Relationship between 25-hydroxyvitamin D level among females at the first trimester of pregnancy and adverse pregnancy outcome in Weifang district: a cohort study_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Lanling ¹ , WANG Bin ² , MOU Yingying ¹ , WANG Zhiyong ³ ,  MA Baohai ⁴

1. Department of Obstetrics, Weifang Maternal and Child Health Hospital (Maternal and Child Health Hospital of Weifang Medical University), Weifang 261011, P.R.China;
2. Department of Medical, Weifang Maternal and Child Health Hospital (Maternal and Child Health Hospital of Weifang Medical University), Weifang 261011, P.R.China;
3. Department of Pediatric, Weifang Maternal and Child Health Hospital (Maternal and Child Health Hospital of Weifang Medical University), Weifang 261011, P.R.China;
4. Department of Nutritional, Weifang Maternal and Child Health Hospital (Maternal and Child Health Hospital of Weifang Medical University), Weifang 261011, P.R.China;

Corresponding author：

MA Baohai, Email: wffymbh@163.com

Keywords：

25-hydroxyvitamin D; First trimester of pregnancy; Adverse pregnancy; Weifang; Cohort study

DOI：

10.7507/1672-2531.202102037

Video：

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Objective The research was performed to investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and the risk of adverse pregnancy outcomes. Methods We enrolled females who were in the first trimester of pregnancy and had arranged antenatal care at the Weifang Maternal and Child Health Hospital between January 2017 and December 2019. The liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was used to detect serum concentrations of 25(OH)D. The health status of the expectant mothers and fetuses and the incidence of adverse pregnancy outcomes of newborns were monitored through the outpatient, prenatal, and delivery stages in the hospital. Results An initial total of 6 770 females were signed up, while 4 997 females were eventually included. The median value of 25(OH)D concentration was 15.40 ng/mL, and the incidence rate of vitamin D deficiency [25(OH)D < 20 ng/mL] was 71.26%. The occurrence rates of gestational diabetes mellitus (GDM), pre-eclampsia, premature rupture of membranes (PROM), oligohydramnios, polyhydramnios, cesarean delivery, spontaneous abortion or stillborn fetus, fetal malformation, premature delivery, fetal macrosomia, low birth weight, small for gestational age infant, and asphyxia of newborn were 28.31%, 2.27%, 23.47%, 12.68%, 0.51%, 45.71%, 1.44%, 0.93%, 9.26%, 5.05%, 11.68%, 2.68%, 3.18%, and 1.16%, respectively. After adjusting for age, parity, season, pre-existing hypertension, pre-existing diabetes, and vitamin D supplementation, no relationship between 25(OH)D levels and adverse pregnancy outcomes was found (P>0.05). Conclusions Levels of 25(OH)D do not affect the risk of adverse pregnancy outcomes in females during the first trimester of pregnancy.

Citation： WANG Lanling, WANG Bin, MOU Yingying, WANG Zhiyong, MA Baohai. Relationship between 25-hydroxyvitamin D level among females at the first trimester of pregnancy and adverse pregnancy outcome in Weifang district: a cohort study. Chinese Journal of Evidence-Based Medicine, 2021, 21(9): 1008-1015. doi: 10.7507/1672-2531.202102037 Copy

1.	Wen J, Hong Q, Zhu L, et al. Association of maternal serum 25-hydroxyvitamin D concentrations in second and third trimester with risk of gestational diabetes and other pregnancy outcomes. Int J Obes (Lond), 2017, 41(4): 489-496.
2.	柳雨雨, 袁涛, 李海鸿, 等. 维生素 D 治疗多囊卵巢综合征有效性的 Meta 分析. 中国循证医学杂志, 2020, 20(6): 695-701.
3.	Holick MF. Vitamin D deficiency. N Engl J Med, 2007, 357(3): 266-281.
4.	Christakos S, Dhawan P, Verstuyf A, et al. Vitamin D: metabolism, molecular mechanism of action, and pleiotropic effects. Physiol Rev, 2016, 96(1): 365-408.
5.	Yuan Y, Tai W, Xu P, et al. Association of maternal serum 25-hydroxyvitamin D concentrations with risk of preeclampsia: a nested case-control study and meta-analysis. J Matern Fetal Neonatal Med, 2021, 34(10): 1576-1585.
6.	Li H, Ma J, Huang R, et al. Prevalence of vitamin D deficiency in the pregnant women: an observational study in Shanghai, China. Arch Public Health, 2020, 78: 31.
7.	Monier I, Baptiste A, Tsatsaris V, et al. First trimester maternal vitamin D status and risks of preterm birth and small-for-gestational age. Nutrients, 2019, 11(12): 3042.
8.	潘颖, 王彩波, 沈洁, 等. 不同孕期及不同季节妊娠妇女 25 羟维生素 D 水平与新生儿生长发育的相关性研究. 实用妇产科杂志, 2018, 34(2): 148-151.
9.	中华医学会骨质疏松和骨矿盐疾病分会. 维生素 D 及其类似物的临床应用共识. 中华内分泌代谢杂志, 2018, 34(3): 187-200.
10.	华克勤, 丰有吉. 实用妇产科学(第 3 版). 北京: 人民卫生出版社, 2013.
11.	邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学(第 4 版). 北京: 人民卫生出版社, 2011.
12.	童峰, 陈坤. 常见结局事件的前瞻性研究中修正 Poisson 回归模型的应用. 中国卫生统计, 2006, 23(5): 410-412.
13.	Saraf R, Morton SM, Camargo CA, et al. Global summary of maternal and newborn vitamin D status - a systematic review. Matern Child Nutr, 2016, 12(4): 647-668.
14.	Xiao JP, Zang J, Pei JJ, et al. Low maternal vitamin D status during the second trimester of pregnancy: a cross-sectional study in Wuxi, China. PLoS One, 2015, 10(2): e0117748.
15.	Zhang Y, Gong Y, Xue H, et al. Vitamin D and gestational diabetes mellitus: a systematic review based on data free of Hawthorne effect. BJOG, 2018, 125(7): 784-793.
16.	Zhou J, Su L, Liu M, et al. Associations between 25-hydroxyvitamin D levels and pregnancy outcomes: a prospective observational study in southern China. Eur J Clin Nutr, 2014, 68(8): 925-930.
17.	Salakos E, Rabeony T, Courbebaisse M, et al. Relationship between vitamin D status in the first trimester of pregnancy and gestational diabetes mellitus - a nested case-control study. Clin Nutr, 2021, 40(1): 79-86.
18.	Schneuer FJ, Roberts CL, Guilbert C, et al. Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr, 2014, 99(2): 287-295.
19.	Miliku K, Vinkhuyzen A, Blanken LM, et al. Maternal vitamin D concentrations during pregnancy, fetal growth patterns, and risks of adverse birth outcomes. Am J Clin Nutr, 2016, 103(6): 1514-1522.
20.	Rodriguez A, García-Esteban R, Basterretxea M, et al. Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes. BJOG, 2015, 122(12): 1695-1704.
21.	Yuan Y, Liu H, Ji C, et al. Association of maternal serum 25-hydroxyvitamin D concentrations in second trimester with delivery mode in a Chinese population. Int J Med Sci, 2017, 14(10): 1008-1014.
22.	Australian Government Department of Health. Pregnancy care guidelines. Available at: https://www.health.gov.au/resources/publications/pregnancy-care-guidelines.
23.	Koplin JJ, Suaini NH, Vuillermin P, et al. Polymorphisms affecting vitamin D-binding protein modify the relationship between serum vitamin D (25D3) and food allergy. J Allergy Clin Immunol, 2016, 137(2): 500-506.
24.	Pereira-Santos M, Carvalho GQ, Louro ID, et al. Polymorphism in the vitamin D receptor gene is associated with maternal vitamin D concentration and neonatal outcomes: a Brazilian cohort study. Am J Hum Biol, 2019, 31(4): e23250.
25.	Bodnar LM, Catov JM, Zmuda JM, et al. Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. J Nutr, 2010, 140(5): 999-1006.
26.	Morley R, Carlin JB, Pasco JA, et al. Maternal 25-hydroxyvitamin D concentration and offspring birth size: effect modification by infant VDR genotype. Eur J Clin Nutr, 2009, 63(6): 802-804.
27.	Levin GP, Robinson-Cohen C, de Boer IH, et al. Genetic variants and associations of 25-hydroxyvitamin D concentrations with major clinical outcomes. JAMA, 2012, 308(18): 1898-1905.
28.	Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary reference intakes for calcium and vitamin D. Washington (DC): National Academies Press (US), 2011.
29.	Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930.
30.	McNutt LA, Wu C, Xue X, et al. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol, 2003, 157(10): 940-943.
31.	Lu ZX, Sikaris KA. Variability in vitamin D assays impairs clinical assessment of vitamin D status. Intern Med J, 2012, 42(8): 960-961.
32.	Roth HJ, Schmidt-Gayk H, Weber H, et al. Accuracy and clinical implications of seven 25-hydroxyvitamin D methods compared with liquid chromatography-tandem mass spectrometry as a reference. Ann Clin Biochem, 2008, 45(Pt2): 153-159.
33.	Kovacs CS. The role of vitamin D in pregnancy and lactation: insights from animal models and clinical studies. Annu Rev Nutr, 2012, 32: 97-123.

1. Wen J, Hong Q, Zhu L, et al. Association of maternal serum 25-hydroxyvitamin D concentrations in second and third trimester with risk of gestational diabetes and other pregnancy outcomes. Int J Obes (Lond), 2017, 41(4): 489-496.
2. 柳雨雨, 袁涛, 李海鸿, 等. 维生素 D 治疗多囊卵巢综合征有效性的 Meta 分析. 中国循证医学杂志, 2020, 20(6): 695-701.
3. Holick MF. Vitamin D deficiency. N Engl J Med, 2007, 357(3): 266-281.
4. Christakos S, Dhawan P, Verstuyf A, et al. Vitamin D: metabolism, molecular mechanism of action, and pleiotropic effects. Physiol Rev, 2016, 96(1): 365-408.
5. Yuan Y, Tai W, Xu P, et al. Association of maternal serum 25-hydroxyvitamin D concentrations with risk of preeclampsia: a nested case-control study and meta-analysis. J Matern Fetal Neonatal Med, 2021, 34(10): 1576-1585.
6. Li H, Ma J, Huang R, et al. Prevalence of vitamin D deficiency in the pregnant women: an observational study in Shanghai, China. Arch Public Health, 2020, 78: 31.
7. Monier I, Baptiste A, Tsatsaris V, et al. First trimester maternal vitamin D status and risks of preterm birth and small-for-gestational age. Nutrients, 2019, 11(12): 3042.
8. 潘颖, 王彩波, 沈洁, 等. 不同孕期及不同季节妊娠妇女 25 羟维生素 D 水平与新生儿生长发育的相关性研究. 实用妇产科杂志, 2018, 34(2): 148-151.
9. 中华医学会骨质疏松和骨矿盐疾病分会. 维生素 D 及其类似物的临床应用共识. 中华内分泌代谢杂志, 2018, 34(3): 187-200.
10. 华克勤, 丰有吉. 实用妇产科学(第 3 版). 北京: 人民卫生出版社, 2013.
11. 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学(第 4 版). 北京: 人民卫生出版社, 2011.
12. 童峰, 陈坤. 常见结局事件的前瞻性研究中修正 Poisson 回归模型的应用. 中国卫生统计, 2006, 23(5): 410-412.
13. Saraf R, Morton SM, Camargo CA, et al. Global summary of maternal and newborn vitamin D status - a systematic review. Matern Child Nutr, 2016, 12(4): 647-668.
14. Xiao JP, Zang J, Pei JJ, et al. Low maternal vitamin D status during the second trimester of pregnancy: a cross-sectional study in Wuxi, China. PLoS One, 2015, 10(2): e0117748.
15. Zhang Y, Gong Y, Xue H, et al. Vitamin D and gestational diabetes mellitus: a systematic review based on data free of Hawthorne effect. BJOG, 2018, 125(7): 784-793.
16. Zhou J, Su L, Liu M, et al. Associations between 25-hydroxyvitamin D levels and pregnancy outcomes: a prospective observational study in southern China. Eur J Clin Nutr, 2014, 68(8): 925-930.
17. Salakos E, Rabeony T, Courbebaisse M, et al. Relationship between vitamin D status in the first trimester of pregnancy and gestational diabetes mellitus - a nested case-control study. Clin Nutr, 2021, 40(1): 79-86.
18. Schneuer FJ, Roberts CL, Guilbert C, et al. Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr, 2014, 99(2): 287-295.
19. Miliku K, Vinkhuyzen A, Blanken LM, et al. Maternal vitamin D concentrations during pregnancy, fetal growth patterns, and risks of adverse birth outcomes. Am J Clin Nutr, 2016, 103(6): 1514-1522.
20. Rodriguez A, García-Esteban R, Basterretxea M, et al. Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes. BJOG, 2015, 122(12): 1695-1704.
21. Yuan Y, Liu H, Ji C, et al. Association of maternal serum 25-hydroxyvitamin D concentrations in second trimester with delivery mode in a Chinese population. Int J Med Sci, 2017, 14(10): 1008-1014.
22. Australian Government Department of Health. Pregnancy care guidelines. Available at: https://www.health.gov.au/resources/publications/pregnancy-care-guidelines.
23. Koplin JJ, Suaini NH, Vuillermin P, et al. Polymorphisms affecting vitamin D-binding protein modify the relationship between serum vitamin D (25D3) and food allergy. J Allergy Clin Immunol, 2016, 137(2): 500-506.
24. Pereira-Santos M, Carvalho GQ, Louro ID, et al. Polymorphism in the vitamin D receptor gene is associated with maternal vitamin D concentration and neonatal outcomes: a Brazilian cohort study. Am J Hum Biol, 2019, 31(4): e23250.
25. Bodnar LM, Catov JM, Zmuda JM, et al. Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. J Nutr, 2010, 140(5): 999-1006.
26. Morley R, Carlin JB, Pasco JA, et al. Maternal 25-hydroxyvitamin D concentration and offspring birth size: effect modification by infant VDR genotype. Eur J Clin Nutr, 2009, 63(6): 802-804.
27. Levin GP, Robinson-Cohen C, de Boer IH, et al. Genetic variants and associations of 25-hydroxyvitamin D concentrations with major clinical outcomes. JAMA, 2012, 308(18): 1898-1905.
28. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary reference intakes for calcium and vitamin D. Washington (DC): National Academies Press (US), 2011.
29. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930.
30. McNutt LA, Wu C, Xue X, et al. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol, 2003, 157(10): 940-943.
31. Lu ZX, Sikaris KA. Variability in vitamin D assays impairs clinical assessment of vitamin D status. Intern Med J, 2012, 42(8): 960-961.
32. Roth HJ, Schmidt-Gayk H, Weber H, et al. Accuracy and clinical implications of seven 25-hydroxyvitamin D methods compared with liquid chromatography-tandem mass spectrometry as a reference. Ann Clin Biochem, 2008, 45(Pt2): 153-159.
33. Kovacs CS. The role of vitamin D in pregnancy and lactation: insights from animal models and clinical studies. Annu Rev Nutr, 2012, 32: 97-123.

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