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VITAMIN D DEFICIENCY IN PREGNANCY AND ITS RELATIONSHIP WITH
MATERNAL-FETAL OUTCOMES IN WOMEN LIVING IN THE TROPICS
Cynthia Salgado, Juliana Maia, Manoel Soares Filho, Paula Aragão, Luiz Griz, Cristiane Farias, Francisco Bandeira
Division of Endocrinology, Diabetes and Obstetrics, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
INTRODUCTION
Vitamin D deficiency in pregnancy has been reported as
variable as 5 to 50% and its association with pregnancy-related
outcomes is still controversial. Measurement of maternal serum
25OHD at the end of pregnancy is closely related to cord blood
levels.
OBJECTIVE
The aim of this study was to evaluate de prevalence of vitamin
D deficiency during pregnancy and its relationship with
maternal-fetal outcomes.
METHODS
Maternal-fetal clinical and laboratory parameters were
analyzed in 165 consecutive pregnant women (mean age
27,30 ±6,32yr). Blood samples were collected at the end of
pregnancy and vitamin D deficiency was defined according to
two cut points for serum 25OHD concentrations (<20 and <30
ng/ml).
RESULTS
40% had skin phototype between I-III, 65% had a cesarean
section as a method of delivery and 72% at term. Gestational
diabetes, hypertension and pre-eclampsia occurred in 16.4%,
31.5% and 20.6%, respectively. Mean serum 25OHD was 27.5
±7.5ng/ml, 67% had levels <30ng/ml and 17% <20ng/ml.
Offspring data showed 80% adequate for gestational age, head
circumference 34.1 ±2.1 cm, arm circumference 9.8 ±1.7cm,
weight 3.0 ±0.7Kg, length 47.4 ±3.5cm and 95% had Apgar
score >5.
Women with 25OHD ≥30ng/ml (in comparison with those with
<20ng/ml) had significant higher serum albumin concentrations
(3.4 ±0.4 vs 3.2 ±0.4g/dl; p=0.03); lower total hemoglobin
(11.23 ±1.2 vs 12.1 ±1.6g/dl; p=0.005); lower BMI at the end
of pregnancy (29.3 ±5.5 vs 32.3±5.7Kg/m2; p=0.03);
and their neonate had lower arm circumference (9.5 ±1.9
vs 10.3 ±1.1cm; p=0.03). There were no differences in
mean sun index between the 2 groups (3.2 ±4.1 vs 3.5
±4.3; p=0.3).
More patients with skin phototypes between I-III had
25OHD <20ng/ml (21% vs 14% in those between IV-VI) but
without statistical significance (p=0.8). There was no
difference using cut point of 25OHD <30ng/ml between
patients with skin phototypes I–III and IV-VI (66.2% vs 68%,
p= 0.8). There was also no significant difference in the rate
of pre-term birth, gestational diabetes and pre-eclampsia
between the two groups.
We found a high prevalence of vitamin D deficiency in late
pregnancy in women living in a tropical area, which was
unrelated to sun index and skin pigmentation. Vitamin D
sufficiency was associated with better nutritional status and
hemodynamic adaptation during pregnancy and to less
neonate adiposity. We found no association between
vitamin D deficiency and pre-term birth, gestation diabetes
or pre-eclampsia.
Table 1 - Maternal Data According to 25 OHD Levels
Age
Sun Index
≥30ng/ml
< 20ng/ml
Gender
Male (%)
Female (%)
CONCLUSION
<20ng/ml
Table 2 - Offspring Data according to 25 OHD Levels
p
≥ 30 ng/ml
36,8
43,3
p
63,2
56,7 p = 587
Weight*
3145 ± 742,33 3054 ± 786,66 p = 0,614
Stature*
48,54 ± 2,26
47,51 ± 4,13
p = 0,153
APGAR 1' (%)
≤5
>5
66,7
38,8
33,3
61,2 p = 0,560
APGAR 5' (%)
≤7
>7
50
39,7
50
60,3 p = 1,000
Head Circumference*
34,46 ± 1,66
33,73 ± 1,86
p = 0,085
Arm Circumference*
10,32 ± 1,09
9,57 ± 1,93
p = 0,030
26,04 ± 4,64 27,21 ± 6,21 p = 0,383
3,50 ± 4,29
3,21 ± 4,19
p = 0,768
(*) DATA EXPRESSED AS MEAN ± SD
Hemoglobin
12,17 ± 1,63 11,23 ± 1,21 p = 0,005
PTH
27,64 ± 25,43 29,18 ± 27,03 p = 0,816
Calcium
8,62 ± 0,56
8,57 ± 0,48
p = 0,701
Albumin
3,20 ± 0,42
3,40 ± 0,36
p = 0,029
Early BMI
27,05 ± 7,13 24,39 ± 4,23 p = 0,078
Final BMI
32,27 ± 5,74 29,38 ± 5,52 p = 0,030
DATA EXPRESSED AS MEAN ± SD
REFERENCES
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chances of pregnancy and pregnancy outcomes: a cohort study in healthy
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3-Clifton-Bligh RJ, McElduff P, McElduff A. Maternal vitamin D deficiency,
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