Changes in plasma concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D during pregnancy: a Brazilian cohort
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To characterize the physiological changes in 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] throughout pregnancy.
Prospective cohort of 229 apparently healthy pregnant women followed at 5th–13th, 20th–26th, and 30th–36th gestational weeks. 25(OH)D and 1,25(OH)2D concentrations were measured by LC–MS/MS. Statistical analyses included longitudinal linear mixed-effects models adjusted for parity, season, education, self-reported skin color, and pre-pregnancy BMI. Vitamin D status was defined based on 25(OH)D concentrations according to the Endocrine Society Practice Guideline and Institute of Medicine (IOM) for adults.
The prevalence of 25(OH)D <75 nmol/L was 70.4, 41.0, and 33.9%; the prevalence of 25(OH)D <50 nmol/L was 16.1, 11.2, and 10.2%; and the prevalence of 25(OH)D <30 nmol/L was 2, 0, and 0.6%, at the first, second, and third trimesters, respectively. Unadjusted analysis showed an increase in 25(OH)D (β = 0.869; 95% CI 0.723–1.014; P < 0.001) and 1,25(OH)2D (β = 3.878; 95% CI 3.136–4.620; P < 0.001) throughout pregnancy. Multiple adjusted analyses showed that women who started the study in winter (P < 0.001), spring (P < 0.001), or autumn (P = 0.028) presented a longitudinal increase in 25(OH)D concentrations, while women that started during summer did not. Increase of 1,25(OH)2D concentrations over time in women with insufficient vitamin D (50–75 nmol/L) at baseline was higher compared to women with sufficient vitamin D (≥75 nmol/L) (P = 0.006).
The prevalence of vitamin D inadequacy varied significantly according to the adopted criteria. There was a seasonal variation of 25(OH)D during pregnancy. The women with insufficient vitamin D status present greater longitudinal increases in the concentrations of 1,25(OH)2D in comparison to women with sufficiency.
KeywordsVitamin D Pregnancy Micronutrients Cohort Tropical country Seasons
The National Council for Scientific and Technological Development (CNPq) and the Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State (FAPERJ) supported this study. Gilberto Kac has a research productivity scholarship from CNPq.
Compliance with ethical standards
The Research Ethics Committees of the Municipal Secretariat of Health and Civil Defense of the State of Rio de Janeiro (Protocol no: 0012.0.249.000-09) approved this study. Written consent from all participants was obtained freely and spontaneously, after all necessary clarifications were provided in accordance with principles of the Declaration of Helsinki.
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.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 96:1191–1130. doi: 10.1210/jc.2011-0385 Google Scholar
- 6.Schneuer FJ, Roberts CL, Guilbert C, Simpson JM, Algert CS, Khambalia AZ, Tasevski V, Ashton AW, Morris JM, Nassar N (2014) Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr 99:287–295. doi: 10.3945/ajcn.113.065672 CrossRefGoogle Scholar
- 9.Dantas EM, Pereira FV, Queiroz JW, Dantas DL, Monteiro GR, Duggal P, Azevedo MdeF, Jeronimo SM, Araújo AC (2013) Preeclampsia is associated with increased maternal body weight in a northeastern Brazilian population. BMC Pregnancy Childbirth 13:159. doi: 10.1186/1471-2393-13-159 CrossRefGoogle Scholar
- 23.Maeda SS, Borba VZC, Camargo MBR, Silva DMW, Borges JLC, Bandeira F, Lazaretti-Castro MSS et al (2014) Recommendations of the Brazilian Society of Endocrinology and Metabology (SBEM) for the diagnosis and treatment of hypovitaminosis D. Arq Bras Endocrinol Metab 58:411–33. doi: 10.1590/0004-2730000003388.CrossRefGoogle Scholar
- 27.Brazilian Institute of Geography and Statistics. National Household Budget Survey. Nutritional composition table of food consumed in Brazil (2011). http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/pof/2008_2009_composicao_nutricional/. Accessed 18 Oct 2015
- 30.StataCorp (2011) Stata statistical software: release 12. StataCorp LP, College Station (TX)Google Scholar
- 32.Pérez-López FR, Fernández-Alonso AM, Ferrando-Marco P, González-Salmerón MD, Dionis-Sánchez EC, Fiol-Ruiz G, Chedraui P (2011) First trimester serum 25-hydroxyvitamin D status and factors related to lower levels in gravids living in the Spanish Mediterranean coast. Reprod Sci 18:730–736. doi: 10.1177/1933719110396720.CrossRefGoogle Scholar
- 35.Kiely ME, Zhang JY, Kinsella M, Khashan AS, Kenny LC (2016) Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. Am J Clin Nutr 104(2):354–361. doi: 10.3945/ajcn.116.130419 CrossRefGoogle Scholar
- 37.Diogenes ME, Bezerra FF, Rezende EP, Donangelo CM (2015) Calcium plus vitamin D supplementation during the third trimester of pregnancy in adolescents accustomed to low calcium diets does not affect infant bone mass at early lactation in a randomized controlled trial. J Nutr 145:1515–1523. doi: 10.3945/jn.114.208140 CrossRefGoogle Scholar
- 39.Marques R, Dos Santos ES (2012) Inhalabel particulate matter network monitoring, law and health hazards. Hygeia 8:115–28.Google Scholar
- 40.World Health Organization (2006). Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide: Global update. World Health Organization, Geneva. http://www.euro.who.int/__data/assets/pdf_file/0005/78638/E90038.pdf?ua=1. Accessed 18 Oct 2015
- 42.Charatcharoenwitthaya N, Nanthakomon T, Somprasit C, Chanthasenanont A, Chailurkit LO, Pattaraarchachai J, Ongphiphadhanakul B (2013) Maternal vitamin D status, its associated factors and the course of pregnancy in Thai women. Clin Endocrinol (Oxf) 78:126–133. doi: 10.1111/j.1365-2265.2012.04470.x.CrossRefGoogle Scholar
- 44.Brasil (2013). Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Programa Nacional de Suplementação de Ferro: manual de condutas gerais / Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Brasília: Ministério da Saúde 24 p. ilGoogle Scholar
- 45.Brazilian Institute of Geography and Statistics (2010) Census: general characteristics of the population, religion and people with disabilities. http://biblioteca.ibge.gov.br/visualizacao/periodicos/94/cd_2010_religiao_deficiencia.pdf. Accessed 03 Aug 2015
- 47.Novakovic B, Sibson M, Ng HK, Manuelpillai U, Rakyan V, Down T, Beck S, Fournier T, Evain-Brion D, Dimitriadis E, Craig JM, Morley R, Saffery R (2009) Placenta-specific methylation of the vitamin D 24-hydroxylase gene: implications for feedback autoregulation of active vitamin D levels at the fetomaternal interface. J Biol Chem 284:14838–14848. doi: 10.1074/jbc.M809542200 CrossRefGoogle Scholar
- 58.Jones G (2007) Expanding role for vitamin D in chronic kidney disease: importance of blood 25-OH-D levels and extra-renal 1alpha-hydroxylase in the classical and nonclassical actions of 1alpha, 25-dihydroxyvitamin D(3). Semin Dial 20:316–324. doi: 10.1111/j.1525-139X.2007.00302.x CrossRefGoogle Scholar
- 61.Litonjua AA, Carey VJ, Laranjo N, Harshfield BJ, McElrath TF, O’Connor GT, Sandel M, Iverson RE, Lee-Paritz A, Strunk RC, Bacharier LB, Macones GA, Zeiger RS, Schatz M, Hollis BW, Hornsby E, Hawrylowicz C, Wu AC, Weiss ST (2016) Effect of prenatal supplementation with vitamin D on asthma or recurrent wheezing in offspring by age 3 years: the VDAART randomized clinical trial. JAMA 315(4):362–370. doi: 10.1001/jama.2015.18589 CrossRefGoogle Scholar