Vitamin D deficiency: a concern in pregnant Asian women

Abstract

Vitamin D status of Asian mothers in Cardiff was investigated during early pregnancy and at the time of the birth of their babies, using serum parathyroid hormone (PTH). Median values in Asian (n 32) and Caucasian (n 63) mothers in early pregnancy were 1.56 and 0.81 pmol/l respectively. PTH levels from a separate sample of nineteen Asian and twenty-five Caucasian mothers at the time of birth were 3.0 and 2.20 pmol/l respectively. Altogether twelve Asian and two Caucasian women had elevated PTH. All Asian women who had high PTH values also had a very low serum 25-hydroxycholecalciferol level (250HD). AU samples were taken from women with no significant medical history and normal obstetric history. These findings suggest that subclinical vitamin D deficiency is still a cause for concern in Asian women. More active measures need to be taken to implement current recommendations to improve their vitamin D intake in pregnancy.Parathyroid hormone: Vitamin D: Pregnancy Vitamin D deficiency can occur whenever the demand for the vitamin exceeds supply, as in periods of rapid growth in fetal life, infancy, early childhood and puberty and during pregnancy, lactation and in the elderly. It was the vulnerability of the growing child to rickets that prompted, in the 1940s, fortification of certain foods with vitamin D with or without Ca, and supplements in the form of cod-liver oil being made available free of charge. Tablets which contained vitamins A and D, Ca,(PO,), and KI were provided free for all mothers during pregnancy and for 30 weeks after delivery. Yet in spite of these measures a small number of cases continued to occur among British infants and young children living in poor social conditions where mothers failed to appreciate the need for vitamin supplements, and when household milk containing small amounts of vitamin D was offered as a substitute for human milk or fortified artificial milks (Department of Health and Social Security, 1980). However, since the early 1960s nutritional rickets has been identified mostly, but not exclusively, in immigrant families, mainly Asians. Prevalences of biochemical and clinical rickets in Glasgow's Asian children of 50 and 5 % respectively were reported in the 1960s and 1970s (Ford et al. 1972;Goel et al. 1976). In Birmingham in the mid 1980s, 40 % of 145 Asian toddlers aged 22 months had low serum vitamin D levels (Grindulis et al. 1986). Osteomalacia has been reported also in Asian women of child-bearing age who had lived for some years in Britain (Stamp et al. 1980) including those who were pregnant (Holmes et al. 1973). Brooke et al. (1980) in a study of vitamin D supplements in pregnant Asian women living in London showed a high incidence of vitamin D deficiency during the last trimester; 37% of 126 women had 25-hydroxycholecalciferol(250HD) concentrations below 4 n g / d at 28-32 weeks gestation.

Vitamin D deficiency: a concern in premenopausal Bangladeshi women of two socio-economic groups in rural and urban region

“…The observed mean serum 25-OHD levels among the subjects of this study were in general lower than those reported in US white women (Jacques et al, 1997) but similar to those of European women (Henriksen et al, 1995;Burnand et al, 1992;Lamberg-Allardt et al, 1993). Interestingly, the mean serum concentration of 25-OHD was higher in our subjects compared with the Asian women living in Europe and North America (Gibson et al, 1987;Alfaham et al, 1995;Henriksen et al, 1995) but much lower than healthy women in Thailand (Chailurkit et al, 1996).…”

“…Low breast-milk concentrations of vitamin D have been reported among vitamin D-deficient mothers but in non-pregnant non-lactating women the effect of vitamin D deficiency is not clear. Vitamin D deficiency is very likely to happen due to increasing demand at rapid growth in fetal life, infancy, early childhood and puberty, during pregnancy, lactation and in the elderly (Alfaham et al, 1995). Physiological factors, lifestyle and environmental characteristics may be the cause of vitamin D deficiency (Webb et al, 1990;Salamone et al, 1993).…”

“…Several studies have been carried out about vitamin D status in subjects of different age groups as well as in women of different physiological conditions of the Asian and Mediterranean immigrants in European countries as well as other developed countries of the world (Gibson et al, 1987;Meulmeester et al, 1990;Brunvand & Haug, 1993;Alfaham et al, 1995;Henriksen et al, 1995;Brunvand et al, 1998;Falch & Steihaug, 2000). All these studies observed that a higher prevalence of vitamin D deficiency is a problem among the Asian immigrants.…”

Dietary and lifestyle factors affecting plasma vitamin D levels in Asian children living in England

“…Asian women have been shown to have low serum vitamin D levels themselves during pregnancy and are therefore less able to provide for their offspring (Alfaham et al, 1995). The vitamin D content of breast-milk is dependent upon the vitamin D status of the mother, and prolonged exclusive breast-feeding has been described as a risk factor.…”

Hypovitaminosis D, insulin resistance and hypertension in pregnancy

“…Strikingly, this condition is reversible upon supplementation of the lacking vitamin either as cholecalciferol (vitamin D 3 ), or as 1,25-dihydroxy-cholecalciferol (Norman et al, 1980;Chertow et al, 1983;Nyomba et al, 1984;Cade & Norman, 1986;Gedik & Akalin, 1986;Cade & Norman, 1987;Boucher et al, 1995;Baynes et al, 1997;Rudnicki & Molsted-Pedersen, 1997;Borissova et al, 2003). These extant data should be appreciated, especially given the fact that that hypovitaminosis D is common in pregnancy (MacLennan et al, 1980;Bashir et al, 1981;Brooke et al, 1981;Dumont, 1991;Zeghoud et al, 1991;Alfaham et al, 1995;Fogelman et al, 1995;Sanchez et al, 1997;Vinutha et al, 2000;Bassir et al, 2001;Grover & Morley, 2001;Mukamel et al, 2001;Nozza & Rodda, 2001;Souberbielle et al, 2001;Datta et al, 2002;Islam et al, 2002). Along the same line of thinking as the one proposed earlier (Rutz, 2002), hypovitaminosis D may hence also predispose to gestational hypertension (Magee et al, 2003;Ryan, 2003), namely, through ensuing activation of the renin-angiotensin system, and under the influence of additional hormonal factors, such as those mentioned (Ryan, 2003).…”