Correlation between Serum Vitamin D levels and hypertensive disorders in pregnancy in primigravida in third trimester

  • Dr. Ashwin Rao Postgraduate, Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
  • Dr. Seetesh Ghose Professor and Head, Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
  • Dr. Setu Rathod Associate Professor, Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
Keywords: Hypertensive disorders of pregnancy, Obesity, Exposure to sunlight, Vitamin D

Abstract

Background: Hypertension related to pregnancy is a common obstetric complication observed in 7-8% of the antenatal cases in India. Vitamin D is involved in the development of the placenta and feto-maternal wellbeing, thereby helping in prevention of obstetric complication like hypertension in pregnancy. It modulates various biochemical reactions in the body to prevent abnormal placentation preventing pregnancy related hypertension.

Materials and methods: A cross sectional observational study was conducted on 120 antenatal women between April 2017 – March 2018 in Mahatma Gandhi Medical College and Research Institute. Based on blood pressure, primigravidas were classified as Mild (Group 1) and Severe (Group 2). Investigations for hypertensive disorders of pregnancy and serum Vitamin D were done. Serum Vitamin D levels were classified into deficiency, insufficiency (20-30ng/ml) and sufficiency (30-100ng/ml). Statistical analysis was done using SPSS-17.

Results: In this study, among the primigravidas with hypertensive disorders of pregnancy 67.5% were Vitamin D deficient, 24.2% had insufficiency and 8.3% had sufficient serum Vitamin D levels. It was also observed that the serum Vitamin D levels were significantly low with an increase in the pre-pregnancy BMI (P value – 0.002) and increase in blood pressure (P value – 0.004). There was significant negative correlation seen between serum vitamin D and blood pressure as we moved from the mild to the severe hypertension group.

Conclusion: With lower levels of serum vitamin D, more was the severity of hypertension in pregnancy. Obesity was also associated with severe vitamin D deficiency in the present study.

Downloads

Download data is not yet available.

References

1. Ota K, Dambaeva S, Kim MW, Han AR, Fukui A, Gilman-Sachs A, Beaman K, Kwak-Kim J. 1,25-Dihydroxy-vitamin D3 regulates NK-cell cytotoxicity, cytokine secretion, and degranulation in women with recurrent pregnancy losses. Eur J Immunol. 2015 Nov;45(11):3188-99. doi: 10.1002/eji.201545541. Epub 2015 Sep 7. [PubMed]

2. Bodnar LM, Simhan HN, Catov JM, Roberts JM, Platt RW, Diesel JC, Klebanoff MA. Maternal vitamin D status and the risk of mild and severe preeclampsia. Epidemiology. 2014 Mar;25(2):207-14. doi: 10.1097/EDE. 0000000000000039.

3. Burris HH, Camargo CA. Vitamin D and gestational diabetes mellitus. Curr Diab Rep. 2014 Jan;14(1):451. doi: 10.1007/s11892-013-0451-3. [PubMed]

4. Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009 Mar;94(3):940-5.doi: 10. 1210/jc.2008-1217.

5. Bener A, Al-Hamaq AO, Saleh NM. Association between vita¬min D insufficiency and adverse pregnancy outcome: global comparisons. Int J Womens Health. 2013;5:523-31.doi: 10.2147/IJWH.S51403. [PubMed]

6. Gernand AD, Simhan HN, Caritis S, Bodnar LM. Maternal vitamin D status and small-for-gestational-age offspring in women at high risk for preeclampsia. Obstet Gynecol. 2014 Jan;123(1):40-8. doi: 10.1097/AOG.0000000000000049.

7. Chan SY, Susarla R, Canovas D, Vasilopoulou E, Ohizua O, McCabe CJ, et al. Vitamin D promotes human extravillous trophoblast invasion in vitro. Placenta. 2015 Apr;36(4):403-9. doi: 10.1016/j.placenta.2014.12.021. Epub 2015 Jan 8. [PubMed]

8. Dave A, Verma M, Jain N, Dave A. A study of vitamin D levels and associated deficiency in pregnancy and its effect on maternal and fetal outcome. Int J Reprod Contracept Obstet Gynecol. 2016 Dec 20;6:84-8.doi: 10.18203/2320-1770.ijrcog20164637.

9. Jain V, Gupta N, Kalaivani M, Jain A, Sinha A, Agarwal R. Vitamin D deficiency in healthy breastfed term infants at 3 months & their mothers in India: Seasonal variation & determinants. Indian J Med Res [serial online ]2011[cited 2018 Jul 18];133:267-73. Available from: http://www.ijmr.org.in/text.asp?2011/133/3/267/78334

10. Goel P, Garg G, Kaur J, Mehra R, Tandon R, Huria A. Association of vitamin D deficiency during pregnancy with preeclampsia and eclampsia. Int J Reprod Contracept Obstet Gyneco l2016;5:3046-50.doi: http://dx.doi.org/10.18203/2320-1770.ijrcog20162982.

11. Agarwal S, Chaudhary M, Chauhan J, Vacchani A. Assessment of Vitamin D Deficiency in Pregnant Females Attending Antenatal Care Clinic at Tertiary Care Hospital. Int J Sci Stud 2016;4(5):99-101. doi: 10.17354/ijss/2016/437

12. Kumari A, Mitra S, Tiwari HC, Srivastav R. Hypovitaminosis D in pregnancy and its correlation with preeclampsia and gestational diabetes mellitus. Int J Reprod Contracept ObstetGynecol2017;6:890-6.doi: http://dx.doi.org/10.18203/2320-1770.ijrcog20170551.

13. Bener A, Al-Ali M, Hoffmann GF. High prevalence of vitamin D deficiency in young children in a highly sunny humid country: A global health problem.MinervaPediatr. 2009;61:15-22.doi: 10.4103/1817-1745.147574. [PubMed]

14. Bodnar LM, Catov JM, Roberts JM, Simhan HN. Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates,.J Nutr. 2007 Nov;137(11):2437-42.

15. Zad ND, Vaezi M, Esmaeli H, Khalatbari S, Hamedani M. PO-0619 Association Between Pre-pregnancy Body Mass Index And First Trimester Vitamin D. Arch Dis Child. 2014 Oct 1;99(Suppl 2):A457–A457.

16. Pena HR, de Lima MC, Brandt KG, de Antunes MMC, da Silva GAP. Influence of preeclampsia and gestational obesity in maternal and newborn levels of vitamin D. BMC Pregnancy Childbirth. 2015 May 13;15:112. doi: 10.1186/s12884-015-0547-7. [PubMed]

17. Magnus P, Eskild A. Seasonal variation in the occurrence of pre-eclampsia. BJOG Int J ObstetGynaecol. 108(11):1116–9.https://doi.org/10.1111/j.1471-0528.2003.00273.x.

18. Algert CS, Roberts CL, Shand AW, Morris JM, Ford JB. Seasonal variation in pregnancy hypertension is correlated with sunlight intensity. Am J Obstet Gynecol. 2010 Sep;203(3):215.e1-5. doi: 10.1016/j.ajog.2010.04.020. [PubMed]

19. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal Vitamin D Deficiency Increases the Risk of Preeclampsia. J Clin Endocrinol Metab. 2007 Sep;92(9):3517-22. Epub 2007 May 29.

20. Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O’Beirne M, Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ. 2013 Mar 26;346:f1169.doi: https://doi.org/10.1136/bmj.f1169.

21. Robinson CJ, Alanis MC, Wagner CL, Hollis BW, Johnson DD. Plasma 25-hydroxyvitamin D levels in early-onset severe preeclampsia. Am J Obstet Gynecol. 2010 Oct;203(4):366.e1-6. doi: 10.1016/j.ajog.2010.06.036. Epub 2010 Aug 8.

22. Hyppönen E, Hartikainen A-L, Sovio U, Järvelin M-R, Pouta A. Does vitamin D supplementation in infancy reduce the risk of pre-eclampsia? Eur J Clin Nutr. 2007 Sep;61(9):1136-9. Epub 2007 Jan 31. [PubMed]

23. Bakacak M, Serin S, Ercan O, Köstü B, Avci F, Kılınç M, Kıran H, Kiran G. Comparison of Vitamin D levels in cases with preeclampsia, eclampsia and healthy pregnant women. Int J Clin Exp Med. 2015 Sep 15;8(9):16280-6. eCollection 2015.
Correlation between Serum Vitamin D levels and hypertensive disorders in pregnancy in primigravida in third trimester
CITATION
DOI: 10.17511/joog.2018.i02.01
Published: 2018-06-30
How to Cite
Rao, A., Ghose, S., & Rathod, S. (2018). Correlation between Serum Vitamin D levels and hypertensive disorders in pregnancy in primigravida in third trimester. Obs Gyne Review: Journal of Obstetric and Gynecology, 4(2), 21-28. https://doi.org/10.17511/joog.2018.i02.01
Section
Original Article