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Vitamin D and its relation with ionic calcium, parathyroid hormone, maternal and neonatal characteristics in pregnancy after roux-en-Y gastric bypass

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The objective of this study was to evaluate vitamin D nutritional status and its relation with ionic calcium, parathyroid hormone (PTH), maternal anthropometry and perinatal outcomes in pregnant women who previously underwent Roux-en-Y gastric bypass (RYGB) surgery.

Methods

In a clinic specialized in obesity control located in the city of Rio de Janeiro (Brazil), the following information were collected for adult women who underwent RYGB before pregnancy: serum concentrations of vitamin D [25(OH)D], calcium and PTH per gestational trimester and data on maternal anthropometry, gestational intercurrences and perinatal outcomes.

Results

The present study included 46 post-RYGB pregnant women. The prevalence of pregnant women with deficiency (≤20 ng/mL) or insufficiency (≥21 and 29 ng/mL) of vitamin D was above 70 % in all trimesters. The prevalence of calcium deficiency was 15.2 % in the first and in the second trimesters and 20 % in the third trimester, while the prevalence of excess PTH was 19.6, 30.4 and 32.6 % in the first, the second and the third trimesters, respectively. In the second and the third trimesters, a significant difference was observed between concentrations of 25(OH)D, and a negative correlation was observed between concentrations of calcium and PTH. Association of 25(OH)D with urinary tract infection (UTI) was found, but there was no association with calcium, PTH, maternal anthropometry, type of delivery and weight and gestational age at birth

Conclusions

The post-RYGB pregnant women showed an elevated serum inadequacy (deficiency or insufficiency) of 25(OH)D during pregnancy. Maternal vitamin D status showed no association with maternal variables, except UTI, and the neonatal variables analyzed.

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References

  1. Gomes GS, Rosa MA, Faria HRM (2009) Perfil nutricional dos pacientes de pós-operatório de cirurgia bariátrica. Nutrir Gerais 3(5):462–476

    Google Scholar 

  2. Facchiano E, Iannelli A, Santulli P, Mandelbrot L, Msika S (2012) Pregnancy after laparoscopic bariatric surgery: comparative study of adjustable gastric banding and Roux-en-Y gastric bypass. Surg Obes Relat Dis. 8(4):429–433

    Article  PubMed  Google Scholar 

  3. WHO (World Health Organization) (2013) World Health Statistics. Available at: http://www.who.int/gho/publications/world_health_statistics/2013/en/. Accessed 10 Feb 2014

  4. Instituto Brasileiro de Geografia e Estatística (2010) Pesquisa de Orçamentos Familiares 2008–2009. Available at: http://www.ibge.gov.br. Accessed 30 Nov 2013

  5. Sociedade Brasileira de Cirurgia Bariátrica e Metabólica (2007) Mapeamento obesidade. Available at: http://www.sbcb.org.br/obesidade.asp?menu=4. Accessed 30 Oct 2013

  6. Nomura RM, Dias MC, Igai AM, Liao AW, Miyadahira S, Zugaib M (2010) Avaliação da vitalidade fetal e resultados perinatais em gestações após gastroplastia com derivação em Y de Roux. Rev Assoc Med Bras 56(6):670–674

    Article  PubMed  Google Scholar 

  7. Lima JG, Nóbrega LHC, Mesquita JB, Nóbrega MLC, Medeiros AC, Maranhão TMO, Azevedo GD (2006) Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura. Rev Bras Ginecol Obstet 28(2):107–111

    Article  Google Scholar 

  8. Schuch NJ, Garcia VC, Martini LA (2009) Vitamina D e doenças endocrinometabólicas. Arq Bras Endocrinol Metab 53(5):625–633

    Article  Google Scholar 

  9. Leffelaar ER, Vrijkotte TG, van Eijsden M (2010) Maternal early pregnancy vitamin D status in relation to fetal and neonatal growth: results of the multi-ethnic Amsterdam Born Children and their Development cohort. Br J Nutr 104(1):108–117

    Article  CAS  PubMed  Google Scholar 

  10. Sørensen IM, Joner G, Jenum PA, Eskild A, Torjesen PA, Stene LC (2012) Maternal serum levels of 25-hydroxy-vitamin D during pregnancy and risk of type 1 diabetes in the offspring. Diabetes 61(1):175–178

    Article  PubMed Central  PubMed  Google Scholar 

  11. Erkkola M, Kaila M, Nwaru BI, Kronberg-Kippilä C, Ahonen S, Nevalainen J, Veijola R, Pekkanen J, Ilonen J, Simell O, Knip M, Virtanen SM (2009) Maternal vitamin D intake during pregnancy is inversely associated with asthma and allergic rhinitis in 5-year-old children. Clin Exp Allergy 39(6):875–882

    Article  CAS  PubMed  Google Scholar 

  12. Viljakainen HT, Saarnio E, Hytinantti T, Miettinen M, Surcel H, Mäkitie O, Andersson S, Laitinen K, Lamberg-Allardt C (2010) Maternal vitamin D status determines bone variables in the newborn. J Clin Endocrinol Metab 95(4):1749–1757

    Article  CAS  PubMed  Google Scholar 

  13. Marwaha RK, Tandon N, Chopra S, Agarwal N, Garg MK, Sharma B, Kanwar RS, Bhadra K, Singh S, Mani K, Puri S (2011) Vitamin D status in pregnant Indian women across trimesters and different seasons and its correlation with neonatal serum 25-hydroxyvitamin D levels. Br J Nutr 106(9):1383–1389

    Article  CAS  PubMed  Google Scholar 

  14. Holmes VA, Barnes MS, Alexander HD, McFaul P, Wallace JM (2009) Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study. Br J Nutr 102(6):876–881

    Article  CAS  PubMed  Google Scholar 

  15. Bodnar LM, Catov JM, Roberts JM, Simhan HN (2007) Prepregnancy obesity predicts poor vitamin d status in mothers and their neonates. J Nutr 137(11):2437–2442

    PubMed Central  CAS  PubMed  Google Scholar 

  16. WHO (World Health Organization) (1998) Obesity: preventing and managing the global epidemic. Report of WHO consultation on obesity. Geneva: WHO

  17. IOM (Institute of Medicine) (2009) Weight Gain during Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press

  18. Dorsey JG (2010) Introduction to modern liquid chromatography. J Am ChemSoc 132:9220

    Article  CAS  Google Scholar 

  19. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society (2011) Evaluation, treatment and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930

    Article  CAS  PubMed  Google Scholar 

  20. Andriolo A, Moreira SR, Silva LA, Carvalho AB, Vieira JGH, Ghiringhello MT, Juliano Y (2004) Cálcio ionizado no soro: estimativa do intervalo de referência e condições de coleta. J Bras Patol Med Lab 40(2):85–89

    Article  CAS  Google Scholar 

  21. Kao PC (1982) Parathyroid hormone assay. Mayo Clin Proc 57(9):596–597

    CAS  PubMed  Google Scholar 

  22. Brasil. Ministério da Saúde. (2012) Atenção ao pré-natal de baixo risco. Brasília: Editora do Ministério da Saúde, 2012

  23. Silva VRG (2009) Marcadores Pró-inflamatórios e de Estresse Oxidativo em Pacientes submetidos à Gastroplastia com Bypass em Y de Roux. Dissertation, Universidade Federal de Santa Catarina, Florianópolis

  24. WHO (World Health Organization) (1995) Physical status: the use and interpretation of anthropometry—report of a WHO Expert Committee. Geneva: WHO

  25. Brasil. Ministério da Saúde (2005) Pré-natal e Puerpério: atenção qualificada e humanizada—manual técnico. Brasília: Ministério da Saúde, 2005

  26. Pedreira CE, Pinto FA, Pereira SP, Costa ES (2011) Birth weight patterns by gestational age in Brazil. An Acad Bras Ciênc 83(2):619–625

    Article  PubMed  Google Scholar 

  27. Haliloglu B, Ilter E, Aksungar FB, Celik A, Coksuer H, Gunduz T, Yucel E, Ozekici U (2011) Bone turnover and maternal 25(OH) vitamin D3 levels during pregnancy and the postpartum period: should routine vitamin D supplementation be increased in pregnant women? Eur J Obstet Gynecol Reprod Biol 158(1):24–27

    Article  CAS  PubMed  Google Scholar 

  28. González Navarro I, Pereira Cunill JL, Serrano Aguayo P, Morales Conde S, Martos Martínez JM, García Luna PP (2011) Resultados materno-fetales de la gestación tras cirugía bariátrica. Nutr Hosp 26(2):376–383

    PubMed  Google Scholar 

  29. Aasheim ET, Björkman S, Søvik TT, Engström M, Hanvold SE, Mala T, Olbers T, Bøhmer T (2009) Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr 90(1):15–22

    Article  PubMed  Google Scholar 

  30. Lewis S, Lucas RM, Halliday J, Ponsonby AL (2010) Vitamin D deficiency and pregnancy: from preconception to birth. Mol Nutr Food Res 54(8):1092–1102

    CAS  PubMed  Google Scholar 

  31. Need AG, O’Loughlin PD, Morris HA, Coates PS, Horowitz M, Nordin BE (2008) Vitamin D metabolites and calcium absorption in severe vitamin D deficiency. J Bone Miner Res 23(11):1859–1863

    Article  CAS  PubMed  Google Scholar 

  32. Shibata M, Suzuki A, Sekiya T, Sekiguchi S, Asano S, Udagawa Y, Itoh M (2011) High prevalence of hypovitaminosis D in pregnant Japanese women with threatened premature delivery. J Bone Miner Metab 29(5):615–620

    Article  CAS  PubMed  Google Scholar 

  33. Andreassen MS, Ferraz LF, Jesus SNR, Piano A, Azevedo CH, Perez AIC (2012) Avaliação do binômio materno fetal após cirurgia bariátrica. BEPA 9(102):21–29

    Google Scholar 

  34. Guelinckx I, Devlieger R, Donceel P, Bel S, Pauwels S, Bogaerts A, Thijs I, Schurmans K, Deschilder P, Vansant G (2012) Lifestyle after bariatric surgery: a multicenter, prospective cohort study in pregnant women. Obes Surg 22(9):1456–1464

    Article  CAS  PubMed  Google Scholar 

  35. Kjær MM, Lauenborg J, Breum BM, Nilas L (2013) The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol 208(6):464.e1–5

  36. Melo ASO, Assunção PL, Gondim SSR, Carvalho DF, Amorim MMR, Benicio MHA, Cardoso MAA (2007) Estado nutricional materno, ganho de peso gestacional e peso ao nascer. Rev Bras Epidemiol 10(2):249–257

    Article  Google Scholar 

  37. Magdaleno R Jr, Pereira BG, Chaim EA, Turato ER (2012) Pregnancy after bariatric surgery: a current view of maternal, obstetrical and perinatal challenges. Arch Gynecol Obstet 285(3):559–566

    Article  PubMed  Google Scholar 

  38. Di Carlo C, Iannotti G, Sparice S, Chiacchio MP, Greco E, Tommaselli GA, Nappi C (2014) The role of a personalized dietary intervention in managing gestational weight gain: a prospective, controlled study in a low-risk antenatal population. Arch Gynecol Obstet 289(4):765–770

    Article  PubMed  Google Scholar 

  39. Santulli P, Mandelbrot L, Facchiano E, Dussaux C, Ceccaldi PF, Ledoux S, Msika S (2010) Obstetrical neonatal outcomes of pregnancies following gastric bypass surgery: a retrospective cohort study in a French referral centre. Obes Surg 20(11):1501–1508

    Article  PubMed  Google Scholar 

  40. Lapolla A, Marangon M, Dalfrà MG, Segato G, De Luca M, Fedele D, Favretti F, Enzi G, Busetto L (2010) Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding. Obes Surg 20(9):1251–1257

    Article  PubMed  Google Scholar 

  41. Savvidou MD, Makgoba M, Castro PT, Akolekar R, Nicolaides KH (2012) First-trimester maternal serum vitamin D and mode of delivery. Br J Nutr 108(11):1972–1975

    Article  CAS  PubMed  Google Scholar 

  42. Fernández-Alonso AM, Dionis-Sánchez EC, Chedraui P, González-Salmerón MD, Pérez-López FR, Spanish Vitamin D and Women’s Health Research Group (2012) First-trimester maternal serum 25-hydroxyvitamin D3 status and pregnancy outcome. Int J Gynaecol Obstet 116(1):6–9

    Article  PubMed  Google Scholar 

  43. Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF (2009) Association between Vitamin D Deficiency and Primary Cesarean Section. J Clin Endocrinol Metab 94(3):940–945

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Bahadi A, El Kabbaj D, Elfazazi H, Abbi R, Hafidi MR, Hassani MM, Moussaoui R, Elouennass M, Dehayni M, Oualim Z (2010) Urinary tract infection in pregnancy. Saudi J Kidney Dis Transpl. 21(2):342–344

    PubMed  Google Scholar 

  45. Nseir W, Taha M, Nemarny H, Mograbi J (2013) The association between serum levels of vitamin D and recurrent urinary tract infections in premenopausal women. Int J Infect Dis. 17(12):e1121–e1124

    Article  CAS  PubMed  Google Scholar 

  46. Lesko J, Peaceman A (2012) Pregnancy outcomes in women after bariatric surgery compared with obese and morbidly obese controls. Obstet Gynecol 119(3):547–554

    Article  PubMed  Google Scholar 

  47. Kominiarek MA (2011) Preparing for and managing a pregnancy after bariatric surgery. Semin Perinatol 35(6):356–361

    Article  PubMed Central  PubMed  Google Scholar 

  48. Prentice A, Jarjou LMA, Goldberg GR, Bennett J, Cole TJ, Schoenmakers I (2009) Maternal plasma 25-hydroxyvitamin D concentration and birthweight, growth and bone mineral accretion of Gambian infants. Acta Paediatr 98(8):1360–1362

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  49. Shand AW, Nassar N, Von Dadelszen P, Innis SM, Green TJ (2010) Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for pre-eclampsia. BJOG 117(13):1593–1598

    Article  CAS  PubMed  Google Scholar 

  50. Farrant HJ, Krishnaveni GV, Hill JC, Boucher BJ, Fisher DJ, Noonan K, Osmond C, Veena SR, Fall CH (2009) Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J ClinNutr 63(5):646–652

    Article  CAS  Google Scholar 

  51. Bodnar LM, Zmuda JM, Cooper ME, Parrott MS, Roberts JM, Marazita ML, Simhan HN (2010) Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. J Nutr 140(5):999–1006

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Research On Micronutrients, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373. Edifício dos Institutos, Bloco J, 2° andar, Ilha do Fundão, Rio de Janeiro, CEP: 21941-590, RJ, Brazil

    Marina Medeiros, Andréa C. Matos, Silvia E. Pereira, Carlos Saboya & Andréa Ramalho

  2. Clínica Cirúrgica Carlos Saboya, Rio de Janeiro, RJ, Brazil

    Silvia E. Pereira & Carlos Saboya

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  1. Marina Medeiros
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  2. Andréa C. Matos
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  3. Silvia E. Pereira
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  4. Carlos Saboya
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  5. Andréa Ramalho
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Correspondence to Marina Medeiros or Andréa Ramalho.

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Medeiros, M., Matos, A.C., Pereira, S.E. et al. Vitamin D and its relation with ionic calcium, parathyroid hormone, maternal and neonatal characteristics in pregnancy after roux-en-Y gastric bypass. Arch Gynecol Obstet 293, 539–547 (2016). https://doi.org/10.1007/s00404-015-3861-4

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  • DOI: https://doi.org/10.1007/s00404-015-3861-4

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