Role of vitamin D in reducing the risk of preterm labour

Jyoti Singh, Chella Hariharan, Dilip Bhaumik

Abstract


Background: Although vitamin D insufficiency is increasingly recognized as a health problem across the world, inadequate vitamin D status appears to be particularly prevalent in certain populations such as the elderly and pregnant women. With respect to the latter, impaired vitamin D status during gestation is associated with adverse outcomes in pregnancy such as preterm birth and poor neonatal outcome.

Methods: A total of 100 healthy, pregnant women in Sawangi, Meghe, Wardha, were recruited in 2012. Of these, 50 were randomised to receive either 2000 IU (study group) of vitamin D3 per day from 12-16 weeks of gestation of pregnancy. The remaining 50 pregnant women, who formed the control group were not supplemented with any drug. 25-hydroxyvitamin D [25(OH)D] in maternal blood was measured by chemiluminescence immunoassay, at recruitment and at the time of delivery and a serum 25(OH)D level <30 nmol/l was defined as deficiency.

Results: Patients had deficiency of vitamin D at baseline (80.00%) was converted into sufficient level (76.00%) in cases after vitamin D supplementation. It was statistically significant at 5% level as P value <0.05 and there was also evidence in reduction of preterm birth.

Conclusions: Maternal vitamin D deficiency is associated with significant increase risk for premature birth with P = 0.001. Maternal serum vitamin D sufficiency can be achieved by supplementing pregnant women with 2000 IU vitamin D supplements.


Keywords


Vitamin D, Preterm labour neonatal and maternal outcome

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References


Romero R, Mazor M, Munoz H, Gomez R, Galasso M, Sherer D. The preterm labor syndrome. N Y Acad Sci. 1994;734:414-29.

Gibbs R, Romero R, Hillier S, Eschenbach D, Sweet R. A review of premature birth and subclinical infection. Am J Obstet Gynecol. 1992;166:1515-28.

Misra PK, Kumar R, Malik GK, Mehra P, Awasthi S. Simple hematological tests for diagnosis of neonatal sepsis. Indian Pediatr. 1989 Feb;26(2):156-60.

Romero R, Espinoza J, Gonçalves LF, Kusanovic JP, Friel LA, Nien JK. Inflammation in preterm and term labour and delivery. Semin Fetal Neonatal Med. 2006 Oct;11(5):317-26.

Bouillon R, Van Assche FA, Van Baelen H, Heyns W, De Moor P. Influence of the vitamin D-binding protein on the serum concentration of 1,25-dihydroxyvitamin D3. Significance of the free 1,25-dihydroxyvitamin D3 concentration. J Clin Invest. 1981;67(3):589-96.

Weisman Y, Harell A, Edelstein S, David M, Spirer Z, Golander A. 1 alpha, 25-Dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 in vitro synthesis by human decidua and placenta. Nature. 1979;281:317-9.

Evans KN, Bulmer JN, Kilby MD, Hewison M. Vitamin D and placental-decidual function. J Soc Gynecol Invest. 2004;11:263-71.

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

Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep). 2007 Aug;(158):1-235.

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

Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academy Press; 2010.

Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, et al. National, regional and worldwide estimates of preterm birth. Lancet. 2012. Jun;379(9832):2162-72.

Klein LL, Gibbs RS. Infection and preterm birth. Obstet Gynecol Clin North Am. 2005 Sep;32(3):397-410.

Gibbs RS, Romero R, Hillier SC, Eschenbach DA, Sweet RL. A review of premature birth and subclinical infection. Am J Obstet Gynecol. 1992 May;166(5):1515-25.

Liu NQ, Hewison M. Vitamin D, the placenta and pregnancy. Arch Biochem Biophys. 2012 Jul;523(1):37-47.

Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll-like receptor triggering of a vitamin D-mediated humanantimicrobial response. Science. 2006;311(5768):1770-3.

Nizet V, Ohtake T, Lauth X, Trowbridge J, Rudisill J, Dorschner RA, et al. Innate antimicrobial peptide protects the skin from invasive bacterial infection. Nature. 2001;414(6862):454-7.

Chesney RW. Vitamin D and the magic mountain: the anti-infectious role of the vitamin. J Pediatr. 2010;156(5):698-703.

Muller K, Diamant M, Bendtzen K. Inhibition of production and function ofinterleukin-6 by 1,25-dihydroxyvitamin D3. Immunol Lett. 1991;28(2):115-20.

Diaz L, Noyola-Martinez N, Barrera D, Hernandez G, Avila E, Halhali A, et al. Calcitriol inhibits TNF-alpha-induced inflammatory cytokines inhuman trophoblasts. J Reprod Immunol. 2009;81(1):17-24.

Helming L, Bose J, Ehrchen J, Schiebe S, Frahm T, Geffers R, et al. 1 alpha, 25-Dihydroxyvitamin D3 is a potent suppressor of interferon gamma-mediated macrophage activation. Blood. 2005;106(13):4351-8.

Bouillon R, Carmeliet G, Verlinden L, van Etten E, Verstuyf A, Luderer HF, et al. Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev. 2008;29(6):726-76.

Liu N, Kaplan AT, Low J, Nguyen L, Liu GY, Equils O, et al. Vitamin D induces innate antibacterial responses in human trophoblasts via an intracrine pathway. Biol Reprod 2009;80(3):398-406.

Delorme AC, Danan JL, Acker MG, Ripoche MA, Mathieu H. In rat uterus 17 beta-estradiol stimulates a calcium-binding protein similar to the duodenal vitamin D-dependent calcium-binding protein. Endocrinology. 1983;113(4):1340-7.

Tribe RM. Regulation of human myometrial contractility during pregnancy and labour: are calcium homeostatic pathways important? Exp Physiol. 2001;86(2):247-54.

Salvesen KA, Morkved S. Randomized controlled trial of pelvic floor muscle training during pregnancy. BMJ. 2004;329:378-80.

Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupiilai N. Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr. 2000;72:472-5.

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 Clin Nutr. 2005;81:1060-4.

Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: Double blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011;26:2341-57.

Shibata M, Suzuki A, Sekiya T, Sekiguchi S, Asano S, Udagawa Y, et al. High prevalence of hypovitaminosis D in pregnant Japanese women with threatened premature delivery. J Bone Miner Metab. 2011 Sep;29(5):615-20.

Wagner CL, McNeil R, Hamilton SA, Winkler J, Rodriguez Cook C, Warner G, et al. A randomized trial of vitamin D supplementation in 2 community health center networks in South Carolina. Am J Obstet Gynecol. 2013 Feb;208(2):137.e1-13.

Mehrdad Shakiba, Mohamad Reza Iranmanesh, Yazd. Vitamin D requirement in pregnancy to prevent deficiency in neonates: a randomised trial. Singapore Med J. 2013;54(5):285-8.

Henan DhSkheel ALjebory, Abeer N. Hamdy. The correlation between vitamin D level and primary cesarean section. Middle East J Fam Med. 2014 Jun;12(5):4-10.

Scholl TO, Chen X, Stein P. Maternal vitamin D status and delivery by cesarean. Nutrients. 2012 Apr;4(4):319-30.

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

Brooke OG, Brown IR, Bone CD, Carter ND, Cleeve HJ, Maxwell JD, et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J. 1980 Mar;280(6216):751-4.

Marya RK, Rathee S, Dua V, Sangwan K. Effect of vitamin D supplementation during pregnancy on fetal growth. Indian J Med Res. 1988;88:488-92.

Hossain N, Kanani FH, Ramzan S, Kausar R, Ayaz S, Khanani R, et al. Obstetric and neonatal outcomes of maternal vitamin D supplementation: results of an open-label, randomized controlled trial of antenatal vitamin D supplementation in Pakistani women. J Clin Endocrinol Metab. 2014 Jul;99(7):2448-55.