Investigation of the Effect of Vitamin D Supplementation During Pregnancy on Maternal and Cord Blood 25(OH)D Levels and Neonatal Anthropometric Measurements

Öz

Objective: This study evaluated the effect of vitamin D supplementation during pregnancy on maternal and cord blood 25-hydroxyvitamin D [25(OH)D] levels, their association with neonatal anthropometry, and changes in 25(OH)D distribution after 400 IU/day prophylaxis. Methods: This study included 46 healthy term mother–infant pairs at Erzurum Atatürk University. Mothers were grouped by use or non-use of 1200 IU/day vitamin D during pregnancy. Maternal demographic and obstetric data, and neonatal gestational age, sex, and anthropometric measurements were recorded. Anthropometry was repeated at one month. Levels of 25(OH)D, parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca), phosphorus (P), and magnesium (Mg) were measured in maternal venous blood, cord venous blood, and one-month infant serum. The Mann–Whitney U test, Spearman correlation, and linear regression were used. Results: Median maternal 25(OH)D was 6.57 ng/mL, and 97.8% of mothers had levels <20 ng/mL. Maternal and cord blood 25(OH)D levels were higher with supplementation (P=0.015 and P=0.003, respectively). Maternal and cord blood 25(OH)D levels were positively correlated (r=0.410; P<0.005), and maternal levels explained 17% of the variance. Maternal or cord blood 25(OH)D levels were not associated with birth anthropometry. At one month, 25(OH)D ≥20 ng/mL increased to 87%. Conclusion: Maternal vitamin D status is reflected in cord blood 25(OH)D levels. Persistent maternal deficiency despite national supplementation suggests that strategies should be re-evaluated, especially in regions with long winters. Standard 400 IU/day prophylaxis appears effective early postnatally.

Anahtar Kelimeler

• Pregnancy
• 25-hydroxyvitamin D
• cord blood
• newborn
• anthropometric measurements

Destekleyen Kurum

The authors declared that this study has receivedno financial support.

Etik Beyan

This study was approved by the Ethics Committee of Atatürk University Faculty of Medicine on 09.06.2017 at meeting no. 3 with decision no. 33, and was conducted in accordance with the Declaration of Helsinki. The study was carried out at the Obstetrics and Gynecology Clinic and the Pediatrics Clinic of Erzurum Atatürk University Faculty of Medicine.

Teşekkür

I would like to thank Assoc. Prof. Dr. Handan ALAY, who supported me throughout my thesis process, for her valuable contributions and kind support.

Gebelikte D Vitamini Desteğinin Maternal ve Kordon Kanı 25(OH)D Düzeyleri ile Yenidoğan Antropometrik Ölçümleri Üzerindeki Etkisinin Araştırılması

Öz

Amaç: Bu çalışmada, gebelik sırasında D vitamini desteğinin maternal ve kordon kanı 25-hidroksivitamin D [25(OH)D] düzeyleri üzerindeki etkisi, bu düzeylerin yenidoğan antropometrik ölçümleriyle ilişkisi ve günlük 400 IU profilaksi sonrasında 25(OH)D dağılımındaki değişiklikler değerlendirilmiştir. Yöntem: Çalışmaya Erzurum Atatürk Üniversitesi’nde takip edilen 46 sağlıklı term anne–bebek çifti dahil edilmiştir. Anneler, gebelik sırasında günlük 1200 IU D vitamini kullanma durumlarına göre destek alan ve almayan gruplara ayrılmıştır. Annelerin demografik ve obstetrik verileri ile yenidoğanların gebelik haftası, cinsiyeti ve antropometrik ölçümleri kaydedilmiştir. Antropometrik ölçümler birinci ayda tekrarlanmıştır. Maternal venöz kan, kordon venöz kanı ve bir aylık bebek serumunda 25(OH)D, paratiroid hormon (PTH), alkalen fosfataz (ALP), kalsiyum (Ca), fosfor (P) ve magnezyum (Mg) düzeyleri ölçülmüştür. İstatistiksel analizlerde Mann–Whitney U testi, Spearman korelasyon analizi ve doğrusal regresyon analizi kullanılmıştır. Bulgular: Ortanca maternal 25(OH)D düzeyi 6,57 ng/mL olarak saptanmış ve annelerin %97,8’inde 25(OH)D düzeyi 20 ng/mL’nin altında bulunmuştur. D vitamini desteği alan annelerde maternal ve kordon kanı 25(OH)D düzeyleri anlamlı olarak daha yüksekti (sırasıyla P=0,015 ve P=0,003). Maternal ve kordon kanı 25(OH)D düzeyleri arasında pozitif korelasyon saptandı (r=0,410; P<0,005) ve maternal 25(OH)D düzeylerinin kordon kanı düzeylerindeki varyansın %17’sini açıkladığı belirlendi. Maternal veya kordon kanı 25(OH)D düzeyleri ile doğum antropometrik ölçümleri arasında anlamlı ilişki bulunmadı. Birinci ayda 25(OH)D düzeyi ≥20 ng/mL olan bebeklerin oranı %87’ye yükseldi. Sonuç: Maternal D vitamini durumu kordon kanı 25(OH)D düzeylerine yansımaktadır. Ulusal destek programına rağmen maternal D vitamini eksikliğinin devam etmesi, özellikle kış mevsiminin uzun sürdüğü bölgelerde mevcut stratejilerin yeniden değerlendirilmesi gerektiğini göstermektedir. Günlük standart 400 IU D vitamini profilaksisinin erken postnatal dönemde etkili olduğu görülmektedir.

Anahtar Kelimeler

• Gebelik
• 25-hidroksivitamin D
• kordon kanı
• yenidoğan
• antropometrik ölçümler

Destekleyen Kurum

Yazarlar, bu çalışma için herhangi bir finansal destek alınmadığını beyan etmişlerdir.

Etik Beyan

Bu çalışma, Atatürk Üniversitesi Tıp Fakültesi Etik Kurulu tarafından 09.06.2017 tarihinde gerçekleştirilen 3 numaralı toplantıda, 33 numaralı karar ile onaylanmış ve Helsinki Bildirgesi’ne uygun olarak yürütülmüştür. Çalışma, Erzurum Atatürk Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği ile Çocuk Sağlığı ve Hastalıkları Kliniğinde gerçekleştirilmiştir.

Teşekkür

Tez sürecim boyunca beni destekleyen, değerli katkıları ve nazik desteği için Doç. Dr. Handan Alay’a teşekkür ederim.

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