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Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes.
Am J Clin Nutr. 2018 10 01; 108(4):821-829.AJ

Abstract

Background

Associations of vitamin D with perinatal outcomes are inconsistent and few studies have considered the wider calcium metabolic system.

Objectives

We aimed to explore functional vitamin D deficiency in pregnancy by investigating associations between vitamin D status, parathyroid hormone (PTH), and perinatal outcomes.

Design

SCOPE (Screening for Pregnancy Endpoints) Ireland is a prospective cohort study of low-risk, nulliparous pregnant women. We measured serum 25-hydroxyvitamin D [25(OH)D] and PTH at 15 wk of gestation in 1754 participants.

Results

Mean ± SD 25(OH)D was 56.6 ± 25.8 nmol/L (22.7 ± 10.3 ng/mL) and geometric mean (95% CI) PTH was 7.84 pg/mL (7.7, 8.0 pg/mL) [0.86 pmol/L (0.85, 0.88 pmol/L)]. PTH was elevated in 34.3% of women who had 25(OH)D <30 nmol/L and in 13.9% of those with 25(OH)D ≥75 nmol/L. Whereas 17% had 25(OH)D <30 nmol/L, 5.5% had functional vitamin D deficiency, defined as 25(OH)D <30 nmol/L with elevated PTH. Elevated mean arterial pressure (MAP), gestational hypertension, pre-eclampsia, and small-for-gestational-age (SGA) birth were confirmed in 9.2%, 11.9%, 3.8%, and 10.6% of participants, respectively. In fully adjusted regression models, neither low 25(OH)D nor elevated PTH alone increased the risk of any individual outcome. The prevalence of elevated MAP (19.1% compared with 9.7%) and SGA (16.0% compared with 6.7%) were highest (P < 0.05) in those with functional vitamin D deficiency compared with the reference group [25(OH)D ≥75 nmol/L and normal PTH]. The adjusted prevalence ratio (PR) and RR (95% CIs) for elevated MAP and SGA were 1.83 (1.02, 3.27) and 1.53 (0.80, 2.93), respectively. There was no effect of functional vitamin D deficiency on the risk of gestational hypertension (adjusted RR: 1.00; 95% CI: 0.60, 1.67) or pre-eclampsia (adjusted RR: 1.17; 95% CI: 0.32, 4.20).

Conclusion

The concept of functional vitamin D deficiency, reflecting calcium metabolic stress, should be considered in studies of vitamin D in pregnancy. The SCOPE pregnancy cohort is registered at http://www.anzctr.org.au as ACTRN12607000551493.

Authors+Show Affiliations

Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland. The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland. The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland. The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.

Pub Type(s)

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

Language

eng

PubMed ID

30169726

Citation

Hemmingway, Andrea, et al. "Exploring the Concept of Functional Vitamin D Deficiency in Pregnancy: Impact of the Interaction Between 25-hydroxyvitamin D and Parathyroid Hormone On Perinatal Outcomes." The American Journal of Clinical Nutrition, vol. 108, no. 4, 2018, pp. 821-829.
Hemmingway A, Kenny LC, Malvisi L, et al. Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes. Am J Clin Nutr. 2018;108(4):821-829.
Hemmingway, A., Kenny, L. C., Malvisi, L., & Kiely, M. E. (2018). Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes. The American Journal of Clinical Nutrition, 108(4), 821-829. https://doi.org/10.1093/ajcn/nqy150
Hemmingway A, et al. Exploring the Concept of Functional Vitamin D Deficiency in Pregnancy: Impact of the Interaction Between 25-hydroxyvitamin D and Parathyroid Hormone On Perinatal Outcomes. Am J Clin Nutr. 2018 10 1;108(4):821-829. PubMed PMID: 30169726.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes. AU - Hemmingway,Andrea, AU - Kenny,Louise C, AU - Malvisi,Lucio, AU - Kiely,Mairead E, PY - 2018/02/27/received PY - 2018/06/11/accepted PY - 2018/9/1/pubmed PY - 2019/8/20/medline PY - 2018/9/1/entrez SP - 821 EP - 829 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 108 IS - 4 N2 - Background: Associations of vitamin D with perinatal outcomes are inconsistent and few studies have considered the wider calcium metabolic system. Objectives: We aimed to explore functional vitamin D deficiency in pregnancy by investigating associations between vitamin D status, parathyroid hormone (PTH), and perinatal outcomes. Design: SCOPE (Screening for Pregnancy Endpoints) Ireland is a prospective cohort study of low-risk, nulliparous pregnant women. We measured serum 25-hydroxyvitamin D [25(OH)D] and PTH at 15 wk of gestation in 1754 participants. Results: Mean ± SD 25(OH)D was 56.6 ± 25.8 nmol/L (22.7 ± 10.3 ng/mL) and geometric mean (95% CI) PTH was 7.84 pg/mL (7.7, 8.0 pg/mL) [0.86 pmol/L (0.85, 0.88 pmol/L)]. PTH was elevated in 34.3% of women who had 25(OH)D <30 nmol/L and in 13.9% of those with 25(OH)D ≥75 nmol/L. Whereas 17% had 25(OH)D <30 nmol/L, 5.5% had functional vitamin D deficiency, defined as 25(OH)D <30 nmol/L with elevated PTH. Elevated mean arterial pressure (MAP), gestational hypertension, pre-eclampsia, and small-for-gestational-age (SGA) birth were confirmed in 9.2%, 11.9%, 3.8%, and 10.6% of participants, respectively. In fully adjusted regression models, neither low 25(OH)D nor elevated PTH alone increased the risk of any individual outcome. The prevalence of elevated MAP (19.1% compared with 9.7%) and SGA (16.0% compared with 6.7%) were highest (P < 0.05) in those with functional vitamin D deficiency compared with the reference group [25(OH)D ≥75 nmol/L and normal PTH]. The adjusted prevalence ratio (PR) and RR (95% CIs) for elevated MAP and SGA were 1.83 (1.02, 3.27) and 1.53 (0.80, 2.93), respectively. There was no effect of functional vitamin D deficiency on the risk of gestational hypertension (adjusted RR: 1.00; 95% CI: 0.60, 1.67) or pre-eclampsia (adjusted RR: 1.17; 95% CI: 0.32, 4.20). Conclusion: The concept of functional vitamin D deficiency, reflecting calcium metabolic stress, should be considered in studies of vitamin D in pregnancy. The SCOPE pregnancy cohort is registered at http://www.anzctr.org.au as ACTRN12607000551493. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/30169726/Exploring_the_concept_of_functional_vitamin_D_deficiency_in_pregnancy:_impact_of_the_interaction_between_25_hydroxyvitamin_D_and_parathyroid_hormone_on_perinatal_outcomes_ DB - PRIME DP - Unbound Medicine ER -