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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 4  |  Page : 243-246

Prevalence of vitamin D deficiency in mother–infant pairs in a tertiary hospital in the west coast of Saudi Arabia


Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Web Publication16-Nov-2016

Correspondence Address:
Dr. Heidi Al-Wassia
Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah 21589
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.194164

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  Abstract 

Background: Vitamin D deficiency in pregnant mothers is a widely recognized public health problem. Methods: A cross-sectional study of pregnant women who gave birth at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 1, 2015, to June 30, 2015, to determine the prevalence and potential risk factors of Vitamin D deficiency and to correlate maternal and cord blood Vitamin D levels. Results: A total of 201 mother–infant pairs were enrolled. There was a high prevalence of Vitamin D deficiency both in mothers (90.5%) and their infants (86%). There was no statistically significant difference in age, parity, body mass index, skin color, education, and employment status between mothers with deficient Vitamin D levels and those with Vitamin D levels > 50 nmol/L. There was a statistically, significant positive correlation between maternal and cord blood Vitamin D levels (r = 0.83, P< 0.001). Conclusion: We demonstrated a high prevalence of Vitamin D deficiency in pregnant mothers, which was strongly correlated with cord blood Vitamin D levels. Clinical trials on the effect of supplementing Vitamin D to pregnant mothers and its effect on maternal and neonatal outcomes should be the focus of future research.

Keywords: Prevalence, risk factors, Vitamin D


How to cite this article:
Al-Wassia H, Abo-Ouf N. Prevalence of vitamin D deficiency in mother–infant pairs in a tertiary hospital in the west coast of Saudi Arabia. J Clin Neonatol 2016;5:243-6

How to cite this URL:
Al-Wassia H, Abo-Ouf N. Prevalence of vitamin D deficiency in mother–infant pairs in a tertiary hospital in the west coast of Saudi Arabia. J Clin Neonatol [serial online] 2016 [cited 2019 Jul 23];5:243-6. Available from: http://www.jcnonweb.com/text.asp?2016/5/4/243/194164


  Introduction Top


The developing fetuses are utterly dependent on their mother for their Vitamin D status. Recently, Vitamin D status in pregnant women and their neonates has gained increasing attention in the obstetric and neonatal literature. Published papers from various regions in the world have documented high prevalence of Vitamin D deficiency in pregnant women ranging from 20% to over 90%.[1],[2],[3],[4],[5],[6] Furthermore, a strongly positive correlation between neonatal cord blood and maternal Vitamin D levels was observed. The high variation in the prevalence of Vitamin D deficiency could be explained by the different cutoff values used to define status of Vitamin D, geographical location, and seasonal variation [7] at the time of the study, cultural and religious factors,[8] and dietary influences in countries demanding Vitamin D fortification.[9] Maternal Vitamin D deficiency has been related to a number of comorbidities in offspring including impaired bone development, diabetes mellitus, impaired function of the immune system, and allergic conditions such as asthma and atopy.[10],[11] In addition, maternal Vitamin D deficiency was found to increase the risk of preterm birth,[12] impaired lung development, neurocognitive difficulties in school-age children, lower peak bone mass, and eating disorders in adolescence.[13] In a recent meta-analysis by Aghajafari et al., Vitamin D insufficiency was associated with gestational diabetes, preeclampsia, small for gestational age, and low birth weight infants.[14] Saudi women are at increased risk of Vitamin D deficiency because of their skin pigmentation, prolonged stay indoor, reduced ultraviolet exposure due to cultural clothing practices, and poor dietary intake. A recent study of Saudi women of childbearing age revealed that 79% exhibited severe Vitamin D deficiency.[15] In a cross-sectional study of term neonates in a tertiary Saudi hospital, 90% of included newborns had Vitamin D levels <50 nmol/L, which correlated positively with the maternal Vitamin D levels.[6] A number of studies explored the prevalence of Vitamin D deficiency in mothers and their neonates in the Eastern and Middle regions of Saudi Arabia. None examined the burden of Vitamin D deficiency in pregnant mothers and their neonates in the western region of Saudi Arabia. The western region lies along the Red Sea Coast. People in the western region are more likely to stay outdoors and spend hours by the seacoast. We do not know that it will make the people residing in the West Coast at lower risk of Vitamin D deficiency.

Purpose

The purpose of the study is to determine the prevalence and potential risk factors of Vitamin D deficiency in mothers who gave birth at term in a tertiary academic hospital in Jeddah, Saudi Arabia, and to correlate maternal Vitamin D status with cord blood Vitamin D levels.


  Methods Top


This is a cross-sectional study of pregnant women who gave birth at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 1, 2015, to June 30, 2015. The Research Ethics Review Board at King Abdulaziz University approved the study. Mothers were included after signing a written informed consent. Mothers with hepatic, renal, or endocrine conditions that would likely affect Vitamin D metabolism or those carrying infants with major congenital anomalies were excluded from the study. Maternal and cord blood samples were collected and analyzed for serum ionized calcium, phosphate, 25-hydroxyvitamin D (25[OH]D), and parathyroid hormone (PTH) levels. Serum 25(OH)D was collected using standard sampling tubes and measured by electrochemiluminescence binding assay using Elecsys 2010 and cobas e 411 immunoassay analyzers. The assay's cross-reactivity at 50% Bo was 100% to 25(OH)D. Mothers who gave an informed written consent were interviewed, and in addition to their demographic characteristics, they were asked about their completed years of education, whether during pregnancy they took Vitamin D supplementation, smoked, or had diabetes or hypertension. Vitamin D deficiency is defined if serum 25(OH)D <50 nmol/L (20 ng/mL), Vitamin D insufficiency if serum 25(OH)D <72.5 nmol/L (30 ng/mL), and high Vitamin D concentrations if serum 25(OH)D >150 nmol/L.[16]

Sample size calculation

We assumed that about 85% of mothers would have Vitamin D deficiency based on the data published in the Saudi population of women of childbearing age.[6],[15] The sample size required for estimating the prevalence of Vitamin D deficiency to within 5% of the true population and within 95% confidence interval was about 200 subjects.

Statistical analysis

For descriptive statistics, continuous variables were compared using t-test and categorical variables were compared using Chi-square and Fisher's exact test. Statistical significance was set at 5% level. Correlation analysis was performed to quantify the association between maternal serum and umbilical cord blood 25(OH)D concentrations. SPSS for Windows 20.0 (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses.


  Results Top


A total of 201 mother–infant pairs were enrolled. One hundred and eighty-two women had Vitamin D levels <50 nmol/L (90.5%). Sixty-six (33%) mothers had 25(OH)D level of 10 or less nmol/L. There was no statistically significant difference in maternal age, education, body mass index (BMI), parity, skin color, diabetes, and employment status between women with Vitamin D deficiency and those with Vitamin D more than 50 nmol/L [Table 1]. None of the mothers in our sample reported smoking during pregnancy. Two mothers, one in each group, had a history of gestational hypertension. One hundred and seventy-three cord samples had 25(OH)D <50 nmol/L (86%). There was a statistically significant positive correlation between 25(OH)D levels in the maternal and cord blood (r = 0.83, P < 0.001) [Figure 1].
Table 1: 25-hydroxy Vitamin D levels according to baseline maternal characteristics

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Figure 1: Correlation of maternal and cord blood 25-hydroxyvitamin D

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Mothers with Vitamin D deficiency had a statistically significant higher PTH levels [Table 2]. Cord blood PTH level was comparable in both groups.
Table 2: Maternal and cord blood biochemical values

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  Discussion Top


The results from this study are comparable to both national and international studies reporting on the high prevalence of Vitamin D deficiency in pregnant women.[5],[6],[15],[17] Moreover, several studies in the literature have documented the positive correlation between maternal and cord blood 25(OH)D levels.[2],[4],[5],[18] Like other published studies, we did not find a statistically significant difference between the two groups in age, parity, employment status, and being diagnosed with diabetes.[4],[18],[19] Although more mothers with BMI >30 and higher parity were more likely to have 25(OH)D <50 nmol/L, that did not reach statistical significance. The aforementioned observation was similar to other studies, in which the statistical analysis failed to detect an association between BMI and parity and 25(OH)D deficiency.[4],[18] Contrary to other studies, dark-skinned women were not found to have lower Vitamin D levels compared to light-skinned women.[20],[21],[22]

Several studies reported on the association between Vitamin D deficiency and respiratory complications in infants [23],[24] More recently, lower maternal and neonatal Vitamin D levels were found to be associated with early-onset sepsis in term infants.[25] In a recent birth cohort study, Hart et al. demonstrated an association between Vitamin D deficiency in pregnant mothers and impaired lung development neurocognitive difficulties, increased risk of eating disorders, and lower peak bone mass in their offspring.[13]

Our study has several limitations. First, the majority of the population we studied is from the low-income working families, which could have other factors contributing to the low Vitamin D levels and may not be representative of the West Coast population in Saudi Arabia. Second, we did not collect information about known risk factors of low Vitamin D levels including physical activity, amount of sunlight exposure, and consumption of Vitamin D-rich food.


  Conclusion Top


Our study sheds the light on the widely recognized public health problem of Vitamin D deficiency in mother–infant pairs in an academic center in the West Coast of Saudi Arabia. Future studies should consider adopting a clinical trial methodology to study the effect of supplementing Vitamin D to pregnant mothers on maternal, neonatal, and childhood outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
El Rifai NM, Abdel Moety GA, Gaafar HM, Hamed DA. Vitamin D deficiency in Egyptian mothers and their neonates and possible related factors. J Matern Fetal Neonatal Med 2014;27:1064-8.  Back to cited text no. 1
    
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Lee JM, Smith JR, Philipp BL, Chen TC, Mathieu J, Holick MF. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila) 2007;46:42-4.  Back to cited text no. 2
    
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Nicolaidou P, Hatzistamatiou Z, Papadopoulou A, Kaleyias J, Floropoulou E, Lagona E, et al. Low Vitamin D status in mother-newborn pairs in Greece. Calcif Tissue Int 2006;78:337-42.  Back to cited text no. 3
    
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Wuertz C, Gilbert P, Baier W, Kunz C. Cross-sectional study of factors that influence the 25-hydroxyvitamin D status in pregnant women and in cord blood in Germany. Br J Nutr 2013;110:1895-902.  Back to cited text no. 4
    
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Dijkstra SH, van Beek A, Janssen JW, de Vleeschouwer LH, Huysman WA, van den Akker EL. High prevalence of Vitamin D deficiency in newborn infants of high-risk mothers. Arch Dis Child 2007;92:750-3.  Back to cited text no. 5
    
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AlFaleh KM, Al-Manie AM, Al-Mahmoud HF, Al-Razqan HM, Al-Mutlaq AB, Al-Rumaih SA, et al. Prevalence of Vitamin D deficiency in Saudi newborns at a tertiary care center. Saudi Med J 2014;35:178-82.  Back to cited text no. 6
    
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Vuistiner P, Rousson V, Henry H, Lescuyer P, Boulat O, Gaspoz JM, et al. A population-based model to consider the effect of seasonal variation on serum 25(OH)D and Vitamin D status. Biomed Res Int 2015;2015:168189.  Back to cited text no. 7
    
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Ojah RC, Welch JM. Vitamin D and musculoskeletal status in Nova Scotian women who wear concealing clothing. Nutrients 2012;4:399-412.  Back to cited text no. 8
    
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Black LJ, Walton J, Flynn A, Cashman KD, Kiely M. Small increments in Vitamin D intake by Irish adults over a decade show that strategic initiatives to fortify the food supply are needed. J Nutr 2015;145:969-76.  Back to cited text no. 9
    
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Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of Vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol 2010;202:429.e1-9.  Back to cited text no. 10
    
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Dror DK, Allen LH. Vitamin D inadequacy in pregnancy: Biology, outcomes, and interventions. Nutr Rev 2010;68:465-77.  Back to cited text no. 11
    
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Bodnar LM, Platt RW, Simhan HN. Early-pregnancy Vitamin D deficiency and risk of preterm birth subtypes. Obstet Gynecol 2015;125:439-47.  Back to cited text no. 12
    
13.
Hart PH, Lucas RM, Walsh JP, Zosky GR, Whitehouse AJ, Zhu K, et al. Vitamin D in fetal development: Findings from a birth cohort study. Pediatrics 2015;135:e167-73.  Back to cited text no. 13
    
14.
Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O'Beirne M, Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: Systematic review and meta-analysis of observational studies. BMJ 2013;346:f1169.  Back to cited text no. 14
    
15.
Al-Mogbel ES. Vitamin D status among adult Saudi females visiting primary health care clinics. Int J Health Sci (Qassim) 2012;6:116-26.  Back to cited text no. 15
    
16.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of Vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30.  Back to cited text no. 16
    
17.
Song SJ, Si S, Liu J, Chen X, Zhou L, Jia G, et al. Vitamin D status in Chinese pregnant women and their newborns in Beijing and their relationships to birth size. Public Health Nutr 2013;16:687-92.  Back to cited text no. 17
    
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Halicioglu O, Aksit S, Koc F, Akman SA, Albudak E, Yaprak I, et al. Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey. Paediatr Perinat Epidemiol 2012;26:53-60.  Back to cited text no. 18
    
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Atiq M, Suria A, Nizami SQ, Ahmed I. Maternal Vitamin-D deficiency in Pakistan. Acta Obstet Gynecol Scand 1998;77:970-3.  Back to cited text no. 19
    
20.
McAree T, Jacobs B, Manickavasagar T, Sivalokanathan S, Brennan L, Bassett P, et al. Vitamin D deficiency in pregnancy – Still a public health issue. Matern Child Nutr 2013;9:23-30.  Back to cited text no. 20
    
21.
Dror DK, King JC, Durand DJ, Allen LH. Association of modifiable and nonmodifiable factors with Vitamin D status in pregnant women and neonates in Oakland, CA. J Am Diet Assoc 2011;111:111-6.  Back to cited text no. 21
    
22.
Cadario F, Savastio S, Pozzi E, Capelli A, Dondi E, Gatto M, et al. Vitamin D status in cord blood and newborns: Ethnic differences. Ital J Pediatr 2013;39:35.  Back to cited text no. 22
    
23.
Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A. Association of subclinical Vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr 2009;63:473-7.  Back to cited text no. 23
    
24.
Belderbos ME, Houben ML, Wilbrink B, Lentjes E, Bloemen EM, Kimpen JL, et al. Cord blood Vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics 2011;127:e1513-20.  Back to cited text no. 24
    
25.
Cetinkaya M, Cekmez F, Buyukkale G, Erener-Ercan T, Demir F, Tunc T, et al. Lower Vitamin D levels are associated with increased risk of early-onset neonatal sepsis in term infants. J Perinatol 2015;35:39-45.  Back to cited text no. 25
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]


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