Citation Information :
Singh S, Garg R, Meena A, Kumar D. Perinatal Outcome in Vitamin D Deficiency and Effect of Oral and Intramuscular Vitamin D3 Supplementation in Antenatal Women on Pregnancy Outcomes. J South Asian Feder Obs Gynae 2021; 13 (3):86-89.
Introduction: There is a high prevalence of low levels of Vitamin D in the pregnant women. Vitamin D deficiency is accompanied with adverse maternal and neonatal outcomes.
Aim and objective: To study perinatal outcomes in vitamin D deficiency, and effect of oral and intramuscular vitamin D3 supplementation in antenatal women on pregnancy outcomes.
Materials and methods: It is a randomized prospective comparative cohort study. Antenatal women attending antenatal outpatient department were screened for vitamin D deficiency (<20 ng/dL), and deficient women were divided into two groups and treated with 60,000 IU oral tablet/capsule weekly and injection vitamin D intramuscular 60,000 IU every fortnight for 8 weeks, respectively. Both the groups were compared both before and after supplementation for variables like clinical profile and maternal and fetal outcomes.
Results: In our study, vitamin D deficiency <20 ng/dL was found in 90.9%. About half of the women had vitamin D3 less than 10 ng/mL and 40.6% women had their vitamin D3 level between 10 ng/mL and 20 ng/mL.
After the oral treatment, mean 25-hydroxy vitamin D level increased to 25.6±1.37 ng/mL and 22.8±2.1 ng/mL at 6 weeks and 12 weeks, respectively, in intramuscular treatment. Mean vitamin D level increased to 26.4±1.85 ng/mL and 29.3± 2.08 ng/mL at 6 weeks and 12 weeks, respectively. At 12 weeks, the mean vitamin D level in the IM vitamin D group was higher as compared to the oral vitamin D group.In the present study, no statistically significant differences could be found in the incidence of preeclampsia, GDM, and preterm birth but low birth weight babies were more in the vitamin D deficiency group (13.33%) as compared to the normal vitamin D group (6.67%).Conclusion: There is a high prevalence of vitamin D deficiency in pregnant women in India. Supplementation of Vitamin D as a part of routine antenatal care needs to be established. Both oral and intramuscular vitamin D are effective.
Al-Faris NA. High prevalence of vitamin D deficiency among pregnant Saudi women. Nutrients 2016;8(2):77. DOI: 10.3390/nu8020077.
Agarwal S, Kovilam O, Agrawal DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: a critical review. Crit Rev Food Sci Nutr 2018;58(5):755–769. DOI: 10.1080/10408398.2016.1220915.
Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96(1):53–58. DOI: 10.1210/jc.2010-2704.
Balvers MG, Brouwer-Brolsma EM, Endenburg S, et al. Recommended intakes of vitamin D to optimise health, associated circulating 25-hydroxyvitamin D concentrations, and dosing regimens to treat deficiency: workshop report and overview of current literature. J Nutr Sci 2015;4:e23. DOI: 10.1017/jns.2015.10.
Basu S, Gupta R, Mitra M, et al. Prevalence of vitamin D deficiency in a pediatric hospital of eastern India. Indian J Clin Biochem 2015;30(2):167–173. DOI: 10.1007/s12291-014-0428-2.
Shukla K, Sharma S, Gupta A, et al. Current scenario of prevalence of vitamin D deficiency in ostensibly healthy Indian population: a hospital based retrospective study. Indian J Clin Biochem 2016;31(4):452–457. DOI: 10.1007/s12291-016-0552-2.
Wang H, Chen W, Li D, et al. Vitamin D and chronic diseases. Aging Dis 2017;8(3):346–353. DOI: 10.14336/AD.2016.1021.
Akbari S, Khodadadi B, Ahmadi SAY, et al. Association of vitamin D level and vitamin D deficiency with risk of preeclampsia: a systematic review and updated meta-analysis. Taiwan J Obstet Gynecol 2018;57(2):241–247. DOI: 10.1016/j.tjog.2018.02.013.
Zhou SS, Tao YH, Huang K, et al. Vitamin D and risk of preterm birth: Up-to-date meta-analysis of randomized controlled trials and observational studies. J Obstet Gynaecol Res 2017;43(2):247–256. DOI: 10.1111/jog.13239.
Gernand AD, Simhan HN, Caritis S, et al. Maternal vitamin D status and small-for-gestational-age offspring in women at high risk for preeclampsia. Obstet Gynecol 2014;123(1):40–48. DOI: 10.1097/AOG.0000000000000049.
Khalessi N, Kalani M, Araghi M, et al. The relationship between maternal vitamin D deficiency and low birth weight neonates. J Family Reprod Health 2015;9(3):113–117.
Marcotorchino J, Gouranton E, Romier B, et al. Vitamin D reduces the inflammatory response and restores glucose uptake in adipocytes. Mol Nutr Food Res 2012;56(12):1771–1782. DOI: 10.1002/mnfr.201200383.
Ustuner I, Keskin HL, Tas EE, et al. Maternal serum 25(OH)D levels in the third trimester of pregnancy during the winter season. J Matern Fetal Neonatal Med 2011;24(12):1421–1426. DOI: 10.3109/14767058.2011.566768.
Marwaha RK, Tandon N, Chopra S, et al. Vitamin D status in pregnant Indian women across trimesters and different seasons and its correlation with neonatal serum 25-hydroxyvitamin D levels. Br J Nutr 2011;106(9):1383–1389. DOI: 10.1017/S000711451100170X.
Gupta N, Farooqui KJ, Batra CM, et al. Effect of oral versus intramuscular vitamin D replacement in apparently healthy adults with vitamin D deficiency. Indian J Endocrinol Metab 2017;21(1):131–136. DOI: 10.4103/2230-8210.196007.
Wei SQ, Audibert F, Hidiroglou N, et al. Longitudinal vitamin D status in pregnancy and the risk of pre-eclampsia. BJOG 2012;119(7):832–839. DOI: 10.1111/j.1471-0528.2012.03307.x.
Hossein-Nezhad A, Maghbooli Z, Vassigh AR, et al. Prevalence of gestational diabetes mellitus and pregnancy outcomes in Iranian women. Taiwan J Obstet Gynecol 2007;46(3):236–241. DOI: 10.1016/S1028-4559(08)60026-1.
Brooke OG, Brown IR, Bone CD, et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980;280(6216):751–754. DOI: 10.1136/bmj.280.6216.751.