Vitamin D Status and Its Relation to Muscle Mass and Muscle Fat in Young Women

Abstract

Despite intensive investigation, an underlying cause of miscarriage has not been found in a high proportion of women with a history of recurrent miscarriage. No effective intervention has been identified that improves rates of live birth. Some investigators have suggested that treatment of women with unexplained recurrent miscarriage with aspirin and low-molecular-weight heparin may increase the proportion of live births; the limited data available from randomized controlled trials have been inconsistent.This multicenter, randomized, placebo-controlled trial investigated whether a combination of aspirin with lowmolecular-weight heparin or aspirin alone, compared with placebo, would improve the live-birth rate in women with a history of unexplained recurrent miscarriage. The study subjects were 364 women aged 18 to 42 years with a history of unexplained recurrent miscarriage who were trying to conceive or were pregnant less than 6 weeks. Women were randomly assigned to receive combined therapy (n ϭ 123) consisting of daily doses of aspirin 80 mg plus open-label subcutaneous low-molecular-weight heparin (nadroparin) at a dose of 2850 IU, or 80 mg of aspirin alone (n ϭ 120), or placebo (n ϭ 121) either before conception or at a gestational age of less than 6 weeks. The main study outcome measure was the rate of live birth. Secondary outcome measures included rates of miscarriage, obstetrical complications, and maternal and neonatal adverse events.No significant difference between the 3 study groups was found in the proportion of live births (combined therapy, 54.5%; aspirin only, 50.8%; and placebo, 57%); the absolute difference in live-birth rate for combined therapy versus placebo was Ϫ2.6 percentage points, with a 95% confidence interval of Ϫ15.0 to 9.9; and for the aspirin only versus placebo was Ϫ6.2, with a 95% confidence interval of Ϫ18.8 to 6.4 (P ϭ 0.63). There was also no significant difference in the live-birth rates among the 299 women in these 3 groups who became pregnant; the rates were 69.1% in the combined therapy group, 61.6% in the aspirin-only group, and 67.0% in the placebo group (P ϭ 0.52). Compared to the other 2 groups, the combined therapy group had a significantly increased tendency for bruising and swelling or itching at the injection site (P Ͻ 0.001).These findings demonstrate that neither aspirin combined with nadroparin nor aspirin alone increase the likelihood of a live birth in comparison with placebo among women with unexplained recurrent miscarriage. EDITORIAL COMMENT(I have mentioned on several occasions that if you want to make a splash in medicine, choose a well-accepted dictum and disprove it. Al-though the treatment of recurrent miscarriage is not exactly in that category, the methods of treatment with aspirin plus heparin or aspirin GYNECOLOGY Volume 65, Number 10 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTCirculating levels of anti-Müllerian hormone (AMH) have significantly increased in adolescent girls with polycystic ovary syndrome (PCOS) compared with that of normal girls...

Vitamin D and Sarcopenia

“…Low levels of vitamin D related to and any of quantification of muscle mass or strength, in either men or women. The findings of this study are similar to some cross-sectional studies [26,27], but not to others [12][13][14][15][16][17].…”

Vitamin D and Obesity

“…Overweight/ obese women, however, are at a higher risk of vitamin D deficiency, largely due to excessive adiposity rather than inadequate in take [98]. Vitamin D insufficiency has also been reported to be associated with increased fat infiltration into the muscle in healthy women [99].…”

2. Vitamin D in Skeletal Growth and Development

“…Vitamin D insufficiency may increase fracture risk through reduced calcium absorption and secondary hyperparathyroidism or potentially through effects on muscle (16). Low serum vitamin D levels are also associated with greater fatty infiltration of muscle in female adolescents (17), and this greater muscle adiposity could lead to reduced muscle strength and, ultimately, reduced bone strength and increased fracture risk.…”