MATERNAL VITAMIN D LEVELS AND ITS RELATIONSHIP WITH BIRTH WEIGHT OF NEWBORNS IN PARTURIENT WITH LATENT TUBERCULOSIS INFECTION
Main Article Content
Keywords
Birthwieght, Maternal and Child Health, Latent TB, Pregnancy Outcomes, Vitamin D
Abstract
Objectives: To see the relationship of maternal vitamin D levels with birthweight of neonates in pregnant females with latent tuberculosis infection
Methodology: A three arm randomized controlled trial was conducted in LTBI pregnant females. A calculated sample 99 parturient were selected and divided into three groups. As per dose of Vitamin-D supplementation participants were categorized in Group-A (No intervention/supplementation), Group-B (2000IU/day) and Group-C (4000IU/day). Vitamin D supplementation was given to the study groups as per study protocols. To maintain the safety measures throughout the study all the study participants were monitored for hypervitaminosis D. The primary outcome analysis was based on whether vitamin D supplementation has any impact on birth weight of neonates in LTBI pregnant females. Improvement in fetal vitamin D levels after supplementation was assessed as our secondary outcome. At the end of the study period, a total of 90 patients were available for follow up with an overall attrition of (n=9); four from Group-A, three from Group-B and two from Group-C.
Results: Mean age of our study participants was 29±3.6 years. 44 (48.8%) participants were having BMI ≥ 25 kg/m2 while remaining were having BMI <25 kg/m2. There were only 14 (15.5%) participants that were having sufficient vitamin D levels, 23 (25.5%) participants were having insufficient Vitamin D levels and 53 (59%) were found deficient for vitamin D levels. An overall 85.8% (85/99) participants were having VD levels < 30ng/dl. Out of total 90 deliveries 21 (23.3%) participants delivered LBW babies. 15 females were from the group that was not receiving any supplementation, 04 females were from the group receiving 2000IU/day of VD and only 01 from the group receiving 4000IU/day supplements. The association was significantly reduced with supplementation of Vitamin-D as p-value <0.001. A positive correlation was found between maternal vitamin D and birthweight of newborn (ρ = 0.691 with p <0.001)
Conclusions: A significant relationship exists between maternal vitamin D levels and birthweight of neonates. Taking Vitamin D by LTBI pregnant women is effective to decrease the incidence of low birth weight.
References
2. Amegah, A.K., M.K. Klevor, and C.L. Wagner, 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): p. e0173605.
3. Vivanti, A.J., et al., Vitamin D and pregnancy outcomes: Overall results of the FEPED study. Journal of Gynecology Obstetrics and Human Reproduction, 2020. 49(8): p. 101883.
4. Berglund, S.K., et al., Effects of iron supplementation of LBW infants on cognition and behavior at 3 years. Pediatrics, 2013. 131(1): p. 47-55.
5. Chawanpaiboon, S., et al., Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. The Lancet global health, 2019. 7(1): p. e37-e46.
6. Blencowe, H., et al., National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. The Lancet global health, 2019. 7(7): p. e849-e860.
7. Thorp, J., et al., Vitamin D status and recurrent preterm birth: a nested case–control study in high‐risk women. BJOG: An International Journal of Obstetrics & Gynaecology, 2012. 119(13): p. 1617-1623.
8. Miliku, K., et al., Maternal vitamin D concentrations during pregnancy, fetal growth patterns, and risks of adverse birth outcomes. The American journal of clinical nutrition, 2016. 103(6): p. 1514-1522.
9. Organization, W.H., WHO recommendations on antenatal care for a positive pregnancy experience: screening, diagnosis and treatment of tuberculosis disease in pregnant women. Evidence-to-action brief: Highlights and key messages from the World Health Organization’s 2016 global recommendations. 2023: World Health Organization.
10. Gale, C.R., et al., Maternal vitamin D status during pregnancy and child outcomes. European journal of clinical nutrition, 2008. 62(1): p. 68-77.
11. Hollis, B.W. and C.L. Wagner, Vitamin D and pregnancy: skeletal effects, nonskeletal effects, and birth outcomes. Calcified tissue international, 2013. 92: p. 128-139.
12. Chen, Y.-H., et al., Maternal vitamin D deficiency during pregnancy elevates the risks of small for gestational age and low birth weight infants in Chinese population. The Journal of Clinical Endocrinology & Metabolism, 2015. 100(5): p. 1912-1919.
13. Tung, Y., T. Ou, and W. Tsai, Defective Mycobacterium tuberculosis antigen presentation by monocytes from tuberculosis patients. The International journal of tuberculosis and lung disease, 2013. 17(9): p. 1229-1234.
14. Ho-Pham, L.T., et al., Association between vitamin D insufficiency and tuberculosis in a Vietnamese population. BMC infectious diseases, 2010. 10: p. 1-8.
15. Kim, J.H., et al., Low serum 25-hydroxyvitamin D level: an independent risk factor for tuberculosis? Clinical nutrition, 2014. 33(6): p. 1081-1086.
16. Arnedo-Pena, A., et al., Vitamin D status and incidence of tuberculosis infection conversion in contacts of pulmonary tuberculosis patients: a prospective cohort study. Epidemiology & Infection, 2015. 143(8): p. 1731-1741.
17. Huang, S.-J., et al., Vitamin D deficiency and the risk of tuberculosis: a meta-analysis. Drug design, development and therapy, 2016: p. 91-102.
18. Zeng, J., et al., A serum vitamin D level< 25nmol/l pose high tuberculosis risk: a meta-analysis. PloS one, 2015. 10(5): p. e0126014.
19. Holick, M.F., et al., Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology & metabolism, 2011. 96(7): p. 1911-1930.
20. Arnedo-Pena, A., et al., Latent tuberculosis infection, tuberculin skin test and vitamin D status in contacts of tuberculosis patients: a cross-sectional and case-control study. BMC infectious diseases, 2011. 11(1): p. 1-8.
21. Wingfield, T., et al., The seasonality of tuberculosis, sunlight, vitamin D, and household crowding. The Journal of infectious diseases, 2014. 210(5): p. 774-783.
22. Mir, S.A., et al., Efficacy and safety of Vitamin D supplementation during pregnancy: A randomized trial of two different levels of dosing on maternal and neonatal Vitamin D outcome. Indian journal of endocrinology and metabolism, 2016. 20(3): p. 337.
23. Davies, T.F., L.M. Sachs, and M.A. Campinho, OPEN ACCESS EDITED AND REVIEWED BY. The Role of Thyroid Hormones in Vertebrate Development, volume II, 2024: p. 4.
24. Abdolrazaghnejad, A., et al., Relationship between vitamin D level and preterm labor in pregnant women in Zahedan, Iran. Fertility, Gynecology and Andrology, 2022. 2(1).
25. Kanike, N., N. Kannekanti, and J. Camacho, Vitamin D Deficiency in Pregnant Women and Newborn. Vitamin D, 2021.
26. Wang, H., et al., Maternal early pregnancy vitamin D status in relation to low birth weight and small-for-gestational-age offspring. The Journal of steroid biochemistry and molecular biology, 2018. 175: p. 146-150.
27. Fang, K., et al., Maternal vitamin D deficiency during pregnancy and low birth weight: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine, 2021. 34(7): p. 1167-1173.
28. Mahon, P., et al., Low maternal vitamin D status and fetal bone development: cohort study. Journal of Bone and Mineral Research, 2010. 25(1): p. 14-19.
29. Qin, L.-L., et al., Does maternal vitamin D deficiency increase the risk of preterm birth: a meta-analysis of observational studies. Nutrients, 2016. 8(5): p. 301.
30. Grether, J.K., et al., Prenatal and perinatal factors and cerebral palsy in very low birth weight infants. The Journal of pediatrics, 1996. 128(3): p. 407-414.
31. Bogazzi, F., et al., Vitamin D status may contribute to serum insulin-like growth factor I concentrations in healthy subjects. Journal of endocrinological investigation, 2011. 34: p. e200-e203.
32. Ameri, P., et al., Vitamin D increases circulating IGF1 in adults: potential implication for the treatment of GH deficiency. European journal of endocrinology, 2013. 169(6): p. 767-772.
33. Woitge, H.W. and B.E. Kream, Calvariae from fetal mice with a disrupted Igf1 gene have reduced rates of collagen synthesis but maintain responsiveness to glucocorticoids. Journal of Bone and Mineral Research, 2000. 15(10): p. 1956-1964.
34. Kajdy, A., et al., Development of birth weight for gestational age charts and comparison with currently used charts: defining growth in the Polish population. The Journal of Maternal-Fetal & Neonatal Medicine, 2021. 34(18): p. 2977-2984.
35. Hoftiezer, L., et al., Defining small-for-gestational-age: prescriptive versus descriptive birthweight standards. European journal of pediatrics, 2016. 175: p. 1047-1057.
36. Lee, A.C., et al., National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. The Lancet global health, 2013. 1(1): p. e26-e36.
37. Frey, H.A. and M.A. Klebanoff. The epidemiology, etiology, and costs of preterm birth. in Seminars in fetal and neonatal medicine. 2016. Elsevier.
38. McCowan, L. and R.P. Horgan, Risk factors for small for gestational age infants. Best practice & research clinical obstetrics & gynaecology, 2009. 23(6): p. 779-793.
39. Gowtham, T., et al., Impact of maternal hypovitaminosis D on birth and neonatal outcome–a prospective cohort study. The Journal of Maternal-Fetal & Neonatal Medicine, 2022. 35(25): p. 9940-9947.
40. Benaim, C., et al., Vitamin D during pregnancy and its association with birth outcomes: a Brazilian cohort study. European Journal of Clinical Nutrition, 2021. 75(3): p. 489-500.
41. Noamam, K.H. and T.N. Abdulla, Relationship of Low Maternal Vitamin D3 Level and Adverse Early Neonatal Outcomes. Indian Journal of Forensic Medicine & Toxicology, 2021. 15(1): p. 1197-1204.
42. Tous, M., et al., Vitamin D status during pregnancy and offspring outcomes: a systematic review and meta-analysis of observational studies. European journal of clinical nutrition, 2020. 74(1): p. 36-53.
43. Karras, S.N., et al., Maternal vitamin D levels during pregnancy and neonatal health: evidence to date and clinical implications. Therapeutic advances in musculoskeletal disease, 2016. 8(4): p. 124-135.
44. McAree, T., et al., Vitamin D deficiency in pregnancy–still a public health issue. Maternal & child nutrition, 2013. 9(1): p. 23-30.
45. Weinert, L.S. and S.P. Silveiro, Maternal–fetal impact of vitamin D deficiency: a critical review. Maternal and child health journal, 2015. 19: p. 94-101.
46. Wagner, C., et al., Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery. The Journal of steroid biochemistry and molecular biology, 2015. 148: p. 256-260.
47. Pérez-López, F.R., et al., Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Fertility and sterility, 2015. 103(5): p. 1278-1288. e4.
48. Hashemipour, S., et al., Effect of treatment of vitamin D deficiency and insufficiency during pregnancy on fetal growth indices and maternal weight gain: a randomized clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014. 172: p. 15-19.
49. Hossain, N., et al., Obstetric and neonatal outcomes of maternal vitamin D supplementation: results of an open-label, randomized controlled trial of antenatal vitamin D supplementation in Pakistani women. The Journal of Clinical Endocrinology & Metabolism, 2014. 99(7): p. 2448-2455.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Usman Javed Iqbal
Department of Public Health/Institute of Social & Cultural Studies, University of the Punjab, Lahore-Pakistan
Rubeena Zakar
Department of Public Health/Institute of Social & Cultural Studies, University of the Punjab, Lahore-Pakistan
Gull Mahnoor Hashmi
Gulab Devi Educational Complex, Lahore / Al-Aleem Medical College, Lahore
Dur-e-Sabeeh
Medical Polyclinic, MOH, KSA
Minahil Abbas
Gulab Devi Educational Complex, Lahore / Al-Aleem Medical College, Lahore
Kifayat Ullah
Department of Public Health/Institute of Social & Cultural Studies, University of the Punjab, Lahore-Pakistan