:: Volume 5, Issue 3 (Jul-Sep 2018) ::
Nutr Food Sci Res 2018, 5(3): 3-10 Back to browse issues page
Evaluation of the Efficacy of Vitamin D Supplementation With Two Different Doses During Pregnancy on Maternal and Cord Blood Vitamin D Status, Metabolic, Inflammatory and Oxidative Stress Biomarkers, and Maternal and Neonatal Outcomes: a Study Protocol
Soudabe Motamed , Bahareh Nikooyeh , Tirang R. Neyestani
Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 198396-3113, Iran , neytr@yahoo.com
Abstract:   (4610 Views)
Background and Objectives: Vitamin D deficiency during pregnancy is prevalent throughout the world and has been associated with complications in mothers and infants. The aim of this study is to evaluate the efficacy of two doses of vitamin D supplementation (1000 IU/d versus 2000 IU/d) during pregnancy on maternal and cord blood vitamin D status, metabolic, inflammatory and oxidative stress biomarkers as well as maternal and neonatal outcomes (birth size and Apgar score).
Methods: A total of 84 pregnant women with the eligible criteria are randomly allocated to one of the two supplementation groups: (a) 1000 IU/d vitamin D which is routinely given to pregnant women, and (b) 2000 IU/d. Biochemical assessments of mothers are performed at the beginning and 34 weeks of gestation. They include serum concentrations of 25-hydroxycalciferol (25(OH)D), calcium, phosphate, intact parathyroid hormone (iPTH), fasting serum glucose (FSG), insulin, lipid profile including triglycerides (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL_C), as well as high sensitivity C-reactive protein (hs-CRP) and the maternal cell-culture supernatant concentrations of inflammatory cytokines IL-1β, IL-6 and TNF-α. Assessments of infants at delivery comprise cord blood serum concentrations of 25(OH)D, iPTH, hs-CRP, IL-1β, IL-6, TNF-α birth sizes and Apgar score.
Discussion: The results obtained from the clinical efficacy trials on the appropriate dose for vitamin D supplementation during pregnancy are controversial. The current study could be a step to attenuate the existent controversy on evaluating the efficacy of two doses of vitamin D supplement on a wide spectrum of both mother and newborn outcomes. Meanwhile our study could give a clue to the policy-makers at MOH by revealing the efficacy of currently prescribed 1000 IU/d vitaminD3 versus 2000 IU/d.
Keywords: Vitamin D supplementation, Clinical efficacy trial, Pregnancy, Study protocol
Full-Text [PDF 139 kb]   (1732 Downloads)    
Article type: Research | Subject: Nutrition
Received: 2018/08/6 | Accepted: 2018/09/17 | Published: 2018/09/17
References
1. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? The Journal of steroid biochemistry and molecular biology. 2014 Oct;144 Pt A:138-45.
2. Saraf R, Morton SM, Camargo CA, Jr., Grant CC. Global summary of maternal and newborn vitamin D status - a systematic review. Maternal & child nutrition. 2016 Oct;12(4):647-68. [DOI:10.1111/mcn.12210] [PMID]
3. Pirdehghan A, Vakili M, Dehghan R, Zare F. High prevalence of Vitamin D deficiency and adverse pregnancy outcomes in Yazd, a central province of Iran. Journal of Reproduction and Infertility. 2016;17(1):34-8. [PMID] [PMCID]
4. Abbasian M, Chaman R, Amiri M, Ajami ME, Jafari-Koshki T, Rohani H, et al. Vitamin D Deficiency in Pregnant Women and Their Neonates. Glob J Health Sci. 2016 Sep 1;8(9):54008. [DOI:10.5539/gjhs.v8n9p83] [PMID] [PMCID]
5. Kelishadi R, Sharifi-Ghazvini F, Poursafa P, Mehrabian F, Farajian S, Yousefy H, et al. Determinants of hypovitaminosis D in pregnant women and their newborns in a sunny region. International Journal of Endocrinology. 2013;2013.
6. Schneuer FJ, Roberts CL, Guilbert C, Simpson JM, Algert CS, Khambalia AZ, et al. Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr. 2014 Feb;99(2):287-95. [DOI:10.3945/ajcn.113.065672] [PMID]
7. Cashman KD, Dowling KG, Skrabakova Z, Gonzalez-Gross M, Valtuena J, De Henauw S, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016 Apr;103(4):1033-44. [DOI:10.3945/ajcn.115.120873] [PMID] [PMCID]
8. Olmos-Ortiz A, Avila E, Durand-Carbajal M, Diaz L. Regulation of calcitriol biosynthesis and activity: focus on gestational vitamin D deficiency and adverse pregnancy outcomes. Nutrients. 2015 Jan 09;7(1):443-80. PubMed PMID: 25584965. [DOI:10.3390/nu7010443] [PMID] [PMCID]
9. Ji JL, Muyayalo KP, Zhang YH, Hu XH, Liao AH. Immunological function of vitamin D during human pregnancy. American Journal of Reproductive Immunology. 2017;78(2). [PMID]
10. Wagner CL, Wei W, Shary JR, Ebeling MD, Garrett-Mayer E, Taylor SN, et al. Preventing Health Disparities during Pregnancy through Vitamin D (VitD) Supplementation: Preliminary Results of a Randomized Controlled Trial. Faseb Journal. 2017 Apr;31.
11. Moon RJ, Harvey NC, Cooper C. ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the fetal skeleton. European Journal of Endocrinology. 2015;173(2):R69-R83. [DOI:10.1530/EJE-14-0826] [PMID] [PMCID]
12. Chen X, Rao SQ, Gao BH, Jiang ZQ. Effect of early vitamin D supplementation on asthma and the possible mechanisms. Genetics and Molecular Research. 2015;14(4):14136-43. [DOI:10.4238/2015.October.29.35] [PMID]
13. Hollis BW, Wagner CL. Vitamin D supplementation during pregnancy: Improvements in birth outcomes and complications through direct genomic alteration. Molecular and Cellular Endocrinology. 2017;453:113-30. [DOI:10.1016/j.mce.2017.01.039] [PMID]
14. Liu NQ, Kaplan AT, Lagishetty V, Ouyang YB, Ouyang Y, Simmons CF, et al. Vitamin D and the regulation of placental inflammation. Journal of Immunology. 2011;186(10):5968-74. [DOI:10.4049/jimmunol.1003332] [PMID]
15. Racicot K, Kwon JY, Aldo P, Silasi M, Mor G. Understanding the complexity of the immune system during pregnancy. American journal of reproductive immunology (New York, NY : 1989). 2014 Aug;72(2):107-16.
16. Noyola-Martinez N, Diaz L, Avila E, Halhali A, Larrea F, Barrera D. Calcitriol downregulates TNF-alpha and IL-6 expression in cultured placental cells from preeclamptic women. Cytokine. 2013 Jan;61(1):245-50. [DOI:10.1016/j.cyto.2012.10.001] [PMID]
17. Ota K, Dambaeva S, Kim MW, Han AR, Fukui A, Gilman-Sachs A, et al. 1,25-Dihydroxy-vitamin D3 regulates NK-cell cytotoxicity, cytokine secretion, and degranulation in women with recurrent pregnancy losses. Eur J Immunol. 2015 Nov;45(11):3188-99. [DOI:10.1002/eji.201545541] [PMID]
18. Tamblyn JA, Hewison M, Wagner CL, Bulmer JN, Kilby MD. Immunological role of vitamin D at the maternal-fetal interface. J Endocrinol. 2015 Mar;224(3):R107-21. [DOI:10.1530/JOE-14-0642] [PMID]
19. Tamblyn JA, Susarla R, Jenkinson C, Jeffery LE, Ohizua O, Chun RF, et al. Dysregulation of maternal and placental vitamin D metabolism in preeclampsia. Placenta. 2017;50:70-7. [DOI:10.1016/j.placenta.2016.12.019] [PMID] [PMCID]
20. Liu NQ, Ouyang Y, Bulut Y, Lagishetty V, Chan SY, Hollis BW, et al. Dietary vitamin D restriction in pregnant female mice is associated with maternal hypertension and altered placental and fetal development. Endocrinology. 2013;154(7):2270-80. [DOI:10.1210/en.2012-2270] [PMID]
21. Barrera D, Diaz L, Noyola-Martinez N, Halhali A. Vitamin D and Inflammatory Cytokines in Healthy and Preeclamptic Pregnancies. Nutrients. 2015 Aug 04;7(8):6465-90. [DOI:10.3390/nu7085293] [PMID] [PMCID]
22. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 Dietary Reference Intakes for Calcium and Vitamin D: what dietetics practitioners need to know. J Am Diet Assoc. 2011 Apr;111(4):524-7. [DOI:10.1016/j.jada.2011.01.004] [PMID]
23. Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Erratum: Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness (Journal of Bone and Mineral Research (2011) 26 (2341-2357) DOI: 10 DOI: 10.1002/jbmr.463). Journal of Bone and Mineral Research. 2011;26(12):3001. [DOI:10.1002/jbmr.537]
24. Sablok A, Batra A, Thariani K, Batra A, Bharti R, Aggarwal AR, et al. Supplementation of Vitamin D in pregnancy and its correlation with feto-maternal outcome. Clinical Endocrinology. 2015;83(4):536-41. [DOI:10.1111/cen.12751] [PMID]
25. Rodda CP, Benson JE, Vincent AJ, Whitehead CL, Polykov A, Vollenhoven B. Maternal Vitamin D supplementation during pregnancy prevents Vitamin D deficiency in the newborn: An open-label randomized controlled trial. Clinical Endocrinology. 2015;83(3):363-8. [DOI:10.1111/cen.12762] [PMID]
26. Aghajafari F, Field CJ, Kaplan BJ, Maggiore JA, O'Beirne M, Hanley DA, et al. The High Prevalence of Vitamin D Insufficiency in Cord Blood in Calgary, Alberta (APrON-D Study). Journal of Obstetrics and Gynaecology Canada. 2017;39(5):347-53.e1. [DOI:10.1016/j.jogc.2017.01.008] [PMID]
27. Figueiredo AC, Cocate PG, Adegboye AR, Franco-Sena AB, Farias DR, de Castro MB, et al. Changes in plasma concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D during pregnancy: a Brazilian cohort. Eur J Nutr. 2017 Mar 28. PubMed PMID: 28353072. Epub 2017/03/30. eng.
28. Karras SN, Anagnostis P, Naughton D, Annweiler C, Petroczi A, Goulis DG. Vitamin D during pregnancy: Why observational studies suggest deficiency and interventional studies show no improvement in clinical outcomes? A narrative review. Journal of Endocrinological Investigation. 2015;38(12):1265-75. [DOI:10.1007/s40618-015-0363-y] [PMID]
29. Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, et al. IOM committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab. 2012 Apr;97(4):1146-52. PubMed PMID: 22442278. Pubmed Central PMCID: PMC5393439. Epub 2012/03/24. eng. [DOI:10.1210/jc.2011-2218] [PMID] [PMCID]
30. Weinert LS. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: comment to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care. 2010 Jul;33(7):e97; author reply e8. PubMed PMID: 20587717. Epub 2010/07/01. eng.
31. Preterm Birth: Causes, Consequences, and Prevention. Behrman RE, Butler AS, editors. Washington DC: National Academy of Sciences.; 2007.
32. Bodnar LM, Catov JM, Zmuda JM, Cooper ME, Parrott MS, Roberts JM, et al. Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. Journal of Nutrition. 2010;140(5):999-1006. [DOI:10.3945/jn.109.119636] [PMID] [PMCID]
33. Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Reviews in obstetrics & gynecology. 2009 Spring;2(2):76-83. [PMID] [PMCID]
34. Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis, and management. Vascular health and risk management. 2011;7:467-74. [PMID] [PMCID]
35. Brustad M, Alsaker E, Engelsen O, Aksnes L, Lund E. Vitamin D status of middle-aged women at 65-71 degrees N in relation to dietary intake and exposure to ultraviolet radiation. Public Health Nutr. 2004 Apr;7(2):327-35. [DOI:10.1079/PHN2003536] [PMID]
36. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985 Jul;28(7):412-9. [DOI:10.1007/BF00280883] [PMID]
37. Satoh K. Serum lipid peroxide in cerebrovascular disorders determined by a new colorimetric method. Clinica chimica acta; international journal of clinical chemistry. 1978 Nov 15;90(1):37-43.
38. Neyestani TR, Shariatzadeh N, Gharavi A, Kalayi A, Khalaji N. Physiological dose of lycopene suppressed oxidative stress and enhanced serum levels of immunoglobulin M in patients with Type 2 diabetes mellitus: a possible role in the prevention of long-term complications. J Endocrinol Invest. 2007 Nov;30(10):833-8. [DOI:10.1007/BF03349224] [PMID]
39. Rice-Evans C, Miller NJ. Total antioxidant status in plasma and body fluids. Methods in enzymology. 1994;234:279-93. [DOI:10.1016/0076-6879(94)34095-1]
40. Neyestani TR, Gharavi A, Kalayi A. Selective effects of tea extract and its phenolic compounds on human peripheral blood mononuclear cell cytokine secretions. Int J Food Sci Nutr. 2009;60 Suppl 1:79-88. [DOI:10.1080/09637480802158184] [PMID]
41. Appelgren KE, Nietert PJ, Hulsey TC, Hollis BW, Wagner CL. Analyzing Adherence to Prenatal Supplement: Does Pill Count Measure Up? International Journal of Endocrinology. 2010. [DOI:10.1155/2010/631971] [PMID] [PMCID]
42. Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. Journal of Bone and Mineral Research. 2011;26(10):2341-57. [DOI:10.1002/jbmr.463] [PMID] [PMCID]
43. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003 Jan;77(1):204-10. [DOI:10.1093/ajcn/77.1.204] [PMID]



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