Online: 1–5 ! 2014 Informa UK Ltd. DOI: 10.3109/14767058.2014.969235
ORIGINAL ARTICLE
High prevalence of vitamin D deficiency among pregnant women in a Turkish population and impact on perinatal outcomes
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Serpil Aydogmus1, Sefa Kelekci1, Huseyin Aydogmus2, Serenat Eri¸s2, Raziye Desdiciog˘lu2, Bulent Yilmaz1, and Gu¨lcan Sag˘lam3 1
_ of Obstetrics and Gynecology, Atatu¨rk Research and Department of Obstetrics and Gynecology Izmi, School of Medicine, 2IDepartment 3 _ _ Training Hospital, and Department of Biochemistry, Atatu¨rk Research and Training Hospital, Izmir Katip C¸elebi University, Izmir, Turkey Abstract
Keywords
Objective: Maternal vitamin D deficiency is a major public health problem. The aim of this study is to investigate the influence of vitamin D deficiency on perinatal results in primigravida. Methods: One-hundred fifty-two healthy nullipar women were included in the study. Pregnant women with serum vitamin D levels 515ng/ml were defined as Group I and 15 ng/dl were defined as Group II; data were evaluated retrospectively. Type of delivery, gestational age at birth, birth weight, intensive care of the newborn, peri-and postpartum complications were recorded. Statistical analyses were performed with SPSS for Windows (version 16.0 ). Categorical variables were assessed using chi-squared test. The numeric variables were analyzed using Student’s t-test and one-way ANOVA. Results: 44.6% of pregnant women were found to have vitamin D deficiency. The mean serum vitamin D levels for Groups I and II were 10.8 ± 3.8 and 23.8 ± 13.3 ng/ml, respectively. SGA deliveries were detected in 16.66% and 4.87% of the primigravidas with and without vitamin D deficiency, respectively. Conclusions: This study has shown that maternal vitamin D deficiency is related with an increased risk of SGA delivery. Further studies are needed to explain the relationship with vitamin D deficiency and poor perinatal outcomes.
Perinatal outcomes, small for gestational age, vitamin D deficiency
Introduction Vitamin D is an essential fat-soluble vitamin and has multiple functions. It is well known that in humans vitamin D deficiency causes osteoporosis, muscle weakness, falling and fractures. Moreover, there are data that show vitamin D deficiency has a role in pathophysiology of various cancers, cardiovascular diseases and pregnancy morbidity [1]. In pregnancy, calcitriol (1,25-dihydroxyvitamin D3) is produced by the placenta as well as the kidneys. Studies show that, vitamin D affects inflammatory cytokine levels in placenta by modulating the activity of 1a hydroxylase and vitamin D receptor (VDR), and the concentration of vitamin D in trofoblastic tissue plays an important role in placental inflammation [2]. Furthermore, vitamin D inhibits cytokine expression induced by TNFa by VDR regulation and stimulates antioxidant gene expression in syncytiotrophoblasts. Apparently, vitamin D has anti-inflammatory effects on placenta [2–4]. Various studies have shown that vitamin D deficiency is related with some important pregnancy complications [5]. There are various studies that put forward the Address for Correspondence: Serpil Aydogmus, Ass Prof, Ilıca _ mah, Zeytin sok, No 20/20, Narlidere, Izmir, Turkey. E-mail: [email protected]
History Received 28 July 2014 Accepted 22 September 2014 Published online 10 October 2014
relationship of vitamin D deficiency with maternal complications such as gestational hypertension, preeclampsia as well as neonatal complications such as low birth weight and increased risk of rickets [6–8]. Maternal vitamin D deficiency is a major global public health problem [9]. The risk groups for vitamin D deficiency are defined as vegetarians, people living in northern countries, dark-skinned people and wearing of skin-covering clothes. Vitamin D deficiency prevalence in Turkey is high, similar to many other regions of the world [10–13]. The aim of this study is to investigate the influence of vitamin D deficiency on perinatal results in primigravida (who live in well-sunlit regions of Turkey).
Material and methods This study was made in Izmir Katip C ¸ elebi University Ataturk Training and Research Hospital (Izmir, Turkey) between April 2013 and January 2014. The study protocol was approved by the Izmir Katip C¸elebi University local ethical committee (IRB 2013-50). Informed voluntary consent was obtained from all patients and the study was in agreement with the Declaration of Helsinki for Medical Research Involving Human Subjects.
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Nyu Medical Center on 01/14/15 For personal use only.
2
S. Aydogmus et al.
J Matern Fetal Neonatal Med, Early Online: 1–5
Among 180 pregnant women admitted to our hospital in their third trimester (428 weeks) aged between 18 and 40 years that were not on vitamin D replacement, 152 healthy, nullipar women who met the study criteria were included in our study. Multipar women with diseases affecting vitamin D and calcium metabolism such as inflammatory bowel syndrome, gastric surgery, diabetes, thyroid and parathyroid diseases; multiple pregnancies, known use of medications during pregnancy for chronic diseases such as pregestational diabetes, chronic hypertension and kidney diseases, and women with major congenital anomalies were excluded from the study. Venous blood samples for measuring vitamin D levels were taken from each participant during routine investigations and stored at 80 C. Three pregnant women admitted during this period were excluded since they did not agree to participate in the study; 14 women not meeting the inclusion criteria and 11 women with insufficient antenatal registrations were also excluded from the study. Four women who were included in the study earlier had to be excluded after not being able to obtain their natal and postnatal data. Eventually, statistical evaluation was made on 148 patients (Figure 1). Medical records of pregnant women such as the first trimester hemoglobin, TSH, HbA1c levels, fetal and gestational diabetes screening tests in the first and second trimesters, 18th and 22nd week fetal anatomic screening tests and fetal cardiotocography findings, if present, were recorded. Type of delivery, gestational age at birth, birth weight, intensive care of the newborn, peri-and postpartum complications were recorded. Once the number of patients was sufficed, serum 25(OH)D3 concentrations were measured by
Figure 1. Flowchart.
ELISA (Global Diagnostics & Medical Solutions KAP1971/ GDMS, 13E27/2, Mortsel, Belgium). Serum 25(OH)D3 concentrations515ng/ml were classified as a deficiency. Insufficient vitamin D status was defined as a serum 25(OH)D3 level between 15 and 29 ng/ml. Vitamin D levels 430 ng/ml were considered sufficient. (intra-assay coefficient variability: 5.7%, interassay coefficient variability: 4.7%). Gestational hypertension was defined according to WHO criteria as a systolic blood pressure 140 mmHg and/or a diastolic blood pressure 90 mmHg for the first time after 20 weeks’ gestation [14]. Preeclampsia was defined as gestational hypertension and proteinuria and the return of all abnormalities to normal by 12 weeks postpartum. According to the criteria of International Association of Diabetes and Pregnancy Study Group (IADPSG), women were diagnosed as GDM by the 24–28th week GDM screening test if at least one of the values were above the cut-off, consisting of a fasting blood glucose of 92 mg/dl, first hour blood glucose of 180 mg/dl and second hour blood glucose of 153 mg/dl [15]. Anemia was defined as a hemoglobin level of 11g/dl for pregnant women according to the WHO criteria [16]. Pregnant women with serum vitamin D levels 515ng/ml were defined as Group I and women with serum vitamin D levels 15 ng/dl were defined as Group II; data were evaluated retrospectively. Statistical analyses were performed with SPSS for Windows (version 16.0, Chicago, IL). Categorical variables were assessed using the chi-squared test. The numeric variables were analyzed using Student’s t-test and one-way ANOVA. Correlation analysis was performed to investigate
Nullipar pregnant women admied between April 2013 and January 2014, n=180
Included (n=152)
Exluded (n=28) Did not agree to parcipate (n=3) Insufficient antenatal records (n=11) Use of medicaons due to chronic diseases (n=2) Diabetes mellitus (n=3) Mulple pregnancy (n=3) Throid pathology (n=5) Inflammatorybowelsyndrome (n=1)
Excluded (n= 4) Insuffiecient medical data
Analyzed (n=148)
Vitamin D
ORIGINAL ARTICLE
High prevalence of vitamin D deficiency among pregnant women in a Turkish population and impact on perinatal outcomes
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Nyu Medical Center on 01/14/15 For personal use only.
Serpil Aydogmus1, Sefa Kelekci1, Huseyin Aydogmus2, Serenat Eri¸s2, Raziye Desdiciog˘lu2, Bulent Yilmaz1, and Gu¨lcan Sag˘lam3 1
_ of Obstetrics and Gynecology, Atatu¨rk Research and Department of Obstetrics and Gynecology Izmi, School of Medicine, 2IDepartment 3 _ _ Training Hospital, and Department of Biochemistry, Atatu¨rk Research and Training Hospital, Izmir Katip C¸elebi University, Izmir, Turkey Abstract
Keywords
Objective: Maternal vitamin D deficiency is a major public health problem. The aim of this study is to investigate the influence of vitamin D deficiency on perinatal results in primigravida. Methods: One-hundred fifty-two healthy nullipar women were included in the study. Pregnant women with serum vitamin D levels 515ng/ml were defined as Group I and 15 ng/dl were defined as Group II; data were evaluated retrospectively. Type of delivery, gestational age at birth, birth weight, intensive care of the newborn, peri-and postpartum complications were recorded. Statistical analyses were performed with SPSS for Windows (version 16.0 ). Categorical variables were assessed using chi-squared test. The numeric variables were analyzed using Student’s t-test and one-way ANOVA. Results: 44.6% of pregnant women were found to have vitamin D deficiency. The mean serum vitamin D levels for Groups I and II were 10.8 ± 3.8 and 23.8 ± 13.3 ng/ml, respectively. SGA deliveries were detected in 16.66% and 4.87% of the primigravidas with and without vitamin D deficiency, respectively. Conclusions: This study has shown that maternal vitamin D deficiency is related with an increased risk of SGA delivery. Further studies are needed to explain the relationship with vitamin D deficiency and poor perinatal outcomes.
Perinatal outcomes, small for gestational age, vitamin D deficiency
Introduction Vitamin D is an essential fat-soluble vitamin and has multiple functions. It is well known that in humans vitamin D deficiency causes osteoporosis, muscle weakness, falling and fractures. Moreover, there are data that show vitamin D deficiency has a role in pathophysiology of various cancers, cardiovascular diseases and pregnancy morbidity [1]. In pregnancy, calcitriol (1,25-dihydroxyvitamin D3) is produced by the placenta as well as the kidneys. Studies show that, vitamin D affects inflammatory cytokine levels in placenta by modulating the activity of 1a hydroxylase and vitamin D receptor (VDR), and the concentration of vitamin D in trofoblastic tissue plays an important role in placental inflammation [2]. Furthermore, vitamin D inhibits cytokine expression induced by TNFa by VDR regulation and stimulates antioxidant gene expression in syncytiotrophoblasts. Apparently, vitamin D has anti-inflammatory effects on placenta [2–4]. Various studies have shown that vitamin D deficiency is related with some important pregnancy complications [5]. There are various studies that put forward the Address for Correspondence: Serpil Aydogmus, Ass Prof, Ilıca _ mah, Zeytin sok, No 20/20, Narlidere, Izmir, Turkey. E-mail: [email protected]
History Received 28 July 2014 Accepted 22 September 2014 Published online 10 October 2014
relationship of vitamin D deficiency with maternal complications such as gestational hypertension, preeclampsia as well as neonatal complications such as low birth weight and increased risk of rickets [6–8]. Maternal vitamin D deficiency is a major global public health problem [9]. The risk groups for vitamin D deficiency are defined as vegetarians, people living in northern countries, dark-skinned people and wearing of skin-covering clothes. Vitamin D deficiency prevalence in Turkey is high, similar to many other regions of the world [10–13]. The aim of this study is to investigate the influence of vitamin D deficiency on perinatal results in primigravida (who live in well-sunlit regions of Turkey).
Material and methods This study was made in Izmir Katip C ¸ elebi University Ataturk Training and Research Hospital (Izmir, Turkey) between April 2013 and January 2014. The study protocol was approved by the Izmir Katip C¸elebi University local ethical committee (IRB 2013-50). Informed voluntary consent was obtained from all patients and the study was in agreement with the Declaration of Helsinki for Medical Research Involving Human Subjects.
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Nyu Medical Center on 01/14/15 For personal use only.
2
S. Aydogmus et al.
J Matern Fetal Neonatal Med, Early Online: 1–5
Among 180 pregnant women admitted to our hospital in their third trimester (428 weeks) aged between 18 and 40 years that were not on vitamin D replacement, 152 healthy, nullipar women who met the study criteria were included in our study. Multipar women with diseases affecting vitamin D and calcium metabolism such as inflammatory bowel syndrome, gastric surgery, diabetes, thyroid and parathyroid diseases; multiple pregnancies, known use of medications during pregnancy for chronic diseases such as pregestational diabetes, chronic hypertension and kidney diseases, and women with major congenital anomalies were excluded from the study. Venous blood samples for measuring vitamin D levels were taken from each participant during routine investigations and stored at 80 C. Three pregnant women admitted during this period were excluded since they did not agree to participate in the study; 14 women not meeting the inclusion criteria and 11 women with insufficient antenatal registrations were also excluded from the study. Four women who were included in the study earlier had to be excluded after not being able to obtain their natal and postnatal data. Eventually, statistical evaluation was made on 148 patients (Figure 1). Medical records of pregnant women such as the first trimester hemoglobin, TSH, HbA1c levels, fetal and gestational diabetes screening tests in the first and second trimesters, 18th and 22nd week fetal anatomic screening tests and fetal cardiotocography findings, if present, were recorded. Type of delivery, gestational age at birth, birth weight, intensive care of the newborn, peri-and postpartum complications were recorded. Once the number of patients was sufficed, serum 25(OH)D3 concentrations were measured by
Figure 1. Flowchart.
ELISA (Global Diagnostics & Medical Solutions KAP1971/ GDMS, 13E27/2, Mortsel, Belgium). Serum 25(OH)D3 concentrations515ng/ml were classified as a deficiency. Insufficient vitamin D status was defined as a serum 25(OH)D3 level between 15 and 29 ng/ml. Vitamin D levels 430 ng/ml were considered sufficient. (intra-assay coefficient variability: 5.7%, interassay coefficient variability: 4.7%). Gestational hypertension was defined according to WHO criteria as a systolic blood pressure 140 mmHg and/or a diastolic blood pressure 90 mmHg for the first time after 20 weeks’ gestation [14]. Preeclampsia was defined as gestational hypertension and proteinuria and the return of all abnormalities to normal by 12 weeks postpartum. According to the criteria of International Association of Diabetes and Pregnancy Study Group (IADPSG), women were diagnosed as GDM by the 24–28th week GDM screening test if at least one of the values were above the cut-off, consisting of a fasting blood glucose of 92 mg/dl, first hour blood glucose of 180 mg/dl and second hour blood glucose of 153 mg/dl [15]. Anemia was defined as a hemoglobin level of 11g/dl for pregnant women according to the WHO criteria [16]. Pregnant women with serum vitamin D levels 515ng/ml were defined as Group I and women with serum vitamin D levels 15 ng/dl were defined as Group II; data were evaluated retrospectively. Statistical analyses were performed with SPSS for Windows (version 16.0, Chicago, IL). Categorical variables were assessed using the chi-squared test. The numeric variables were analyzed using Student’s t-test and one-way ANOVA. Correlation analysis was performed to investigate
Nullipar pregnant women admied between April 2013 and January 2014, n=180
Included (n=152)
Exluded (n=28) Did not agree to parcipate (n=3) Insufficient antenatal records (n=11) Use of medicaons due to chronic diseases (n=2) Diabetes mellitus (n=3) Mulple pregnancy (n=3) Throid pathology (n=5) Inflammatorybowelsyndrome (n=1)
Excluded (n= 4) Insuffiecient medical data
Analyzed (n=148)
Vitamin D
