High blood pressure during pregnancy (preeclampsia) associated with low vitamin D, c-section

Created January 2015

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

The Journal of Obstetrics and Gynecology of India, January 2015

Taru Gupta, Sonika Wahi, Nupur Gupta, Sarika Arora, Sangeeta Gupta, Pushpa Bhatia

ESI Post Graduate Institute Medical Science & Research, Basaidarapur, New Delhi, India

1. || | preeclamptic|normotensive Severe vitamin D deficiency|90 %|62 % Vitamin D level| 4 ng/ml|9 ng/ml Cesarean section|36 %|9 %|| 1. See also VitaminDWiki * Risk of preeclampsia might be cut in half if take an amount of Vitamin D – meta-analysis Sept 2017 Overview Pregnancy and vitamin D has the following summary {include} Preeclampsia 280 items as of Jan 2015 Preeclampsia rate cut in half by high level of vitamin D – meta-analysis March 2014 Dark skin pregnancies and Vitamin D - many studies study on this page was done in India Why India's vitamin D deficiency is grim - 40 pages Feb 2014 study on this page was done in India Overview Hypertension and Vitamin D See also web Clinical trials for Preeclampsia with Vitamin D intervention 12 as of Sept 2017 One trial which used 4,000 IU of vitamin D has completed, but not published as of Jan 2015

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.

Results

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.

References

  1. Forman JP, Giovannucci E, Holmes MD, et al. Plasma 25-hydroxyvitamin d levels and risk of incident hypertension. Hypertension. 2007;49:1063–9. CrossRef

  2. Martins D, Wolf M, Pan D, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin d in the united states: Data from the third national health and nutrition examination survey. Arch Intern Med. 2007;167:1159–65. CrossRef

  3. Melamed ML, Michos ED, Post W, et al. 25-hydroxyvitamin d levels and the risk of mortality in the general population. Arch Intern Med. 2008;168:1629–37. CrossRef

  4. Bodnar LM, Catov JM, Simhan HN, et al. Maternal vitamin D deficiency increases the risk of pre eclampsia. Clin J Endocrinol Metab. 2007;92:3517–22. CrossRef

  5. Merewood A, Mehta SD, Chen TC, et al. Association between vitamin D deficiency and primary cesarean section. J ClinEndocrinolMetab. 2009;94(3):940–5. CrossRef

  6. Sahu M, Das V, Agarwal A, et al. Vitamin D replacement in pregnant women in rural north india: a pilot study. Eur J Clin Nutr. 2009;63:1157–9. CrossRef

  7. Evans KN, Bulmer JN, Kilby MD, et al. Vitamin D and placental-decidual function. J SocGynecolInvestig. 2004;11:263–71.

  8. Daftary GS, Taylor HS. Endocrine regulation of HOX genes. Endocr Rev. 2006;27:331–55. CrossRef

  9. Braam LA, Hoeks AP, Brouns F, et al. Beneficial effects of vitamins D and K on the elastic properties of the vessel wall in postmenopausal women: a follow-up study. ThrombHaemost. 2004;91:373–80.

  10. Powe CE, Seely EW, Rana S, et al. First trimester vitamin D, vitamin D binding protein, and subsequent preeclampsia. Hypertension. 2010;56(4):758–63. CrossRef

  11. Kumru S, Aydin S, Simsek M, et al. Comparison of serum copper, zinc, calcium, and magnesium levels in pre-eclamptic and healthy pregnant women. Biol Trace Elem Res. 2003;94:105–12. CrossRef

  12. Adam B, Malatyalioglu E, Alvur M, et al. Magnesium, zinc and iron levels in pre-eclampsia. J Matern Fetal Med. 2001;10:246–50. CrossRef

  13. Joshi VK, Sapre S, Govilla V. Role of micronutrients and calcium in pregnancy induced hypertension. Obs Gynae Today. 2003;8:617–9.

  14. Sukonpan K, Phupong V. Serum calcium and serum magnesium in normal and pre-eclamptic pregnancy. Arch Gynecol Obstet. 2005;273:12–6. CrossRef

  15. Belizan JM, Villar J. The relationship between calcium intake and edema, proteinuria and hypertension-gestosis: a hypothesis. Am J Clin Nutr. 1980;33:2202–10.

  16. Hamlin RH. The prevention of eclampsia and pre-eclampsia. Lancet. 1952;1:64–8. CrossRef

  17. Villar J, Belizan JM, Fischer PJ. Epidemiologic observations on the relationship between calcium intake and eclampsia. Int J Gynaecol Obstet. 1983;21:271–8. CrossRef

  18. Belizan JM, Villar J, Repke J. The relationship between calcium intake and pregnancy-induced hypertension: up-to-date evidence. Am J Obstet Gynecol. 1988;158:898–902. CrossRef

  19. Jain S, Sharma P, Kulshreshtha S, et al. The role of calcium, magnesium, and zinc in pre-eclampsia. Biol Trace Elem Res. 2010;133:162–70. CrossRef

  20. Xiong X, Demianczuk NN, Saunders LD, et al. Impact of preeclampsia and gestational hypertension on birth weight by gestational age. Am J Epidemiol. 2002;155(3):203–9. CrossRef

  21. Bodnar LM, Simhan HN, Catov JM. Maternal vitamin D status and the risk of mild and severe preeclampsia. Epidemiology. 2014;25(2):207–14. CrossRef

  22. Wei SQ, Audibert F, Hidiroglou N, et al. Longitudinal vitamin D status in pregnancy and the risk of pre-eclampsia. BJOG. 2012;119(7):832–9. CrossRef

  23. Baker AM, Haeri S, Camargo CA Jr, et al. A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia. J Clin Endocrinol Metab. 2010;95(11):5105–9. CrossRef

  24. Ullah MI, Koch CA, Tamanna S, et al. Vitamin D deficiency and the risk of preeclampsia and eclampsia in Bangladesh. Horm Metab Res. 2013;45(9):682–7. CrossRef

Tags: Pregnancy