Pregnancy Outcomes among Obese Pregnant Women with Varying Levels of Vitamin D in King Abdulaziz University Hospital: A Single-center Retrospective Study

Abstract

BackgroundVitamin D deficiency among pregnant women is a global issue. Despite its high prevalence, the optimal level of vitamin D among pregnant women is not well established. On the other hand, multiple adverse pregnancy outcomes have been strongly associated with vitamin D deficiency.ObjectivesTo identify the potential effect varying levels of vitamin D have on maternal and neonatal outcomes.MethodsThis is a non-intervention retrospective record review conducted on pregnant women who delivered in King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 1, 2013, and December 31, 2018. Data were collected from their hospital electronic files and analyzed by Statistical Package for Social Sciences (SPSS; IBM Corp., Armonk, NY) version 24. A p-value of <0.05 is used to calculate statistical significance.ResultsA total of 9095 pregnant women had delivered in the last five years, 137 of these pregnant women had vitamin D measurement during their pregnancy. Out of 137, 99 were deficient, 20 optimal, 11 therapeutic, and two excess. A total of 97 (70.8%) were Saudis and 40 (29.2%) were non-Saudis. The majority of pregnant women in obese class 1 and 2 were deficient with 99 cases, while obese class 3 was mostly those with optimal levels. Regarding pregnancy outcomes, those with vitamin D deficiency had the majority of undesired antepartum, neonatal, and postpartum outcomes. Placenta previa, endometritis, poor APGAR scores, birth defects, intrauterine fetal demise, low birthweight, and macrosomia were significantly associated with abnormal vitamin D levels (P < 0.05).ConclusionAlthough vitamin D optimum level during pregnancy is not known, pregnant women with deficient levels appeared to have more serious risks to develop adverse pregnancy outcomes. Therefore, early screening during prenatal visit or antenatal for vitamin D level with vitamin D supplementations is important to reduce these negative pregnancy outcomes for pregnant women with deficient levels.

Predictors of Adverse Pregnancy Outcomes in Pregnant Women Living with Obesity: A Systematic Review

“…Inspection of these citations by two reviewers excluded a total of 6692 citations due to not meeting inclusion criteria, leading to 1202 articles for review at full text. Amongst these citations, a total of 1141 were excluded by reviewers (reasons provided in Figure 1 ), leaving a total of 61 publications for final inclusion [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ,…”

“…Table 1 presents a summary of the outcomes of interest that were reported by each of the included studies. Outcomes evaluated consisted of the following measures: GDM (32; 52.5%) [ 13 , 14 , 16 , 17 , 18 , 21 , 25 , 29 , 30 , 36 , 37 , 38 , 39 , 41 , 43 , 44 , 45 , 46 , 47 , 50 , 51 , 53 , 54 , 56 , 57 , 58 , 60 , 64 , 65 , 66 , 68 , 69 ]; LBW or SGA (30; 49.2%) [ 13 , 14 , 15 , 16 , 17 , 21 , 23 , 26 , 27 , 30 , 36 , 37 , 41 , 46 , 47 , 50 , 51 , 52 , 53 , 55 , 57 , ...…”

“…Five studies [ 14 , 17 , 27 , 35 , 70 ] reported findings from analyses of race/ethnicity: Halloran et al [ 27 ] and Anderson et al [ 70 ] found no difference in risk among ethnicities, while Snowden et al [ 17 ] noted increased risk of preterm birth <37 weeks in Black, Hispanic, and Asian American women compared to White women; Salihu et al [ 35 ] also found increased risks in Black women compared to White women; while Davies-Tuck et al [ 14 ] noted an increased risk in South Asian versus Australian women. Amongst other risk factors that were assessed, there was evidence of greater risk of preterm birth in women with abdominal adiposity obesity [ 18 ]; type 1 diabetes mellitus [ 20 ]; GDM [ 49 ]; nulliparity [ 31 ]; singleton [ 51 ]; vitamin D deficiency [ 53 ]; and lower GWG [ 24 ]. Additional risk factors explored included prior bariatric surgery/gastric bypass [ 26 , 41 ], history of sleep apnea [ 28 ], mode of conception [ 16 ], DII [ 13 ], and presence of PCOS; however, no evidence of associations was found.…”

“…One study found no difference in women aged ≥40 years versus 20–29 years [ 37 ]; however, another study reported statistically significance that GDM was higher among women who were 35 years or older [ 54 ]. Seven studies assessed the effects of race/ethnicity [ 14 , 17 , 39 , 53 , 54 , 64 , 69 ]. Snowden et al [ 17 ] found that, compared to White women, Black women were at reduced risk of GDM, while risk was increased in Hispanic and Asian American women.…”

“…Bar-Zeev et al [ 54 ] reported that GDM was higher among non-Hispanic Black, Hispanic, and other racial-ethnic groups women compared to non-Hispanic White women. Similarly, Fallatah et al [ 53 ] reported more cases of GDM in pregnant Saudi Arabian women than non-Saudi Arabian women, and Shaukat et al [ 64 ] demonstrated a statistically significant difference in prevalence of GDM in Middle Eastern women compared to non-Middle Eastern women, while Reeske et al [ 39 ] reported more cases of GDM in Turkish than German women. Amongst other risk factors that were studied, an increased risk of GDM was observed in women with abdominal adiposity obesity [ 18 ], women with BMI ≥ 50 kg/m 2 [ 46 ], inadequate GWG [ 54 , 56 , 58 , 60 , 65 ], and in women living with class I obesity without a history of bariatric surgery (though this finding did not remain significant in sub-populations of class II or III obesity in the same study) [ 41 ].…”