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Vitamin D Concentration during Early Pregnancy and Adverse Outcomes among HIV-Negative Women in Dar-es-Salaam, Tanzania: A Case-Control Study.

Published on Dec 2, 2019in Nutrients4.171
· DOI :10.3390/NU11122906
Aneth V. Kalinjuma , Anne Marie Darling6
Estimated H-index: 6
+ 8 AuthorsWafaie W. Fawzi65
Estimated H-index: 65
Abstract
We examined the associations of plasma vitamin D concentration and adverse pregnancy outcomes among HIV-negative women in Dar-es-Salaam, Tanzania. We used an unmatched case-control study design, with 25-hydroxyvitamin D [25(OH)D] concentration assessed in the first trimester. Cases were individuals with adverse pregnancy outcomes, including stillbirth, premature birth, or small for gestational age births (SGA). Unconditional logistic regression and weighted logistic regression models were used to describe the associations of 25(OH)D concentration with the composite of adverse pregnancy outcome and individual adverse pregnancy outcomes, respectively. We included 310 cases and 321 controls. In controls, 5(2%) were vitamin D deficient (25(OH)D < 20 ng/mL), and 17(5%) had insufficient 25(OH)D concentration (20.0–29.9 ng/mL). Women with 25(OH)D < 20 ng/mL had 1.82 times the odds of occurrence of the composite adverse pregnancy outcome (OR = 1.82, 95% CI: 0.56–5.93; p = 0.32), however we noted a non-linear association between 25(OH)D concentration and adverse pregnancy outcome (p = 0.02). We found a 3-fold increased odds of stillbirth in women with low 25(OH)D concentration (OR = 3.11, 95% CI: 1.18–8.23, p = 0.02). Vitamin D concentration in early pregnancy may be an important factor in determining the course of pregnancy. Further research is needed to investigate whether the association of maternal 25(OH)D concentration in early pregnancy and stillbirth is causal.
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References40
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#1Daniel E. Roth (U of T: University of Toronto)H-Index: 17
#2Shaun K. Morris (U of T: University of Toronto)H-Index: 16
Last. Abdullah Al Mahmud (International Centre for Diarrhoeal Disease Research, Bangladesh)H-Index: 10
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Abstract Background It is unclear whether maternal vitamin D supplementation during pregnancy and lactation improves fetal and infant growth in regions where vitamin D deficiency is common. Methods We conducted a randomized, double-blind, placebo-controlled trial in Bangladesh to assess the effects of weekly prenatal vitamin D supplementation (from 17 to 24 weeks of gestation until birth) and postpartum vitamin D supplementation on the primary outcome of infants’ length-for-age z scores at 1 yea...
23 CitationsSource
#1John R. Weinstein (UCSF: University of California, San Francisco)H-Index: 6
#2Lisa M. Thompson (UCSF: University of California, San Francisco)H-Index: 11
Last. John P. McCracken (Universidad del Valle de Guatemala)H-Index: 27
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Background Preterm birth is the leading cause of death among children <5 years of age. Accurate determination of prematurity is necessary to provide appropriate neonatal care and guide preventive measures. To estimate the most accurate method to identify infants at risk for adverse outcomes, we assessed the validity of two widely available methods—last menstrual period (LMP) and the New Ballard (NB) neonatal assessment—against ultrasound in determining gestational age and preterm birth in highla...
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Abstract Maternal vitamin D deficiency is an independent risk factor for fetal growth. We examined the associations between maternal vitamin D status (defined by 25-hydroxyvitamin D [25(OH)D]) at the first prenatal visit and measures of newborn and placental weight, in a large China cohort of singleton, term, live births. From July 2015 to June 2016, women delivering singleton, term, live births with 25(OH)D measured at a first prenatal visit (N = 747). Birth weight, placental weight, the placen...
12 CitationsSource
#1Fiorella Bianchi-Jassir (Lond: University of London)H-Index: 5
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Background: Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a series. We aimed to assess the association between GBS maternal colonization and preterm birth in order to inform estimates of the burden of GBS. Methods: We conducted systematic literature reviews (PubMed/Me...
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#1Bruce W. Hollis (MUSC: Medical University of South Carolina)H-Index: 90
#2Carol L. Wagner (MUSC: Medical University of South Carolina)H-Index: 41
Pregnancy represents a dynamic period with physical and physiological changes in both the mother and her developing fetus. The dramatic 2–3 fold increase in the active hormone 1,25(OH)2D concentrations during the early weeks of pregnancy despite minimal increased calcium demands during that time of gestation and which are sustained throughout pregnancy in both the mother and fetus suggests an immunomodulatory role in preventing fetal rejection by the mother. While there have been numerous observ...
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#1Yao Chen (Anhui Medical University)H-Index: 1
#2Beibei Zhu (Anhui Medical University)H-Index: 1
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Objective To determine whether maternal vitamin D deficiency during pregnancy is associated with small for gestational age (SGA). Methods A comprehensive literature search of PubMed, the Cochrane Library, Embase, and the Elsevier ScienceDirect library was conducted to identify relevant articles reporting prospective cohort studies in English, with the last report included published in February 2017. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used to evaluate t...
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#2Keith A. BaggerlyH-Index: 52
Last. Carol L. Wagner (MUSC: Medical University of South Carolina)H-Index: 41
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Background Given the high rate of preterm birth (PTB) nationwide and data from RCTs demonstrating risk reduction with vitamin D supplementation, the Medical University of South Carolina (MUSC) implemented a new standard of care for pregnant women to receive vitamin D testing and supplementation. Objectives To determine if the reported inverse relationship between maternal 25(OH)D and PTB risk could be replicated at MUSC, an urban medical center treating a large, diverse population. Methods Medic...
32 CitationsSource
#1A. Kofi Amegah (University of Cape Coast)H-Index: 5
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Last. Carol L. Wagner (MUSC: Medical University of South Carolina)H-Index: 41
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Background Three previous reviews on the association of vitamin D insufficiency in pregnancy with preterm birth (PTB) and stillbirth were limited in scope and deemed inconclusive. With important new evidence accumulating, there is the need to update the previous estimates and assess evidence on other clinically important outcomes such as spontaneous abortion and Apgar score. We conducted a systematic review and meta-analysis to evaluate the quality and strength of the available evidence on the r...
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Aim We performed a meta-analysis of randomized controlled trials (RCT) and observational studies to answer the two following questions: (i) whether low maternal circulating 25 hydroxyvitamin D (25-OHD) is associated with an increased risk of preterm birth (PTB) or spontaneous PTB (sPTB); and (ii) whether vitamin D supplementation alone during pregnancy can reduce the risk of PTB. Methods Literature search was carried out using Pubmed, Web of Science and Embase databases up to June 2016. Pooled O...
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#1Anne Marie Darling (Harvard University)H-Index: 6
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Vitamin A and zinc are important for immune function and may improve host defense against malaria and reduce the risk of adverse pregnancy outcomes. Our objective was to determine whether daily oral supplementation with either or both nutrients starting in the first trimester reduces the risk of placental malaria and adverse pregnancy outcomes. We undertook a randomized, double‐blind placebo‐controlled trial with a factorial design among 2,500 human immunodeficiency virus–negative primigravid or...
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