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.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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