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Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status.
Am J Clin Nutr. 2016 08; 104(2):354-61.AJ

Abstract

BACKGROUND

Associations between vitamin D and pregnancy outcomes have been inconsistent.

OBJECTIVES

We described the distribution of 25-hydroxyvitamin D3 [25(OH)D3], 3-epi-25(OH)D3, and 25(OH)D2 in early pregnancy and investigated associations with pre-eclampsia and small-for-gestational-age (SGA) birth, which are indicative of uteroplacental dysfunction.

DESIGN

The SCOPE (Screening for Pregnancy Endpoints) Ireland prospective pregnancy cohort study included 1768 well-characterized low-risk, nulliparous women resident at 52°N. Serum 25(OH)D3, 3-epi-25(OH)D3, and 25(OH)D2 were quantified at 15 wk of gestation with the use of a CDC-accredited liquid chromatography-tandem mass spectrometry method.

RESULTS

The mean ± SD total 25(OH)D concentration was 56.7 ± 25.9 nmol/L, and 17% and 44% of women had 25(OH)D concentrations <30 and <50 nmol/L, respectively. The prevalence of pre-eclampsia was 3.8%, and 10.7% of infants were SGA. There was a lower risk of pre-eclampsia plus SGA combined (13.6%) at 25(OH)D concentrations >75 nmol/L (adjusted OR: 0.64; 95% CI: 0.43, 0.96). The main predictors of 25(OH)D were the use of vitamin D-containing supplements (adjusted mean difference: 20.1 nmol/L; 95% CI: 18.5, 22.7 nmol/L) and summer sampling (adjusted mean difference: 15.5 nmol/L; 95% CI: 13.4, 17.6 nmol/L). Non-Caucasian ethnicity (adjusted mean difference: -19.3 nmol/L; 95% CI: -25.4, -13.2 nmol/L) and smoking (adjusted mean difference: -7.0 nmol/L; 95% CI: -10.5, -3.6 nmol/L) were negative predictors of 25(OH)D. The mean ± SD concentration of 3-epi-25(OH)D3, which was detectable in 99.9% of samples, was 2.6 ± 1.6 nmol/L. Determinants of 3-epi-25(OH)D3 were 25(OH)D3 (adjusted mean difference: 0.052 nmol/L; 95% CI: 0.050, 0.053 nmol/L) and maternal age (adjusted mean difference: -0.018 nmol/L; 95% CI: -0.026, -0.009 nmol/L). The mean ± SD concentration of 25(OH)D2 was 3.1 ± 2.7 nmol/L, which was present in all samples. No adverse effects of 25(OH)D concentrations >125 nmol/L were observed.

CONCLUSIONS

In the first report to our knowledge of CDC-accredited 25(OH)D data and pregnancy outcomes from a large, clinically validated, prospective cohort study, we observed a protective association of a 25(OH)D concentration >75 nmol/L and a reduced risk of uteroplacental dysfunction as indicated by a composite outcome of SGA and pre-eclampsia. Well-designed, adequately powered randomized controlled trials are required to verify this observation. The SCOPE pregnancy cohort was registered at www.anzctr.org.au as ACTRN12607000551493.

Authors+Show Affiliations

Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, The Irish Centre for Fetal and Neonatal Translational Research, and m.kiely@ucc.ie.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences.The Irish Centre for Fetal and Neonatal Translational Research, and Departments of Epidemiology and Public Health and.The Irish Centre for Fetal and Neonatal Translational Research, and Obstetrics and Gynecology, University College Cork, Cork, Ireland.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27357092

Citation

Kiely, Mairead E., et al. "Vitamin D Status Is Associated With Uteroplacental Dysfunction Indicated By Pre-eclampsia and Small-for-gestational-age Birth in a Large Prospective Pregnancy Cohort in Ireland With Low Vitamin D Status." The American Journal of Clinical Nutrition, vol. 104, no. 2, 2016, pp. 354-61.
Kiely ME, Zhang JY, Kinsella M, et al. Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. Am J Clin Nutr. 2016;104(2):354-61.
Kiely, M. E., Zhang, J. Y., Kinsella, M., Khashan, A. S., & Kenny, L. C. (2016). Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. The American Journal of Clinical Nutrition, 104(2), 354-61. https://doi.org/10.3945/ajcn.116.130419
Kiely ME, et al. Vitamin D Status Is Associated With Uteroplacental Dysfunction Indicated By Pre-eclampsia and Small-for-gestational-age Birth in a Large Prospective Pregnancy Cohort in Ireland With Low Vitamin D Status. Am J Clin Nutr. 2016;104(2):354-61. PubMed PMID: 27357092.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. AU - Kiely,Mairead E, AU - Zhang,Joy Y, AU - Kinsella,Michael, AU - Khashan,Ali S, AU - Kenny,Louise C, Y1 - 2016/06/29/ PY - 2016/01/25/received PY - 2016/05/25/accepted PY - 2016/7/1/entrez PY - 2016/7/1/pubmed PY - 2017/6/1/medline KW - 25-hydroxyvitamin D KW - pre-eclampsia KW - pregnancy KW - small for gestational age KW - vitamin D SP - 354 EP - 61 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 104 IS - 2 N2 - BACKGROUND: Associations between vitamin D and pregnancy outcomes have been inconsistent. OBJECTIVES: We described the distribution of 25-hydroxyvitamin D3 [25(OH)D3], 3-epi-25(OH)D3, and 25(OH)D2 in early pregnancy and investigated associations with pre-eclampsia and small-for-gestational-age (SGA) birth, which are indicative of uteroplacental dysfunction. DESIGN: The SCOPE (Screening for Pregnancy Endpoints) Ireland prospective pregnancy cohort study included 1768 well-characterized low-risk, nulliparous women resident at 52°N. Serum 25(OH)D3, 3-epi-25(OH)D3, and 25(OH)D2 were quantified at 15 wk of gestation with the use of a CDC-accredited liquid chromatography-tandem mass spectrometry method. RESULTS: The mean ± SD total 25(OH)D concentration was 56.7 ± 25.9 nmol/L, and 17% and 44% of women had 25(OH)D concentrations <30 and <50 nmol/L, respectively. The prevalence of pre-eclampsia was 3.8%, and 10.7% of infants were SGA. There was a lower risk of pre-eclampsia plus SGA combined (13.6%) at 25(OH)D concentrations >75 nmol/L (adjusted OR: 0.64; 95% CI: 0.43, 0.96). The main predictors of 25(OH)D were the use of vitamin D-containing supplements (adjusted mean difference: 20.1 nmol/L; 95% CI: 18.5, 22.7 nmol/L) and summer sampling (adjusted mean difference: 15.5 nmol/L; 95% CI: 13.4, 17.6 nmol/L). Non-Caucasian ethnicity (adjusted mean difference: -19.3 nmol/L; 95% CI: -25.4, -13.2 nmol/L) and smoking (adjusted mean difference: -7.0 nmol/L; 95% CI: -10.5, -3.6 nmol/L) were negative predictors of 25(OH)D. The mean ± SD concentration of 3-epi-25(OH)D3, which was detectable in 99.9% of samples, was 2.6 ± 1.6 nmol/L. Determinants of 3-epi-25(OH)D3 were 25(OH)D3 (adjusted mean difference: 0.052 nmol/L; 95% CI: 0.050, 0.053 nmol/L) and maternal age (adjusted mean difference: -0.018 nmol/L; 95% CI: -0.026, -0.009 nmol/L). The mean ± SD concentration of 25(OH)D2 was 3.1 ± 2.7 nmol/L, which was present in all samples. No adverse effects of 25(OH)D concentrations >125 nmol/L were observed. CONCLUSIONS: In the first report to our knowledge of CDC-accredited 25(OH)D data and pregnancy outcomes from a large, clinically validated, prospective cohort study, we observed a protective association of a 25(OH)D concentration >75 nmol/L and a reduced risk of uteroplacental dysfunction as indicated by a composite outcome of SGA and pre-eclampsia. Well-designed, adequately powered randomized controlled trials are required to verify this observation. The SCOPE pregnancy cohort was registered at www.anzctr.org.au as ACTRN12607000551493. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/27357092/Vitamin_D_status_is_associated_with_uteroplacental_dysfunction_indicated_by_pre_eclampsia_and_small_for_gestational_age_birth_in_a_large_prospective_pregnancy_cohort_in_Ireland_with_low_vitamin_D_status_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.116.130419 DB - PRIME DP - Unbound Medicine ER -