Correlation of Vitamin D Levels in Term Normotensive and Pre-eclamptic Patients in Labor

Abstract

Objective To evaluate maternal vitamin D levels in term normotensive and preeclamptic patients in labor and to assess additional factors such as maternal and cord blood levels of calcium, phosphorus, parathormone, and alkaline phosphatase and associated factors such as BMI, birth weight, and mode of delivery. Method This was a case control study carried out in Department of Obstetrics and Gynaecology, ESIC-PGIMSR, New Delhi, India from August 2012-April 2014.A total of 100 patients were divided into two equal groups (control and study groups of 50 each). Control group had women with singleton uncomplicated, term normotensive pregnant women in labor while the study group composed of term preeclamptic women in labor. Blood samples were drawn for vitamin D, serum calcium, serum phosphorus, serum alkaline phosphatase, and serum parathormone levels during first stage of labor, and subsequently, their levels were evaluated in cord blood also. 123Results All the enrolled patients had vitamin D deficiency pointing toward a universal prevalence of this micronutrient deficiency in antenatal patients. We found more incidence of severe vitamin D deficiency (90 %) in preeclamptic patients as compared to normotensive patients (62 %). Also preeclamptic group had lower median vitamin D levels (3.9 ng/ml) when compared to normotensive group (9 ng/ml). Similarly, all the neonates were found to be vitamin D deficient as assessed by their cord blood levels. Neonates born to preeclamptic mothers had lower median cord blood vitamin D levels (4.4 ng/ml) when compared to those born to normotensive mothers (7.25 ng/ml). The mean maternal calcium levels followed trends observed in vitamin D levels with preeclamptic patients having consistently lower calcium levels (mean value of 8.50 ± 0.80 mg/dl) when compared to normotensive patients (mean value of 8.89 ± 0.56 mg/dl). Preeclamptic group was found to have more number of patients (58 %) with higher BMI when compared to normotensive group (32 % of patients). A slightly more incidence (36 %) of low birth weight babies is being born to preeclamptic mothers as compared to normotensive mothers (34 %). Significantly a more number of patients (36 %) with vitamin D levels below 15 ng/ml underwent cesarean section when compared to only 9 % of patients having vitamin D level above this level. Conclusion Preeclampsia is indeed associated with lower vitamin D levels, and its pathophysiology involves vitamin D and calcium metabolism.

High burden of hypovitaminosis D among the children and adolescents in South Asia: A systematic review and meta-analysis

“…Several kinds of measurement methods were used to determine the serum level of vitamin D. Among these Radioimmunoassay (RIA; 14 out of 41) Chemiluminescent Immunoassay (CLIA; 9 out of 41), and Enzyme-linked Immunosorbent assay (ELISA; 4 out of 41) were mostly used. Only two studies did not mention their procedure of vitamin D estimation [49,64]. Among the selected studies, more than half did not mention demographic area (25 out of 41), and socio-economic condition (26 out of 41) for the study population.…”

“…We found 6 out of 41 studies which included participants who were up to 1 month in age. Among, these studies 4 were conducted in India and 2 in Pakistan [46,49,52,55,63,64]. Together, these studies consisted of 763 participants and random-effect meta-analysis revealed that 85% [95% CI: 76%…”

Association of maternal serum vitamin D level with preeclampsia or eclampsia and its relationship with neonatal outcome and neonatal serum calcium level

“…27 Further supporting our results, Gupta et al estimated serum vitamin D level in term normotensive and preeclamptic. 28 All the patients enrolled in both the study and control group were found to be vitamin D deficient. They found more incidence of severe vitamin D deficiency (90%) in preeclamptic patients as compared to normotensive patients (62%).…”

A study to evaluate serum 25-hydroxy vitamin D3 and calcium levels in maternal and cord blood and their effect on pregnancy outcome

“…There have been evidence through studies that vitamin D deficiency is associated with an increased risk of pre-eclampsia and small for gestational age (SGA) infants. 5,12,13 Baker et al have shown a five-fold increased risk of severe pre-eclampsia with vitamin D levels less than 50 nmol/l. 14 Early onset severe pre-eclampsia has been shown to be associated with reduced levels of vitamin D compared to control women.…”