Gestational Age and Maternal Serum 25-hydroxyvitamin D Concentration Interact to Affect the 24,25-dihydroxyvitamin D Concentration in Pregnant Adolescents

Abstract

Background: Interpretation of serum vitamin D biomarkers across pregnancy is complex due to limited understanding of pregnancy adaptations in vitamin D metabolism. During pregnancy, both gestational age and serum 25-hydroxyvitamin D [25(OH)D] concentrations may influence the concentrations of 1,25-dihydroxyvitamin D [1,25(OH)2D], 24,25-dihydroxyvitamin D [24,25(OH)2D], and parathyroid hormone (PTH).

Objective: We aimed to identify predictors of change in serum 25(OH)D across gestation in pregnant adolescents and to assess the contribution made by cholecalciferol (vitamin D3) supplementation. We sought to determine whether gestational age and 25(OH)D concentration interacted to affect serum 1,25(OH)2D, 24,25(OH)2D, or PTH.

Methods: Pregnant adolescents (n = 78, 59% African American, mean ± SD age: 17 ± 1 y) living in Rochester, NY (latitude 43°N) were supplemented with 200 IU or 2000 IU vitamin D3/d and allowed to continue their daily prenatal supplement that contained 400 IU vitamin D3. Serum was collected at study entry (18 ± 5 wk of gestation), halfway through study participation, and at delivery (40 ± 2 wk). Serum concentrations of the biochemical markers were modeled with linear mixed-effects regression models.

Results: Vitamin D3 supplement intake and season of delivery determined change in 25(OH)D across pregnancy. Fall-winter delivery was associated with a decline in 25(OH)D unless vitamin D3 supplement intake was >872 IU/d. The interaction of gestational age and 25(OH)D affected 24,25(OH)2D concentrations. For a given 25(OH)D concentration, model-predicted serum 24,25(OH)2D increased across gestation except when 25(OH)D was <13 ng/mL. Below this threshold, 24,25(OH)2D was predicted to decline over time. Mean serum 1,25(OH)2D was elevated (>100 pg/mL) throughout the study.

Conclusion: Our results suggest that when maternal serum 25(OH)D was low, its catabolism into 24,25(OH)2D decreased or remained stable as pregnancy progressed in order to maintain persistently elevated serum 1,25(OH)2D. Furthermore, in adolescents living at latitude 43°N, standard prenatal supplementation did not prevent a seasonal decline in 25(OH)D during pregnancy. This study was registered at clinicaltrials.gov as NCT01815047.

Figures

FIGURE 1

Model-predicted serum 25(OH)D concentration across gestation by season of delivery and daily intake of intervention vitamin D3 in pregnant adolescents. Values are marginal predictions for 25(OH)D concentration across gestation when vitamin D3 supplement intake was set at 0, 500, or 1000 IU/d. Data were analyzed with a regression coefficients model with an unstructured covariance matrix (Table 2). IU, International Units; 25(OH)D, 25-hydroxyvitamin D.

FIGURE 2

Model-predicted serum 24,25(OH)2D concentration as a function of gestational age and serum 25(OH)D concentration in pregnant adolescents. Values are marginal predictions for serum 24,25(OH)2D across gestation when 25(OH)D concentration was set at 10, 20, 30, 40, or 50 ng/mL. Data were analyzed with a regression coefficients model with an unstructured covariance matrix (Table 3). 24,25(OH)2D, 24,25 dihydroxyvitamin D; 25(OH)D, 25-hydroxyvitamin D.