Maternal Serum Vitamin D at 11–13 Weeks in Pregnancies Delivering Small for Gestational Age Neonates

Ertl, Rebecca; Yu, Christina; Brawura-Biskupski-Samaha, Robert; Akolekar, Ranjit; Nicolaides, Kypros H.

doi:10.1159/000333810

Cited by 26 publications

(42 citation statements)

References 41 publications

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“…Two studies evaluated serum levels of vitamin D, two evaluated metabolomic profile, and one each urinary albumin : creatinine ratio and thyroid function tests . Overall, these biomarkers had low positive LRs (0.8–3.9) and high negative LRs (0.3–1.0; Table ).…”

Section: Resultsmentioning

confidence: 99%

Novel biomarkers for predicting intrauterine growth restriction: a systematic review and meta‐analysis

Conde-Agudelo

Papageorghiou

Kennedy

et al. 2013

BJOG

130

101

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Background Several biomarkers for predicting intrauterine growth restriction (IUGR) have been proposed in recent years. However, the predictive performance of these biomarkers has not been systematically evaluated.Objective To determine the predictive accuracy of novel biomarkers for IUGR in women with singleton gestations.Search strategy Electronic databases, reference list checking and conference proceedings.Selection criteria Observational studies that evaluated the accuracy of novel biomarkers proposed for predicting IUGR.Data collection and analysis Data were extracted on characteristics, quality and predictive accuracy from each study to construct 2 9 2 tables. Summary receiver operating characteristic curves, sensitivities, specificities and likelihood ratios (LRs) were generated.Main results A total of 53 studies, including 39 974 women and evaluating 37 novel biomarkers, fulfilled the inclusion criteria. Overall, the predictive accuracy of angiogenic factors for IUGR was minimal (median pooled positive and negative LRs of 1.7, range 1.0-19.8; and 0.8, range 0.0-1.0, respectively). Two small case-control studies reported high predictive values for placental growth factor and angiopoietin-2 only when IUGR was defined as birthweight centile with clinical or pathological evidence of fetal growth restriction. Biomarkers related to endothelial function/ oxidative stress, placental protein/hormone, and others such as serum levels of vitamin D, urinary albumin : creatinine ratio, thyroid function tests and metabolomic profile had low predictive accuracy.Conclusions None of the novel biomarkers evaluated in this review are sufficiently accurate to recommend their use as predictors of IUGR in routine clinical practice. However, the use of biomarkers in combination with biophysical parameters and maternal characteristics could be more useful and merits further research.

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Section: Resultsmentioning

confidence: 99%

Novel biomarkers for predicting intrauterine growth restriction: a systematic review and meta‐analysis

Conde-Agudelo

Papageorghiou

Kennedy

et al. 2013

BJOG

130

101

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“…39 Small for gestational age was defined as a birth weight less than the 10th centile in all of the eligible studies, 11 30 33 35 36 except one (less than fifth centile). 38 …”

Section: Study Characteristicsmentioning

confidence: 99%

“…The association between small for gestational age infants and 25-OHD insufficiency remained significant at all levels of stratification. Stratified analysis based on 25-OHD quantification method was not conducted because only one study 38 used the high performance liquid chromatography assay method. Metaregression analyses did not show adjustment for critical confounders, 25-OHD level cut-offs, gestational age at sampling, and study design to be predictive of heterogeneity.…”

Section: Association Between Birth Variables and 25-ohd Insufficiencymentioning

confidence: 99%

Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies

Aghajafari

Nagulesapillai

Ronksley

et al. 2013

BMJ

620

545

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Objective To assess the effect of 25-hydroxyvitamin D (25-OHD) levels on pregnancy outcomes and birth variables.Design Systematic review and meta-analysis. Medline (1966 to August 2012, PubMed (2008 to August 2012, Embase (1980 to August 2012, CINAHL (1981 to August 2012, the Cochrane database of systematic reviews, and the Cochrane database of registered clinical trials. Data sourcesStudy selection Studies reporting on the association between serum 25-OHD levels during pregnancy and the outcomes of interest (pre-eclampsia, gestational diabetes, bacterial vaginosis, caesarean section, small for gestational age infants, birth weight, birth length, and head circumference). Data extractionTwo authors independently extracted data from original research articles, including key indicators of study quality. We pooled the most adjusted odds ratios and weighted mean differences. Associations were tested in subgroups representing different patient characteristics and study quality.Results 3357 studies were identified and reviewed for eligibility. 31 eligible studies were included in the final analysis. Insufficient serum levels of 25-OHD were associated with gestational diabetes (pooled odds ratio 1.49, 95% confidence interval 1.18 to 1.89), pre-eclampsia (1.79, 1.25 to 2.58), and small for gestational age infants (1.85, 1.52 to 2.26). Pregnant women with low serum 25-OHD levels had an increased risk of bacterial vaginosis and low birthweight infants but not delivery by caesarean section. ConclusionVitamin D insufficiency is associated with an increased risk of gestational diabetes, pre-eclampsia, and small for gestational age infants. Pregnant women with low 25-OHD levels had an increased risk of bacterial vaginosis and lower birth weight infants, but not delivery by caesarean section. IntroductionVitamin D insufficiency has been associated with several adverse health outcomes, including pregnancy outcomes, and is increasingly recognised as a public health concern. Observational data suggest a link between low 25-hydroxyvitamin D (25-OHD) levels-the best measure of vitamin D status in humans-and an increased risk of adverse pregnancy outcomes such as gestational diabetes, pre-eclampsia, infections, caesarean section, and fetal growth restriction. 1 Despite these findings, the knowledge and understanding of the clinical importance and implications of these associations are limited. A systematic review of the association between 25-OHD levels in the first trimester and subsequent adverse pregnancy outcomes concluded that there was no clear definition of vitamin D deficiency in pregnancy.2 Although this review identified several studies showing inverse associations between maternal 25-OHD levels in the first trimester and the risk of adverse pregnancy outcomes, the authors did not perform a meta-analysis of the data and quantification of the association, citing inconsistent reporting of results across studies. RESEARCHThe literature on vitamin D insufficiency in pregnancy is growing rapidly, with several studie...

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“…The diverse results may be due to varied study methodologies or different populations studied. Two studies noted a link between maternal vitamin D levels and fetal growth in non‐Hispanic White women but not in non‐Hispanic Black women . The lack of association among non‐Hispanic Blacks may be explained by small sample size and a relatively narrower distribution of vitamin D levels among non‐Hispanic Blacks.…”

mentioning

confidence: 99%

“…Intervention trials of maternal vitamin D supplementation during pregnancy have reported mixed results with regard to effects on birthweight . Observational studies of vitamin D deficiency and fetal growth have likewise produced conflicting findings . The diverse results may be due to varied study methodologies or different populations studied.…”

mentioning

confidence: 99%

Maternal Serum 25‐Hydroxyvitamin D Concentrations during Pregnancy and Infant Birthweight for Gestational Age: a Three‐Cohort Study

Tian

Holzman

Siega‐Riz

et al. 2015

Paediatric Perinatal Epid

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Background In response to inconsistent findings, we investigated associations between maternal serum 25-hydroxyvitamin D (25(OH)D) concentrations and infant birthweight for gestational age (BW/GA), including potential effect modification by maternal race/ethnicity and infant sex. Methods Data from 2,558 pregnant women were combined in a nested case-control study (preterm and term) sampled from three cohorts: the Omega study, the Pregnancy, Infection and Nutrition study, and the Pregnancy Outcomes and Community Health study. Maternal 25(OH)D concentrations were sampled at 4 to 29 weeks’ gestation (80% 14–26 weeks). BW/GA was modeled as sex-and gestational age-specific birthweight z-scores. General linear regression models (adjusting for age, education, parity, pre-pregnancy body mass index, season at blood draw, and smoking) assessed 25(OH)D concentrations in relation to BW/GA. Results Among non-Hispanic Black women, the positive association between 25(OH)D concentrations and BW/GA was of similar magnitude in pregnancies with female or male infants (beta (β)=0.015, standard error (SE)=0.007, P=0.025; β=0.018, SE=0.006, P=0.003, respectively). Among non-Hispanic White women, 25(OH)D-BW/GA association was observed only with male infants and the effect size was lower (β=0.008, SE=0.003, P=0.02). Conclusions Maternal serum concentrations of 25(OH)D in early and mid-pregnancy were positively associated with BW/GA among non-Hispanic Black male and female infants and non-Hispanic White male infants. Effect modification by race/ethnicity may be due, in part, to overall lower concentrations of 25(OH)D in non-Hispanic Blacks. Reasons for effect modification by infant sex remain unclear.

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Maternal Serum Vitamin D at 11–13 Weeks in Pregnancies Delivering Small for Gestational Age Neonates

Cited by 26 publications

References 41 publications

Novel biomarkers for predicting intrauterine growth restriction: a systematic review and meta‐analysis

Novel biomarkers for predicting intrauterine growth restriction: a systematic review and meta‐analysis

Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies

Maternal Serum 25‐Hydroxyvitamin D Concentrations during Pregnancy and Infant Birthweight for Gestational Age: a Three‐Cohort Study

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