Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes

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dc.check.date2019-08-28
dc.check.infoAccess to this article is restricted until 12 months after publication at the request of the publisheren
dc.contributor.authorHemmingway, Andrea
dc.contributor.authorKenny, Louise C.
dc.contributor.authorMalvisi, Lucio
dc.contributor.authorKiely, Mairead E.
dc.contributor.funderSeventh Framework Programmeen
dc.contributor.funderHealth Research Boarden
dc.contributor.funderScience Foundation Irelanden
dc.contributor.funderEuropean Regional Development Funden
dc.date.accessioned2019-01-15T12:07:39Z
dc.date.available2019-01-15T12:07:39Z
dc.date.issued2018
dc.date.updated2019-01-15T11:51:45Z
dc.description.abstractBackground: Associations of vitamin D with perinatal outcomes are inconsistent and few studies have considered the wider calcium metabolic system. Objectives: We aimed to explore functional vitamin D deficiency in pregnancy by investigating associations between vitamin D status, parathyroid hormone (PTH), and perinatal outcomes. Design: SCOPE (Screening for Pregnancy Endpoints) Ireland is a prospective cohort study of low-risk, nulliparous pregnant women. We measured serum 25-hydroxyvitamin D [25(OH)D] and PTH at 15 wk of gestation in 1754 participants. Results: Mean ± SD 25(OH)D was 56.6 ± 25.8 nmol/L (22.7 ± 10.3 ng/mL) and geometric mean (95% CI) PTH was 7.84 pg/mL (7.7, 8.0 pg/mL) [0.86 pmol/L (0.85, 0.88 pmol/L)]. PTH was elevated in 34.3% of women who had 25(OH)D <30 nmol/L and in 13.9% of those with 25(OH)D ≥75 nmol/L. Whereas 17% had 25(OH)D <30 nmol/L, 5.5% had functional vitamin D deficiency, defined as 25(OH)D <30 nmol/L with elevated PTH. Elevated mean arterial pressure (MAP), gestational hypertension, pre-eclampsia, and small-for-gestational-age (SGA) birth were confirmed in 9.2%, 11.9%, 3.8%, and 10.6% of participants, respectively. In fully adjusted regression models, neither low 25(OH)D nor elevated PTH alone increased the risk of any individual outcome. The prevalence of elevated MAP (19.1% compared with 9.7%) and SGA (16.0% compared with 6.7%) were highest (P < 0.05) in those with functional vitamin D deficiency compared with the reference group [25(OH)D ≥75 nmol/L and normal PTH]. The adjusted prevalence ratio (PR) and RR (95% CIs) for elevated MAP and SGA were 1.83 (1.02, 3.27) and 1.53 (0.80, 2.93), respectively. There was no effect of functional vitamin D deficiency on the risk of gestational hypertension (adjusted RR: 1.00; 95% CI: 0.60, 1.67) or pre-eclampsia (adjusted RR: 1.17; 95% CI: 0.32, 4.20). Conclusion: The concept of functional vitamin D deficiency, reflecting calcium metabolic stress, should be considered in studies of vitamin D in pregnancy. The SCOPE pregnancy cohort is registered at http://www.anzctr.org.au as ACTRN12607000551493.en
dc.description.sponsorshipHealth Research Board (SCOPE Ireland pregnancy cohort study, grant (CSA 02/2007));en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationHemmingway, A., Kenny, L. C., Malvisi, L. and Kiely, M. E. (2018) 'Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes', The American Journal of Clinical Nutrition, 108(4), pp. 821-829. doi: 10.1093/ajcn/nqy150en
dc.identifier.doi10.1093/ajcn/nqy150
dc.identifier.endpage829en
dc.identifier.issn0002-9165
dc.identifier.issued4en
dc.identifier.journaltitleThe American Journal of Clinical Nutritionen
dc.identifier.startpage821en
dc.identifier.urihttps://hdl.handle.net/10468/7296
dc.identifier.volume108en
dc.language.isoenen
dc.publisherOxford University Pressen
dc.relation.projectinfo:eu-repo/grantAgreement/EC/FP7::SP1::KBBE/613977/EU/Food-based solutions for Optimal vitamin D Nutrition and health through the life cycle/ODINen
dc.relation.projectinfo:eu-repo/grantAgreement/SFI/SFI Spokes Programme/14/SP APC INFANT/B3067/IE/The Cork Nutrition and Microbiome Maternal-Infant Cohort Study (COMBINE)/en
dc.relation.projectinfo:eu-repo/grantAgreement/SFI/SFI Research Centres/12/RC/2272/IE/Irish Centre for Fetal and Neonatal Translational Research (INFANT)/en
dc.relation.urihttp://dx.doi.org/10.1093/ajcn/nqy150
dc.rights© 2018 American Society for Nutrition. Published by Oxford University Press. This is a pre-copyedited, author-produced version of an article accepted for publication in American Journal of Clinical Nutrition following peer review. The version of record, 108, Issue 4, 1 October 2018, Pages 821–829, is available online at: https://doi.org/10.1093/ajcn/nqy150en
dc.subjectVitamin Den
dc.subject25-hydroxyvitamin Den
dc.subjectParathyroid hormoneen
dc.subjectPregnancyen
dc.subjectPerinatalen
dc.subjectMean arterial pressureen
dc.subjectGestational hypertensionen
dc.subjectPreeclampsiaen
dc.subjectSmall-for-gestational-ageen
dc.titleExploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomesen
dc.typeArticle (peer-reviewed)en
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