Hypovitaminosis D in pregnancy and its correlation with preeclampsia and gestational diabetes mellitus

Authors

  • Ankita Kumari Department of Obstetrics and Gynecology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
  • Shaila Mitra Department of Pathology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
  • Harish C Tiwari Department of Community Medicine, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
  • Reena Srivastav Department of Obstetrics and Gynecology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20170551

Keywords:

Gestational diabetes mellitus, Preeclampsia, Vitamin D deficiency

Abstract

Background: Hypovitaminosis D has been associated with a number of adverse pregnancy outcomes, and has been recognised as a public health concern. The objective of this study was to determine the impact of Vitamin D deficiency on maternal complications like gestational diabetes mellitus (GDM) and preeclampsia (PE) among pregnant women.

Methods: This was a case control study undertaken at antenatal clinics and indoor of BRD Medical College, Gorakhpur, Uttar Pradesh, India. Two maternal blood samples, one at <20 weeks and other at term along with cord blood at delivery were taken. Patients were classified into preeclampsia (n=60), gestational diabetes mellitus (n=35) and control group (n=180) after abstracting past medical records at delivery. Vitamin D was estimated by 25- Hydroxyvitamin D125 RIA kit and categorized according to ACOG criteria. Statistical analysis was done by using chi square test, binary logistic regression and Pearson’s correlation coefficient to compare between two variables. P<0.05 was considered statistically significant.

Results: Out of 275 women included in the study, 78% of women were Vitamin D deficient. Mean serum vitamin D was significantly lower among preeclamptic women 11.53±6.22 ng/ml and GDM women 12.62±6.69 ng/ml as compared to controls 24.25±14.44 ng/ml (median=18.2 ng/ml) (P<0.05). Vitamin D deficiency was significantly higher in pregnant women GDM (94.28% vs 68.3%) and preeclampsia (96.67% vs 68.3%) when compared to uncomplicated group.

Conclusions: Maternal vitamin D deficiency is highly prevalent in early pregnancy and is significantly associated with elevated risk for GDM and preeclampsia.

References

Duckitt K, Harrington D. Risk factors for preeclampsia in antenatal booking: systematic review of controlled studies. BMJ. 2005;330: 565.

Guidotti R. Geographical variation in the incidence of hypertension in pregnancy. Am J Obstet Gynecol. 1988;158:80-3.

Roberts CL, Ford JB, Algert CS, Antosen S, Chalmers J, Cnattingires S et al. Population based trends in pregnancy hypertension and preeclampsia: an international comparative study. BMJ. 2011;1:1-9.

Osungbade KO, Ige OK. Implications for health system strengthening. J Pregnancy. 2011;2011:1-6.

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Vanlook PFA. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Evans KN, Bulmer JN, Kibly MD. Hewson M Vitamin D and placental decidual function. J soc Gynecol Investig. 2004;11:263-71.

Norman AV. Vitamin D receptor: new assignments for an already busy receptor. Endocrinol. 2006;147:5542-8.

Zhender D, Bland R, Williams MC, McNinch RW, Howie AJ, Stewart PM et al. Extrarenal expression of 25-hydroxy-vitamin d(3)-1 alpha hydrodylase. J Clin Endocrinol Metab. 2001;86:888-94.

American Diabetes Association. Standards of medical care in diabetes . Dia care. 2014;37(1):S14-S80.

Kjos SL, Buchanan TA. Gestational diabetes mellitus. N Eng J Med. 1999;341:1749.

Reece EA, Leguizamon G, Wiznitzer A. Gestational diabetes. The need for a common ground. Lancet. 2009;373,1789-97.

Diagnosis and management of preeclampsia and eclampsia. American College of Obstetricians and Gynecologists (ACOG) Practice bulletin. Obstet Gynecol. 2002;99(1):159-67.

Diagnosis and classification of Diabetes Mellitus. American Diabetes Association. Dia Care. 2014;37(1):S81-90.

Holick MF. Vitamin D deficiency. N Eng J Med. 2007;357:266-81.

Madhusmita M, Daniele P, Anna P, Paulo F, Michael K. Vitamin D deficiency in children and its management. On behalf of Drug and therapeutics committee of Lawsons Wilkins Endocrine society. Pediatrics. 2008;2:398-417.

Munns C, Zocharin MR, Roddo CP. Prevention and treatment of infant and childhood Vitamin D deficiency in Australia and New Zealand consensus statement. Med J Aust. 2006;185:268-72.

Gordan CMDPHA, Grace E, Emans SJ. Prevalance of Vitamin D deficiency among healthy adolescents. Arch Pediatr Adoles Mes. 2004;6:531-7.

Bener A, Al- Hamaq AOOA, Saleh NM. Association between vitamin D deficiency and adverse pregnancy outcome: global comparisons. Int J Wom Health. 2013;5:523-31.

Lawoyn TO, Ani F. Epidemiological aspects of preeclampsia in Saudi Arabia. East Afr Med J. 1996;73:404-6.

Rosenberg TJ. Pre-pregnancy weight and adverse perinatal outcome in an ethnically diverse population. Obstet Gynecol. 2004,103:219-24.

Cedergerm MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004;103:219-24.

Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, et al. Obesity, obstetric complications and caesarean delivery rate- a population based screening study. Am J Obstet Gynecol 2004; 190: 1091-1097.

Ramos GA, Caughly AB. The interrelationship between ethnicity and obesity on obstetric outcomes. Am J Obstet Gynecol 2005; 193: 1089- 1093.

Nohr EA et al. Prepregnancy and fetal death: a study within the Danish national birth cohort. Obstet Gynecol. 2005;106:250-9.

Bodnar LM, Ness RB, Harger GF, Roberts JM. Inflammation and triglycerides partially mediate the effect of prepregnancy body mass index on the result of preeclampsia. Am J Epidemiol. 2005;162:1198-206.

Belogolovkin V. The effect of low body mass index on the development of gestational hypertension and preeclampsia. J Matern Fetal Neonatal Med. 2007;20:509-13.

Haugen M, Brantsaeteo AL, Trogsted L, Alexander J, Roth C, Pand M, Meltzer HM. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiol (Cambridge mass). 2009;20(5):720-6.

Ros HS, Cnattingius S, Lipworth L. Comparison of risk factors for preeclampsia and gestation HTN in a population based cohort study. Am J Epidemiol. 1998;147:1062-70.

Baker AM, Haeri S, Camagro CA Jr, Stuebe AM. A nested case control study of mid gestation vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2010;95:5105-9.

Robinsons CJ, Alanis MC, Wagner CL, Hollis BW, Johnson DD. Plasma 25 hydroxyvitamin D levels in early onset severe preeclampsia. Am J Obstet Gynecol. 2010;203:366-e1-e6.

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 preeclampsia. BJOG. 2010;117:1593-8.

Bodnar LM, Catov JM, Simhan HN, Holick MF, Robert PW, James RM. Maternal Vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92:3517-22.

Zeghoud F, Vervel C, Guillozo H, Walrant Debray O, Boutignon H, Garabedian M. Subclinical Vitamin D deficiency in neonates: definition and response to vitamin D suppliments. Am J Clin Nutr. 1997;65:771-8.

Maghbooli Z, Hossein NA, Karini F, Shafaei AR, Larijani B. Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes metab Res Rev. 2008;24:27-32.

Ferrant HJ, Krishnaveni GV, HillJC. Vit D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J Clin Nutr. 2009;63:646-52.

Tsur A, Feldman BS, Feldhammer I, Hoshen MB, Leibowitz G, Balicer RD. Decreased serum concentrations of 25 hydroxycholecalciferol are associated with increased risk of progression to impaired fasting glucose and diabetes. Dia care. 2013;36:1361-7.

McGrath J. Does imprinting with low prenatal vitamin D contribute to the risk of various adult disorders? Med hypothesis. 2001;56:367-71.

Downloads

Published

2017-02-19

Issue

Section

Original Research Articles