Serum 25(OH) Vitamin D Levels in Polish Women during Pregnancies Complicated by Hypertensive Disorders and Gestational Diabetes

Piotr Domaracki, Pawel Sadlecki, Grazyna Odrowaz-Sypniewska, Ewa Dzikowska, Pawel Walentowicz, Joanna Siodmiak, Marek Grabiec, Malgorzata Walentowicz-Sadlecka, Piotr Domaracki, Pawel Sadlecki, Grazyna Odrowaz-Sypniewska, Ewa Dzikowska, Pawel Walentowicz, Joanna Siodmiak, Marek Grabiec, Malgorzata Walentowicz-Sadlecka

Abstract

Background: An association between the level of vitamin D and the risk of pregnancy-related complications remains unclear. The aim of this study was to examine concentrations of 25(OH) vitamin D in Polish women with normal pregnancies and pregnancies complicated by gestational hypertension, preeclampsia or gestational diabetes mellitus (GDM). Moreover, we analyzed an association between maternal serum 25(OH)D and the risk of gestational hypertension, preeclampsia and GDM.

Material and methods: The study included 207 pregnant women, among them 171 with pregnancy-related complications: gestational hypertension (n = 45), preeclampsia (n = 23) or GDM (n = 103). The control group consisted of 36 women with normal pregnancies. Concentrations of serum 25(OH)D were measured at admission to the hospital prior to delivery Results: Patients with hypertension did not differ significantly from the controls in terms of their serum 25(OH)D concentrations (18.20 vs. 22.10 ng/mL, p = 0.15). Highly significant differences were found in 25(OH)D concentrations of women with preeclampsia and the controls (14.75 vs. 22.10 ng/mL, p = 0.0021). GDM was not associated with significant differences in 25(OH)D concentration. A low level of 25(OH)D turned out to be associated with an increased risk of preeclampsia during pregnancy on both univariate and multivariate regression analysis, and was a significant predictor of this condition on ROC (receiver operating characteristic) analysis (AUC = 0.70, p < 0.01).

Conclusions: 25(OH)D deficiency is common among pregnant Polish women. Low concentrations of 25(OH)D may play a role in the etiopathogenesis of preeclampsia. Routine assessment of the 25(OH)D level during pregnancy may be crucial for the identification of women at increased risk of preeclampsia.

Keywords: 25(OH)D; gestational diabetes; gestational hypertension; preeclampsia.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
ROC curve relationship between 25(OH)D concentrations (ng/mL) and occurrence of gestational hypertension (red point—cut-off value).
Figure 2
Figure 2
ROC curve-relationship between 25(OH)D concentrations (ng/mL) and occurrence of preeclampsia (AUC 0.7029), (red point—cut-off value).
Figure 3
Figure 3
ROC curve-relationship between 25(OH)D concentrations (ng/mL) and occurrence of diabetes (AUC 0.5721) (red point—cut-off value).

References

    1. Karras S., Paschou S.A., Kandaraki E., Anagnostis P., Annweiler C., Tarlatzis B.C., Hollis B.W., Grant W.B., Goulis D.G. Hypovitaminosis D in pregnancy in the Mediterranean region: A systematic review. Eur. J. Clin. Nutr. 2016 doi: 10.1038/ejcn.2016.12.
    1. Holick M.F. Vitamin D and sunlight: Strategies for cancer prevention and other health benefits. Clin. J. Am. Soc. Nephrol. 2008;3:1548–1554. doi: 10.2215/CJN.01350308.
    1. Sutton A., MacDonald P. Vitamin D: More than a “bone-a-fide” hormone. Mol. Endocrinol. 2003;17:777–791. doi: 10.1210/me.2002-0363.
    1. Granado-Lorencio F., Olmedilla-Alonso B., Herrero-Barbudo C., Blanco-Navarro I., Blázquez-García S., Pérez-Sacristán B. Simultaneous determination of vitamins A, E and 25-OH-vitamin D: Application in clinical assessments. Clin. Biochem. 2006;39:180–182. doi: 10.1016/j.clinbiochem.2005.11.004.
    1. Fried D.A., Rhyu J., Odato K., Blunt H., Karagas M.R., Gilbert-Diamond D. Maternal and cord blood vitamin D status and childhood infection and allergic disease: A systematic review. Nutr. Rev. 2016 doi: 10.1093/nutrit/nuv108.
    1. Walentowicz-Sadlecka M., Grabiec M., Sadlecki P., Gotowska M., Walentowicz P., Krintus M., Mankowska-Cyl A., Sypniewska G. 25(OH)D3 in patients with ovarian cancer and its correlation with survival. Clin. Biochem. 2012;45:1568–1572. doi: 10.1016/j.clinbiochem.2012.07.110.
    1. Dusso A.S. Kidney disease and vitamin D levels: 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and VDR activation. Kidney Int. Suppl. 2011 doi: 10.1038/kisup.2011.30.
    1. Walicka M., Marcinowska-Suchowierska E. Vitamin D deficiency during pregnancy and lactation. Ginekol. Pol. 2008;79:780–784.
    1. Bener A., Al-Hamaq A.O., Saleh N.M. Association between vitamin D insufficiency and adverse pregnancy outcome: Global comparisons. Int. J. Womens Health. 2013;5:523–531. doi: 10.2147/IJWH.S51403.
    1. Rajagambeeram R., Abu Raghavan S., Ghosh S., Basu S., Ramasamy R., Murugaiyan S.B. Diagnostic utility of heat stable alkaline phosphatase in hypertensive disorders of pregnancy. J. Clin. Diagn. Res. 2014 doi: 10.7860/JCDR/2014/10895.5084.
    1. Gillon T.E.R., Pels A., von Dadelszen P., MacDonell K., Magee L.A. Hypertensive disorders of pregnancy: A systematic review of international clinical practice guidelines. PLoS ONE. 2014;9:1574. doi: 10.1371/journal.pone.0113715.
    1. Khan K.S., Wojdyla D., Say L., Gülmezoglu A.M., van Look P.F. WHO analysis of causes of maternal death: A systematic review. Lancet. 2006;367:1066–1074. doi: 10.1016/S0140-6736(06)68397-9.
    1. Bärebring L., Bullarbo M., Glantz A., LeuAgelii M., Jagner Å., Ellis J., Hulthén L., Schoenmakers I., Augustin H. Preeclampsia and blood pressure trajectory during pregnancy in relation to vitamin D status. PLoS ONE. 2016;11:1574. doi: 10.1371/journal.pone.0152198.
    1. Kazimierak W., Kowalska-Koprek U., Karowicz-Bilińska A., Berner-Trąbska M., Lenczowska-Wężyk M., Brzozowska M., Kuś E. 24-hour Holter measurement of blood pressure in pregnant women and effectiveness of the treatment. Ginekol. Pol. 2008;79:174–176.
    1. Szczepaniak-Chicheł L., Tykarski A. Treatment of arterial hypertension in pregnancy in relation to current guidelines of the Polish Society of Arterial Hypertension from 2011. Ginekol. Pol. 2012;83:778–783.
    1. Sibai B., Dekker G., Kupferminc M. Pre-eclampsia. Lancet. 2005;365:785–799. doi: 10.1016/S0140-6736(05)71003-5.
    1. Głuchowska M., Kowalska-Koprek U., Karowicz-Bilińska A. Evaluation of the usefulness of endoglin level as a predictor of preeclampsia in pregnant women with hypertension. Ginekol. Pol. 2013;84:835–840. doi: 10.17772/gp/1648.
    1. Perez-Sepulveda A., Monteiro L.J., Dobierzewska A., España-Perrot P.P., Venegas-Araneda P., Guzmán-Rojas A.M., González M.I., Palominos-Rivera M., Irarrazabal C.E., Figueroa-Diesel H., et al. Placental aromatase is deficient in placental ischemia andpreeclampsia. PLoS ONE. 2015;10:1574. doi: 10.1371/journal.pone.0139682.
    1. Kornacki J., Skrzypczak J. Preeclampsia—Two manifestations of the same disease. Ginekol. Pol. 2008;79:432–437.
    1. Weinert L.S. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: Comment to the international association of diabetes and pregnancy study groups consensus panel. Diabetes Care. 2010;33:e97. doi: 10.2337/dc10-0544.
    1. Wojcikowski C., Lech M., Chećka Z., Wierzchowska J., Lukaszuk K. Large-scale screening for early diagnosis of gestational diabetes mellitus (GDM) Ginekol. Pol. 1997;68:297–301.
    1. Genuis S.J. Maternal and pediatric health outcomes in relation to gestational vitamin D sufficiency. Obst. Gynecol. Int. 2015;2015:501829. doi: 10.1155/2015/501829.
    1. Pleskačová A., Bartáková V., Pácal L., Kuricová K., Bělobrádková J., Tomandl J., Kaňková K. Vitamin D status in women with gestational diabetes mellitus during pregnancy and postpartum. BioMed Res. Int. 2015;2015:1574. doi: 10.1155/2015/260624.
    1. Kaur H., Sangha R., Cassidy-Bushrow A.E., Wegienka G. Maternal-cord blood vitamin D correlations vary by maternal levels. J. Pregnancy. 2016;2016:7474192.
    1. Ali M.M., Vaidya V. Vitamin D and cancer. J. Cancer Res. Ther. 2007;3:225–230. doi: 10.4103/0973-1482.38998.
    1. Dawodu A., Wagner C.L. Prevention of vitamin D deficiency in mothers and infants worldwide—A paradigm shift. Paediatr. Int. Child Health. 2012;32:3–13. doi: 10.1179/1465328111Y.0000000024.
    1. Baggerly C.A., Cuomo R.E., French C.B., Garland C.F., Gorham E.D., Grant W.B., Heaney R.P., Holick M.F., Hollis B.W., McDonnell S.L., et al. Sunlight and vitamin D: Necessary for public health. J. Am. Coll. Nutr. 2015;34:359–365. doi: 10.1080/07315724.2015.1039866.
    1. Zhou J., Su L., Liu M., Liu Y., Cao X., Wang Z., Xiao H. Associations between 25-hydroxyvitamin D levels and pregnancy outcomes: A prospective observational study in southern China. Eur. J. Clin. Nutr. 2014;68:925–930. doi: 10.1038/ejcn.2014.99.
    1. Burris H.H., Rifas-Shiman S.L., Huh S.Y., Kleinman K., Litonjua A.A., Oken E., Rich-Edwards J.W., Camargo C.A., Gillman M.W. Vitamin D status and hypertensive disorders in pregnancy. Ann. Epidemiol. 2014;24:399–403. doi: 10.1016/j.annepidem.2014.02.001.
    1. Van Weert B., van den Berg D., Hrudey E.J., Oostvogels A.J., de Miranda E., Vrijkotte T.G. Is first trimester vitamin D status in nulliparous women associated with pregnancy related hypertensive disorders? Midwifery. 2016;34:117–122. doi: 10.1016/j.midw.2015.12.007.
    1. Powe C.E., Seely E.W., Rana S., Bhan I., Ecker J., Karumanchi S.A., Thadhani R. First trimester vitamin D, vitamin D binding protein and subsequent preeclampsia. Hypertension. 2010;56:758–763. doi: 10.1161/HYPERTENSIONAHA.110.158238.
    1. Hill A.B. The environment and disease: Association or causation? Proc. R. Soc. Med. 1965;58:295–300. doi: 10.1177/0141076814562718.
    1. Hyppönen E. Vitamin D for the prevention of preeclampsia? A hypothesis. Nutr. Rev. 2005;63:225–232. doi: 10.1111/j.1753-4887.2005.tb00378.x.
    1. Villa P.M., Hämäläinen E., Mäki A., Räikkönen K., Pesonen A.-K., Taipale P., Kajantie E., Laivuori H. Vasoactive agents for the prediction of early- and late-onset preeclampsia in a high-risk kohort. BMC Pregnancy Childbirth. 2013;13:1574. doi: 10.1186/1471-2393-13-110.
    1. Lehnen H., Mosblech N., Reineke T., Puchooa A., Menke-Möllers I., Zechner U., Gembruch U. Prenatal clinical assessment ofsFlt-1(soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio as a diagnostic tool for preeclampsia, pregnancy-inducedhypertension and proteinuria. Geburtshilfe Frauenheilkd. 2013;73:440–445.
    1. Holmes V.A., Young I.S., Patterson C.C., Maresh M.J., Pearson D.W., Walker J.D., McCance D.R., diabetesand preeclampsia intervention trial (dapit) study group The role of angiogenic and antiangiogenic factors in the second trimester in the prediction of preeclampsia in pregnant women with type 1diabetes. Diabetes Care. 2013;36:3671–3677. doi: 10.2337/dc13-0944.
    1. Zabul P., Wozniak M., Slominski A.T., Preis K., Gorska M., Korozan M., Wieruszewski J., Zmijewski M.A., Zabul E., Tuckey R., et al. A Proposed molecular mechanism of high-dose vitamin D3 supplementation in prevention and treatment of preeclampsia. Int. J. Mol. Sci. 2015;16:13043–13064. doi: 10.3390/ijms160613043.
    1. Mutter W.P., Karumanchi S.A. Molecular mechanisms ofpreeclampsia. Microvasc. Res. 2008;75:1–8. doi: 10.1016/j.mvr.2007.04.009.
    1. Hyppönen E., Cavadino A., Williams D., Fraser A., Vereczkey A., Fraser W.D., Banhidy F., Lawlor D., Czeizel A.E. Vitamin D and Pre-Eclampsia: Original data, systematic review and meta-analysis. Ann. Nutr. Metab. 2013;63:331–340. doi: 10.1159/000358338.
    1. Haugen M., Brantsaeter A.L., Trogstad L., Aleksander J., Roth C., Magnus P., Meltzer H.M. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology. 2009;20:720–726. doi: 10.1097/EDE.0b013e3181a70f08.
    1. Tabesh M., Salehi-Abargouei A., Tabesh M., Esmaillzadeh A. Maternal vitamin D status and risk of pre-eclampsia: A systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 2013;98:3165–3173. doi: 10.1210/jc.2013-1257.
    1. Pena H.R., de Lima M.C., Brandt K.G., de Antunes M.M., da Silva G.A. Influence of preeclampsia and gestational obesity in maternal and newborn levels of vitamin D. BMC Pregnancy Childbirth. 2015;15:1574. doi: 10.1186/s12884-015-0547-7.
    1. Mohaghegh Z., Abedi P., Dilgouni T., Namvar F., Ruzafza S. The relation of preeclampsia and serum level of 25-hydroxyvitamin D in mothers and their neonates: A case control study in Iran. Horm. Metab. Res. 2015;47:284–288. doi: 10.1055/s-0034-1395607.
    1. Halhali A., Díaz L., Barrera D., Avila E., Larrea F. Placental calcitriol synthesis and IGF-I levels in normal and preeclampticpregnancies. J. Steroid Biochem. Mol. Biol. 2014;144:44–49. doi: 10.1016/j.jsbmb.2013.12.014.
    1. Zehnder D., Evans K.N., Kilby M.D., Bulmer J.N., Innes B.A., Stewart P.M., Hewison M. The ontogeny of 25-hydroxyvitamin D3 1α-hydroxylase expression in human placenta and deciduas. Am. J. Pathol. 2002;161:105–114. doi: 10.1016/S0002-9440(10)64162-4.
    1. Farrant H.J., Krishnaveni G.V., Hill J.C., Boucher B.J., Fisher D.J., Noonan K., Osmond C., Veena S.R., Fall C.H.D. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur. J. Clin. Nutr. 2009;63:646–652. doi: 10.1038/ejcn.2008.14.
    1. Loy S.L., Lek N., Yap F., Soh S.E., Padmapriya N., Tan K.H., Biswas A., Yeo G.S., Kwek K., Gluckman P.D., et al. Association of maternal vitamin D status with glucose tolerance and caesarean section in a Multi-Ethnic Asian Cohort: The growing up in Singapore towards healthy outcomes study. PLoS ONE. 2015;10:1574. doi: 10.1371/journal.pone.0142239.
    1. Nobles C.J., Markenson G., Chasan-Taber L. Early pregnancy vitamin D status and risk for adverse maternal and infant outcomes in a bi-ethnic cohort: The behaviors affecting baby and you (baby) study. Br. J. Nutr. 2015;114:2116–2128. doi: 10.1017/S0007114515003980.
    1. Zhang M.X., Pan G.T., Guo J.F., Li B.Y., Qin L.Q., Zhang Z.L. Vitamin D deficiency increases the risk of gestational diabetes mellitus: A meta-analysis of observational studies. Nutrients. 2015;7:8366–8375. doi: 10.3390/nu7105398.
    1. White P. Pregnancy complicating diabetes. Am. J. Med. 1949;7:609–616. doi: 10.1016/0002-9343(49)90382-4.

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