OPTIMIZING REPRODUCTIVE HEALTH: A STUDY ON MATERNAL VITAMIN D STATUS AND INTERVENTIONS IN RECURRENT MISCARRIAGES
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Keywords
Case-control Study, Obstetrics and Gynecology, Pregnancy, Public Health, Recurrent Miscarriages, Vitamin D Deficiency
Abstract
This study explores the correlation between maternal vitamin D status and recurrent miscarriages, encapsulating a comprehensive examination within a case-control framework at Mubarak Hospital's Obstetrics and Gynecology clinic over one year. Amid growing evidence linking environmental and lifestyle factors to miscarriage risk, such as advanced maternal age and non-genetic influences, this research delves into the role of vitamin D, recognized for its immune-modulatory capabilities critical to maternal-fetal tolerance. Given the semi-allogenic nature of the human embryo, vitamin D's immunological function is of particular interest, with the study investigating the precursor hormone, 25(OH)D, as a marker for serum vitamin D concentration. Despite mixed findings on the association between 25(OH)D levels and pregnancy outcomes such as preeclampsia and fetal growth, recent analyses suggest significant risks associated with vitamin D deficiency. This research also highlights the placenta's crucial function in vitamin D metabolism, contributing to its impact on fetal development and the maternal immune response. Preliminary global data indicates a widespread prevalence of vitamin D deficiency among pregnant women, underscoring the public health imperative to address this issue. Through an in-depth analysis involving patient recruitment, blood sample evaluation before the 22nd week of gestation, and meticulous consideration of variables including pregestational BMI and maternal age, the study aims to contribute valuable insights into optimizing reproductive health through vitamin D status intervention.
References
2. Andersen, L. B., Abrahamsen, B., Dalgard, C., Kyhl, H., Beck-Nielsen, S., Frost-Nielsen, M., Jorgensen, J., Barington, T., & Christesen, H. (2013). Parity and tanned white skin as novel predictors of vitamin D status in early Pregnancy: A population-based cohort study. Clinical Endocrinology (Oxford), 79, 333–341.
3. Barrera, D., Avila, E., Hernandez, G., Halhali, A., Biruete, B., Larrea, F., & Diaz, L. (2007). Estradiol and progesterone synthesis in the human placenta is stimulated by calcitriol. Journal of Steroid Biochemistry and Molecular Biology, 103, 529–532.
4. Barrera, D., Avila, E., Hernandez, G., Mendez, I., Gonzalez, L., Halhali, A., Larrea, F., Morales, A., & Diaz, L. (2008). Calcitriol affects hCG gene transcription in cultured human syncytiotrophoblasts. Reproductive Biology and Endocrinology, 6, 3.
5. Boonstra, A., Barrat, F. J., Crain, C., Heath, V. L., Savelkoul, H. F., & O’Garra, A. (2001). 1alpha,25-Dihydroxyvitamin D3 has a direct effect on naive CD4(+) T cells to enhance the development of Th2 cells. Journal of Immunology, pp. 167, 4974–4980.
6. Christesen, H., Falkenberg, T., Lamont, R., & Jørgensen, J. (2012). The impact of vitamin D on Pregnancy: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 91, 1357–1367.
7. Du, H., Daftary, G. S., Lalwani, S. I., & Taylor, H. S. (2005). Directly regulated HOXA10 by 1,25-(OH)2D3 in human myelomonocytic and endometrial stromal cells. Molecular Endocrinology, pp. 19, 2222–2233.
8. Everett, C. (1997). Incidence and outcome of bleeding before the 20th week of Pregnancy: Prospective study from general practice. BMJ, pp. 315, 32–34.
9. Feodor Nilsson, S., Andersen, P., Strandberg-Larsen, K., & Nybo Andersen, A. M. (2014). Risk factors for miscarriage from a prevention perspective: A nationwide follow-up study. BJOG, 121, 1439.
10. Halhali, A., Acker, G. M., & Garabedian, M. (1991). 1,25-Dihydroxyvitamin D3 induces in vivo the decidualization of rat endometrial cells. Journal of Reproduction and Fertility, 91, 59–64.
11. Hewison, M. (2008). Vitamin D and innate immunity. Current Opinion in Investigational Drugs, pp. 9, 485–490.
12. Hewison, M. (2012). Vitamin D and immune function: Autocrine, paracrine or endocrine? Scandinavian Journal of Clinical and Laboratory Investigation, pp. 243, 92–102.
13. Jensen, T. K., Andersen, L. B., Kyhl, H. B., Nielsen, F., Christesen, H. T., & Grandjean, P. (2015). Association between perfluorinated compound exposure and miscarriage in Danish pregnant women. PLoS One, 10, e0123496.
14. Joshi, S., Pantalena, L. C., Liu, X. K., Gaffen, S. L., Liu, H., Rohowsky-Kochan, C., Ichiyama, K., Yoshimura, A., Steinman, L., & Christakos, S. (2011). 1,25-Dihydroxyvitamin D(3) ameliorates Th17 autoimmunity via transcriptional modulation of interleukin-17A. Molecular and Cellular Biology, 31, 3653–3669.
15. Kyhl, H. B., Jensen, T. K., Barington, T., Buhl, S., Norberg, L. A., Jorgensen, J. S., Jensen, D. F., Christesen, H. T., Lamont, R. F., & Husby, S. (2015). The Odense Child Cohort: Aims, design, and cohort profile. Paediatric and Perinatal Epidemiology, 29, 250–258.
16. Lagishetty, V., Liu, N. Q., & Hewison, M. (2011). Vitamin D metabolism and innate immunity. Molecular and Cellular Endocrinology, pp. 347, 97–105.
17. Lathi, R. B., Gray Hazard, F. K., Heerema-McKenney, A., Taylor, J., & Chueh, J. T. (2011). First-trimester miscarriage evaluation. Seminars in Reproductive Medicine, pp. 29, 463–469.
18. Nepomnaschy, P. A., Sheiner, E., Mastorakos, G., & Arck, P. C. (2007). Stress, immune function, and women’s reproduction. Annals of the New York Academy of Sciences, 1113, 350–364.
19. Nigro, G., Mazzocco, M., Mattia, E., Di Renzo, G. C., Carta, G., & Anceschi, M. M. (2011). Role of infections in recurrent spontaneous abortion. Journal of Maternal-Fetal and Neonatal Medicine, 24, 983–989.
20. Tavakoli, M., Jeddi-Tehrani, M., Salek-Moghaddam, A., Rajaei, S., Mohammadzadeh, A., Sheikhhasani, S., Kazemi-Sefat, G. E., & Zarnani, A. H. (2011). Effects of 1,25(OH)2 vitamin D3 on cytokine production by endometrial cells of women with recurrent spontaneous abortion. Fertility and Sterility, 96, 751–757.
21. Vigano, P., Lattuada, D., Mangioni, S., Ermellino, L., Vignali, M., Caporizzo, E., Panina-Bordignon, P., Besozzi, M., & Di Blasio, A. M. (2006). Cycling and early pregnant endometrium as a site of regulated expression of the vitamin D system. Journal of Molecular Endocrinology, 36, 415–424.
22. Vijayendra Chary, A., Hemalatha, R., Seshacharyulu, M., Vasudeva Murali, M., Jayaprakash, D., & Dinesh Kumar, B. (2015). Vitamin D deficiency in pregnant women impairs regulatory T cell function. Journal of Steroid Biochemistry and Molecular Biology, pp. 147, 48–55.
23. Wei, S. Q., Qi, H. P., Luo, Z. C., & Fraser, W. D. (2013). Maternal vitamin D status and adverse pregnancy outcomes: A systematic review and meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine, pp. 26, 889–899.
24. Weisman, Y., Harell, A., Edelstein, S., David, M., Spirer, Z., & Golander, A. (1979). One alpha, 25-dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 in vitro synthesis by human decidua and placenta. Nature, 281, 317–319.
25. Zehnder, D., Evans, K. N., Kilby, M. D., Bulmer, J. N., Innes, B. A., Stewart, P. M., & Hewison, M. (2002). The ontogeny of 25-hydroxyvitamin D (3) 1alpha-hydroxylase expression in human placenta and decidua. American Journal of Pathology, 161, 105–114.
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Dr Khawaja Fawad Parvez
Gyne and OBS Clinic Mubarak Hospital Peshawar, Pakistan