Are Vitamin D Levels Linked to Preeclampsia and Preterm Birth?
BACKGROUND AND PURPOSE:
There are previous studies showing that vitamin D deficiency may be related to adverse obstetrical outcomes
Recent Cochrane review of prenatal vitamin D supplementation (see ‘Related ObG Topics’ below) found that vitamin D, compared with no intervention or placebo, reduced the risk of preterm birth and may lower risk of preeclampsia
Gernand et al. (BJOG, 2017) examined the correlation between maternal vitamin D status and risk of preeclampsia and preterm birth in women at high-risk for preeclampsia
Analysis of prospectively collected data and blood samples from a trial of prenatal low-dose aspirin in women at high risk for preeclampsia (multicentered MFMU study)
25-hydroxyvitamin D [25(OH)D] concentrations were measured from stored maternal serum samples drawn at 12–26 weeks’ gestation (n= 822)
Used multiple cut-points of 30, 50, and 75 nmol/l (which correspond to 12, 20, and 30 ng/ml, respectively)
Primary outcomes were preeclampsia and preterm birth
Mixed effects models were used to control for confounders including prepregnancy BMI and race
Majority were non-Hispanic black (62.8%), parous (77.6%), 20–29 years old (56.1%), not married (63.4) and non-smokers (83.2%)
12% of women were vitamin D deficient [25(OH)D <30 nmol/l]
Compared to women with 25(OH)D ≥75 nmol/l (highest cut-point level)
Women with 25(OH)D <30 had a 2.4-fold (95% CI 1.0–5.6) higher risk of early-onset pre-eclampsia (<35 weeks’ gestation)
Women with 25(OH)D <50 nmol/l had a 1.8-fold (95% CI 1.0–3.2) increased risk of preterm birth at <35 weeks, mostly driven by indicated preterm births
No association between vitamin D status and preeclampsia or preterm birth at <37 weeks was observed
Low levels of maternal vitamin D status in the second trimester were associated with higher risk of early-onset pre-eclampsia and preterm birth at <35 weeks in women at high risk for pre-eclampsia
The authors are in agreement with Cochrane Review that more rigorous studies are need to determine causation and if supplementation is effective
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