Association of Deficiency of Maternal Vitamin D Levels with Severity of Preeclampsia

  • Shilpa Jindal DNB Student, Department of Obstetrics & Gynaecology, Hindurao Hospital.
  • Jasmine Chawla Sharma CMO NFSG, Department of Obstetrics & Gynaecology, Hindurao Hospital.
  • Manisha Sharma Senior Specialist, Department of Obstetrics & Gynaecology, Hindurao Hospital.
Keywords: Preeclampsia, Vit D Deficiency, Maternal Mortality

Abstract

Introduction: Preeclampsia remains to be an important cause of maternal morbidity and mortality in both the developing and developed world. It is imperative to devise preventive strategies to reduce the burden of this disease. Vitamin D deficiency has emerged as an important inflammatory mediator in its pathogenesis.

Objective: To find an association between the severity of preeclampsia and vitamin D deficiency amongst women attending a tertiary hospital in northern India.

Material & Methods: this was a prospective comparative observational study. 125 women of preeclampsia and 125 controls were enrolled in the study after due written consent. The women of preelampsia were further divided into preeclampsia with or without severe features. After history, examination and relevant routine investigations, both groups underwent testing for vitamin D. Statistical analysis was conducted with the statistical package for the social science software version SPSS 20.0. The comparison of normally distributed continuous variables between the two groups was performed using Student’s t test and for more than two groups comparison done through ANOVA test. For all statistical tests, a p value less than 0.05 was taken to indicate a significant difference/ association.

Result: 80% subjects of study group were significantly more vitamin D deficient as compared to 68% of controls (p-value=0.03). Patients with preeclampsia with severe features had significantly lower levels of Vitamin D as compared to controls indicating that increased vitamin D deficiency was associated with increased severity of preeclampsia. None of the cases with severe preeclampsia had normal levels of Vitamin D. This was statistically significant (p-value=0.046).

Conclusion: Severe pre-eclampsia was significantly associated with Vit D deficiency. Prevention of Vitamin D deficiency could be beneficial to prevent pre-eclampsia but community intervention studies are required.

References

Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmmill A et al. Global, regional and national

levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections

to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet

; 387(10017): 462-474. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00838-7/fulltext [PubMed/ Google Scholar].

Sample Registration Bulletin/ SRS_Bulletins/ MMR_Bulletin-2015-17. Available from: http://censusindia.gov.in/vital_statistics/SRS_Bulletins/Bulletins.html.

Hodgins S. Pre-eclampsia as underlying cause for perinatal deaths: time for action. Glob Health Sci

Pract 2015; 3(4): 525-527. Available from: http://www.ghspjournal.org/content/3/4/525.abstract [PubMed/ Google Scholar/ ResearchGate].

World Health Organisation. Global burden of hypertensivedisorders of pregnancy in the year 2000. Geneva; 2003. Available from: https://pdfs.semanticscholar.

org/2d77/75c57e6a91969156c78cb38e37a95093b351.pdf [Google Scholar].

American College of Obstetricians and Gynaecologists. Task Force on Hypertension in Pregnancy. Hypertension

in Pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on

Hypertension in Pregnancy. Obstet Gynecol 2013; 122(5): 1122-1131. Available from: https://insights.ovid.com/article/00006250-201311000-00036 [PubMed].

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; 92(9): 3517-3522. Available from: https://academic.oup.com/jcem/article/92/9/3517/2597795 [PubMed/ Google Scholar].

Domaracki P, Sadlecki P, Odrowaz-Sypniewska G, Dzikowska E, Walentowicz P, Siodmiak J et al. Serum 25(OH) Vitamin D Levels in Polish Women during

Pregnancies Complicated by Hypertensive Disorders and Gestational Diabetes. Int J Mol Sci 2016; 17(10): 1574. Available from: https://www.mdpi.com/1422-

/17/10/1574 [PubMed/ Google Scholar].

Behjat Sasan S, Zandvakili F, Soufizadeh N, Baybordi E. The Effects of Vitamin D Supplement on Prevention of Recurrence of Preeclampsia in Pregnant Women with a History of Preeclampsia. Obstet Gynecol Int 2017;8249264. [PubMed/ Google Scholar].

Gil A, Diaz JP, Mesa MD. Vitamin D: Classic and Novel Actions. Ann Nutr Metab 2018; 72(2): 87-95. Available from: https://www.karger.com/Article/FullText/486536 [PubMed/ Google Scholar].

Kaushal M, Magon N. Vitamin D in pregnancy: A metabolic outlook. Indian J Endocr Metab 2013; 17(1): 76-82. Available from: http://www.ijem.in/article.

asp?issn=2230-8210;year=2013;volume=17;issue=1;spage=76;epage=82;aulast=Kaushal [PubMed/ Google Scholar].

Evans KN, Bulmer JN, Kilby MD, Hewison M. Vitamin D and placental-decidual function. J Soc Gynecol Investig 2004; 11(5): 263-271. [PubMed/ Google Scholar].

Ritu G, Gupta A. Vitamin D Deficiency in India: Prevalence, Causalities and Interventions. Nutrients 2014; 6(2): 729-775. Available from: [PubMed/ Google

Scholar].

Sahu M, Tripathy S, Bhuyan P. Association of maternal serum vitamin D level with preeclampsia or eclampsia and its relationship with neonatal outcome and

neonatal serum calcium level. Int J Reprod Contracept Obstet Gynecol 2017; 6(12): 5580-5586. Available from: https://www.ijrcog.org/index.php/ijrcog/article/

view/3901.

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 Gynecol 2016; 5(9): 3046-3050. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/1592.

Bakacak M, Serin S, Ercan O, Köstü B, Avci F, Kılınç M et al. Comparison of Vitamin D levels in cases with preeclampsia, eclampsia and healthy pregnant women.

Int J Clin Exp Med 2015; 8(9): 16280-16286. [PubMed/ Google Scholar/ ResearchGate].

Baror S, Rajoria L, Hemani S, Vyas J, Sharma A, Baghotia P. Role of Vitamin D in Predicting the Risk of Preeclampsia. IJSR 2017; 6(4): 640-642. Available from:

https://www.worldwidejournals.com/internationaljournal-of-scientific-research-(IJSR)/article/role-ofvitamin-d-in-predicting-the-risk-of-preeclampsia/

MTA2Nzc=/.

Rao A, Ghose S, Rathod S. Correlation between Serum Vitamin D levels and hypertensive disorders in pregnancyin primigravida in third trimester. J obstet Gynecol 2018; 4(2): 21-28. Available from: http://medresearch.in/index.php/JOOG/article/view/2650/3672.

Mehta S, Mahala M, Sharma M. Maternal Vitamin D levels in Hypertensive disorder of Pregnancy and Healthy pregnant women. IOSR Journal of

Dental and Medical Sciences 2016; 15(6): 86-88. Available from: https://pdfs.semanticscholar.org/480e/5b26715dbf2fcdc4a85d110b9a4d6a6aa9c5.pdf.

Arumaikannu J, Usha-Rani S, Shanthi S. Role of vitamin D in preeclampsia: Our experience. J Clin Obstet Gynaecol 2018; 2(2): 29-32. Available from: http://

www.gynaecologyjournal.com/articles/54/2-2-3-727.pdf.

SamirAbdalla A, Faris T, Elaziz AFA, Abdelhafiz AA. Ratio between Low Serum Maternal 25-Hydroxy vitamin D Concentration and the Risk of Preeclampsia. Egypt J Hosp Med 2018; 72(8): 5044-5049. Available from: http://ejhm.journals.ekb.eg/article_10285.html [Google Scholar].

Sadin B, Pourghassem Gargari B, Pourteymour Fard Tabrizi F. Vitamin D Status in Preeclamptic and Nonpreeclamptic Pregnant Women: a Case-Control Study in the North West of Iran. Health Promot Perspect 2015; 5(3): 183-190. [PubMed/ Google Scholar].

Xiao JP, Lv JX, Yin YX, Jhang L, Li WS, Tao T et al. Lower maternal and fetal vitamin D status and higher placental and umbilical vitamin D receptorexpression

in preeclamptic pregnancies. Int J Clin Exp Pathol 2017; 10(11): 10841-10851. Available from: http://www.ijcep.com/files/ijcep0061372.pdf [Google Scholar].

Sharma N, Nath C, Mohammad J. Vitamin D status in pregnant women visiting a tertiary care center of North Eastern India. J Family Med Prim Care. 2019

Feb; 8(2): 356-360. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436274/ [PubMed/ Google Scholar].

Choudhary N, Rastogi R, Joshi P. Comparative Study of Vitamin D Status and Fetomaternal Outcome in Preeclampsia/ Eclampsia and Normal Pregnant Women

at Term. Indian Journal of Obstetrics and Gynecology 2018; 6(5): 478-485. Available from: https://rfppl.co.in/subscription/upload_pdf/Dr.%20Nidhi%20

Choudhary%20(IJOG-7993-2018)_7735.pdf.

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 Obstet Gynecol 2017; 6(3): 890-896. Available from: https://pdfs.semanticscholar.org/32e0/b0ed9b3de65bafc344ea65670bc8707db626.

pdf[Google Scholar].

Singla R, Gurung P, Aggarwal N, Dutta U, Kochhar R. Relationship between preeclampsia and vitamin D deficiency: a case control study. Arch Gynecol Obstet

; 291(6): 1247-51. [PubMed/ Google Scholar].

Hashemipour S, Esmailzadehha N, Ziaee A, Khoeiniha MH, Darvishgoftar E, Mesgari Z et al. The Relationship of Vitamin D and Calcium level with Preeclampsia

Severity: A Case- control Study. Int J Pediatr 2017; 5(5): 5203-5210. [Google Scholar].

Shand AW, Nassar N, Dadelszen PV, Innis SM, Green TJ. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for preeclampsia. BJOG 2010; 117(13): 1593-1598.Available from: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2010.02742.x [PubMEd/

Google Scholar].

Ullah MI, Koch CA, Tamanna S, Rouf S, Shamsuddin L. Vitamin D Deficiency and the Risk of Pre eclampsia and Eclampsia in Bangladesh. Horm Metab Res 2013;

(09):682-687. [PubMed/ Google Scholar].

Singh A, Mishra S, Aditya V, Srivastava R. Association of vitamin D deficiency with occurrence of pre eclampsia among inpatients of tertiary care centre, Gorakhpur, Uttar Pradesh, India. Int J Reprod Contracept Obstet Gynecol 2016; 5(5): 1304-1308. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/1008 [Google scholar].

Mehmood S, Karim SA. Vitamin D Deficiency during Pregnancy and its Relationship with Pre-Eclampsia, Eclampsia and Gestational Hypertension. Austin J

Nutr Metab 2016; 3(2): 1040. Available from: https://austinpublishinggroup.com/nutrition-metabolism/fulltext/ajnm-v3-id1040.php.

Published
2019-12-17