Determinants of Vitamin D Status of Women of Reproductive Age in Dhaka, Bangladesh: Insights from Husband-Wife Comparisons

Joo-Hyun Jeong, Jill Korsiak, Eszter Papp, Joy Shi, Alison D Gernand, Abdullah Al Mahmud, Daniel E Roth, Joo-Hyun Jeong, Jill Korsiak, Eszter Papp, Joy Shi, Alison D Gernand, Abdullah Al Mahmud, Daniel E Roth

Abstract

Background: Vitamin D deficiency is common among women of reproductive age (WRA) in Bangladesh, but the causes remain unclear.

Objective: To explain the high prevalence of vitamin D deficiency in WRA in Dhaka, Bangladesh, we compared the vitamin D status of pregnant women with that of their husbands and between pregnant and nonpregnant states.

Methods: This study was an observational substudy of the Maternal Vitamin D for Infant Growth trial conducted in Dhaka, Bangladesh. Women (n = 1300) were enrolled in the second trimester of pregnancy and randomly assigned to 1 of 5 arms consisting of different doses of vitamin D supplements or placebo, with 1 arm continuing supplementation until 6 mo postpartum. A subgroup of trial participants and their husbands with plasma 25-hydroxyvitamin D [25(OH)D] concentration measurements (n = 84), and placebo-group trial participants with serum 25(OH)D measured in the second trimester of pregnancy and 6 mo postpartum (n = 89) were studied using linear mixed-effects regression models.

Results: The mean ± SD plasma 25(OH)D in pregnant women in the second trimester was 23 ± 11 nmol/L. Adjusting for age and season, 25(OH)D of pregnant women was 30 nmol/L lower (95% CI: -36, -25 nmol/L) than that of men. Only 9% of total variance in 25(OH)D was explained by factors shared by spousal pairs. Selected nonshared factors (BMI, time spent outdoors, involvement in an outdoor job, sunscreen use) did not explain the association of sex with 25(OH)D. Adjusting for age, season, and BMI, 25(OH)D was similar during pregnancy and 6 mo postpartum (mean difference: -2.4 nmol/L; 95% CI: -5.3, 0.4 nmol/L).

Conclusions: In Dhaka, WRA have substantially poorer vitamin D status than men. Variation in 25(OH)D is not greatly influenced by determinants shared by spouses. Measured nonshared characteristics or pregnancy did not account for the gender differential in 25(OH)D. This trial was registered at clinicaltrials.gov as NCT01924013.

Keywords: Bangladesh; pregnancy; spouses; vitamin D; women.

Copyright © The Author(s) 2019.

Figures

FIGURE 1
FIGURE 1
Distributions of plasma 25(OH)D concentrations of pregnant women (second trimester) and their husbands (n = 84 pairs), and serum 25(OH)D concentrations of women during pregnancy (second trimester) and 6 mo postpartum (n = 89). Group means are shown as horizontal lines, whereas vertical lines represent the 95% CIs. Among spousal pairs, the mean plasma 25(OH)D concentration for men (55 nmol/L; 95% CI: 51, 59 nmol/L) was significantly higher than that of women (23 nmol/L; 95% CI: 20, 25 nmol/L; P < 0.001 for the comparison of men with women). The mean serum 25(OH)D concentration at pregnancy (26 nmol/L; 95% CI: 23, 29 nmol/L) was lower than at the postpartum measurement (29 nmol/L; 95% CI: 27, 32 nmol/L; P = 0.03 for the comparison of pregnancy and postpartum). The dotted horizontal line indicates the conventional cutoff for vitamin D deficiency (30 nmol/L). 25(OH)D, 25-hydroxyvitamin D.
FIGURE 2
FIGURE 2
Association between plasma 25(OH)D concentrations of pregnant women (second trimester) and their husbands (n = 84 pairs). Among the married couples, there was no significant correlation between spouses’ vitamin D status (r = 0.1; P = 0.4). The dotted horizontal and vertical lines indicate the conventional cutoff for vitamin D deficiency (30 nmol/L) for women and men, respectively. 25(OH)D, 25-hydroxyvitamin D.

References

    1. Institute of Medicine Dietary reference intakes for calcium and vitamin D. Ross AC, Taylor CL, Yaktine AL, De Valle HB, editors. Washington (DC): The National Academies Press; 2011.
    1. Wimalawansa SJ. Non-musculoskeletal benefits of vitamin D. J Steroid Biochem Mol Biol 2018;175:60–81.
    1. Tsiaras WG, Weinstock MA. Factors influencing vitamin D status. Acta Derm Venereol 2011;91(2):115–24.
    1. Seamans KM, Cashman KD. Existing and potentially novel functional markers of vitamin D status: a systematic review. Am J Clin Nutr 2009;89(6):1997S–2008S.
    1. Lowe NM, Bhojani I. Special considerations for vitamin D in the south Asian population in the UK. Ther Adv Musculoskelet Dis 2017;9(6):137–44.
    1. Webb AR. Who, what, where and when-influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 2006;92(1):17–25.
    1. Sofi NY, Jain M, Kapil U, Seenu V, Ramakrishnan L, Yadav CP, Pandey RM. Status of serum vitamin D and calcium levels in women of reproductive age in national capital territory of India. Indian J Endocr Metab 2017;21(5):731–3.
    1. Hossain N, Khanani R, Hussain-Kanani F, Shah T, Arif S, Pal L. High prevalence of vitamin D deficiency in Pakistani mothers and their newborns. Int J Gynaecol Obstet 2011;112(3):229–33.
    1. Smith G Wimalawansa SJ Laillou A Sophonneary P Un S Hong R Poirot E Kuong K Chamnan C De Los Reyes FN et al. .. High prevalence of vitamin D deficiency in Cambodian women: a common deficiency in a sunny country. Nutrients 2016;8(5):290.
    1. Alagöl F, Shihadeh Y, Boztepe H, Tanakol R, Yarman S, Azizlerli H, Sandalci O. Sunlight exposure and vitamin D deficiency in Turkish women. J Endocrinol Invest 2000;23(3):173–7.
    1. Islam MZ, Shamim AA, Kemi V, Nevanlinna A, Akhtaruzzaman M, Laaksonen M, Jehan AH, Jahan K, Khan HU, Lamberg-Allardt C. Vitamin D deficiency and low bone status in adult female garment factory workers in Bangladesh. Br J Nutr 2008;99(6):1322–9.
    1. Elshafie DE, Al-Khashan HI, Mishriky AM. Comparison of vitamin D deficiency in Saudi married couples. Eur J Clin Nutr 2012;66(6):742–5.
    1. Islam MZ, Akhtaruzzaman M, Lamberg-Allardt C. Hypovitaminosis D is common in both veiled and nonveiled Bangladeshi women. Asia Pac J Clin Nutr 2006;15(1):81–7.
    1. Islam MZ, Lamberg-Allardt C, Kärkkäinen M, Outila T, Salamatullah Q, Shamim AA. Vitamin D deficiency: a concern in premenopausal Bangladeshi women of two socio-economic groups in rural and urban region. Eur J Clin Nutr 2002;56(1):51–6.
    1. Roth DE Morris SK Zlotkin S Gernand AD Ahmed T Shanta SS Papp E Korsiak J Shi J Islam MM et al. .. Vitamin D supplementation in pregnancy and lactation and infant growth. N Engl J Med 2018;379(6):535–46.
    1. 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;346:f1169.
    1. Wei SQ, Qi HP, Luo ZC, Fraser WD. Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2013;26(9):889–99.
    1. Amegah AK, Klevor MK, Wagner CL. Maternal vitamin D insufficiency and risk of adverse pregnancy and birth outcomes: a systematic review and meta-analysis of longitudinal studies. PLoS One 2017;12(3):e0173605.
    1. Roth DE Gernand AD Morris SK Pezzack B Islam MM Dimitris MC Shanta SS Zlotkin SH Willan AR Ahmen T et al. .. Maternal vitamin D supplementation during pregnancy and lactation to promote infant growth in Dhaka, Bangladesh (MDIG trial): study protocol for a randomized controlled trial. Trials 2015;16:300.
    1. Botros RM, Sabry IM, Abdelbaky RS, Eid YM, Nasr MS, Hendawy LM. Vitamin D deficiency among healthy Egyptian females. Endocrinol Nutr 2015;62(7):314–21.
    1. Van Der Meer IM, Middelkoop BJ, Boeke AJ, Lips P. Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: an overview. Osteoporos Int 2011;22(4):1009–21.
    1. Batieha A, Khader Y, Jaddou H, Hyassat D, Batieha Z, Khateeb M, Belbisi A, Ajlouni K. Vitamin D status in Jordan: dress style and gender discrepancies. Ann Nutr Metab 2011;58(1):10–18.
    1. McCarty CA. Sunlight exposure assessment: can we accurately assess vitamin D exposure from sunlight questionnaires? Am J Clin Nutr 2008;87(4):1097S–101S.
    1. Cooper M, Shanta S, Mahmud A, Roth D, Gernand A. Availability and intake of foods with naturally occurring or added vitamin D in a setting of high vitamin D deficiency. FASEB J 2015;29(1_supplement):391.3.
    1. Institute of Public Health Nutrition National strategy on prevention and control of micronutrient deficiencies, Bangladesh (2015–2024). Dhaka: Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh; 2015.
    1. Shaunak S, Colston K, Ang L, Patel SP, Maxwell JD. Vitamin D deficiency in adult British Hindu Asians: a family disorder. Br Med J (Clin Res Ed) 1985;291(6503):1166–8.
    1. Ostertag A, Cohen-Solal M, Madec Y, Baudoin C, de Vernejoul MC. Bone changes in spouses having shared lifestyle for 40 years. Joint Bone Spine 2011;78(3):285–90.
    1. Xue Y, Ying L, Horst RL, Watson G, Goltzman D. Androgens attenuate vitamin D production induced by UVB irradiation of the skin of male mice by an enzymatic mechanism. J Invest Dermatol 2015;135(12):3125–32.
    1. Gorman S, Scott NM, Tan DH, Weeden CE, Tuckey RC, Bisley JL, Grimbaldeston MA, Hart PH. Acute erythemal ultraviolet radiation causes systemic immunosuppression in the absence of increased 25-hydroxyvitamin D3 levels in male mice. PLoS One 2012;7(9):e46006.
    1. Lee SR, Park MY, Yang H, Lee GS, An BS, Park BK, Jeung EB, Hong EJ. 5α-dihydrotestosterone reduces renal Cyp24a1 expression via suppression of progesterone receptor. J Mol Endocrinol 2018;60(2):159–70.
    1. Zhang JY, Lucey AJ, Horgan R, Kenny LC, Kiely M. Impact of pregnancy on vitamin D status: a longitudinal study. Br J Nutr 2014;112(7):1081–7.
    1. Jones KS, Assar S, Prentice A, Schoenmakers I. Vitamin D expenditure is not altered in pregnancy and lactation despite changes in vitamin D metabolite concentrations. Sci Rep 2016;6:26795.
    1. Papapetrou PD. The interrelationship of serum 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D in pregnancy at term: a meta-analysis. Hormones (Athens) 2010;9(2):136–44.
    1. Moon RJ, Crozier SR, Dennison EM, Davies JH, Robinson SM, Inskip HM, Godfrey KM, Cooper C, Harvey NC. Tracking of 25-hydroxyvitamin D status during pregnancy: the importance of vitamin D supplementation. Am J Clin Nutr 2015;102(5):1081–7.
    1. Zhu K, Oddy WH, Holt P, Ping-Delfos WCS, Mountain J, Lye S, Pennell C, Hart PH, Walsh JP. Tracking of vitamin D status from childhood to early adulthood and its association with peak bone mass. Am J Clin Nutr 2017;106(1):276–83.
    1. Coates JC, Webb P, Houser RF, Rogers BL, Wilde P. “He said, she said”: who should speak for households about experiences of food insecurity in Bangladesh? Food Secur 2010;2(1):81–95.
    1. Levay AV, Mumtaz Z, Rashid SF, Willows N. Influence of gender roles and rising food prices on poor, pregnant women's eating and food provisioning practices in Dhaka, Bangladesh. Reprod Health 2013;10:53.

Source: PubMed

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