Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-11T11:42:39.179Z Has data issue: false hasContentIssue false
  • English
  • Français

Vitamin D status of pregnant women with obesity in the UK and its association with pregnancy outcomes: a secondary analysis of the UK Pregnancies Better Eating and Activity Trial (UPBEAT) study

Published online by Cambridge University Press:  18 April 2024

Karen M. O’Callaghan Open the ORCID record for Karen M. O’Callaghan [Opens in a new window] ,
Katarzyna G. Nowak ,
Kathryn V. Dalrymple Open the ORCID record for Kathryn V. Dalrymple [Opens in a new window] ,
Lucilla Poston ,
Jessica Rigutto-Farebrother ,
Ola F. Quotah ,
Sara L. White ,
Angela C. Flynn  and
UPBEAT Consortium
Karen M. O’Callaghan
Affiliation:
Department of Nutritional Sciences, School of Life Course and Population Sciences, King’s College London, London, UK
Katarzyna G. Nowak
Affiliation:
Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Department of Women and Children’s Health, School of Life Course and Population Sciences, King’s College London, London, UK
Kathryn V. Dalrymple
Affiliation:
Department of Nutritional Sciences, School of Life Course and Population Sciences, King’s College London, London, UK
Lucilla Poston
Affiliation:
Department of Women and Children’s Health, School of Life Course and Population Sciences, King’s College London, London, UK
Jessica Rigutto-Farebrother
Affiliation:
Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
Ola F. Quotah
Affiliation:
Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Department of Clinical Nutrition, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
Sara L. White
Affiliation:
Department of Women and Children’s Health, School of Life Course and Population Sciences, King’s College London, London, UK Department of Diabetes and Endocrinology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
Angela C. Flynn*
Affiliation:
Department of Nutritional Sciences, School of Life Course and Population Sciences, King’s College London, London, UK School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
*
*Corresponding author: Angela C. Flynn, email angela.flynn@kcl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Prenatal vitamin D deficiency is widely reported and may affect perinatal outcomes. In this secondary analysis of the UK Pregnancies Better Eating and Activity Trial, we examined vitamin D status and its relationship with selected pregnancy outcomes in women with obesity (BMI ≥ 30 kg/m2) from multi-ethnic inner-city settings in the UK. Determinants of vitamin D status at a mean of 17 ± 1 weeks’ gestation were assessed using multivariable linear regression and reported as percent differences in serum 25-hydroxyvitamin D (25(OH)D). Associations between 25(OH)D and clinical outcomes were examined using logistic regression. Among 1089 participants, 67 % had 25(OH)D < 50 nmol/l and 26 % had concentrations < 25 nmol/l. In fully adjusted models accounting for socio-demographic and anthropometric characteristics, 25(OH)D was lower among women of Black (% difference = −33; 95 % CI: −39, −27), Asian (% difference = −43; 95 % CI: −51, −35) and other non-White (% difference = −26; 95 % CI: −35, −14) ethnicity compared with women of White ethnicity (n 1086; P < 0·001 for all). In unadjusted analysis, risk of gestational diabetes was greater in women with 25(OH)D < 25 nmol/l compared with ≥ 50 nmol/l (OR = 1·58; 95 % CI: 1·09, 2·31), but the magnitude of effect estimates was attenuated in the multivariable model (OR = 1·33; 95 % CI: 0·88, 2·00). There were no associations between 25(OH)D and risk of preeclampsia, preterm birth or small for gestational age or large-for-gestational-age delivery. These findings demonstrate low 25(OH)D among pregnant women with obesity and highlight ethnic disparities in vitamin D status in the UK. However, evidence for a greater risk of adverse perinatal outcomes among women with vitamin D deficiency was limited.

Keywords

25-hydroxyvitamin DVitamin DPregnancy outcomesPerinatal healthHigh BMIObesityGestational diabetesHyperglycaemia
Type
Research Article
Information
British Journal of Nutrition , First View , pp. 1 - 10
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

†

These authors contributed equally to this work.

References

Institute of Medicine (2011) Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press (US).Google Scholar
Saraf, R, Morton, SMB, Camargo, CA Jr, et al. (2016) Global summary of maternal and newborn vitamin D status – a systematic review. Matern Child Nutr 12, 647–668.CrossRefGoogle ScholarPubMed
van der Pligt, P, Willcox, J, Szymlek-Gay, EA, et al. (2018) Associations of maternal vitamin D deficiency with pregnancy and neonatal complications in developing countries: a systematic review. Nutrients 10, 640.CrossRefGoogle ScholarPubMed
Scientific Advisory Committee on Nutrition (2016) Vitamin D and Health. London: Scientific Advisory Committee on Nutrition (SACN).Google Scholar
National Diet and Nutrition Survey (2020) NDNS: Results from Years 9 to 11 (combined) – Data Tables. –https://www.gov.uk/government/statistics/ndns-results-from-years-9-to-11–2016-to-2017-and-2018-to-2019 (accessed November 2023).Google Scholar
Kiely, ME, Wagner, CL & Roth, DE (2020) Vitamin D in pregnancy: where we are and where we should go. J Steroid Biochem Mol Biol 201, 105669. CrossRefGoogle ScholarPubMed
Sadeghian, M, Asadi, M, Rahmani, S, et al. (2020) Circulating vitamin D and the risk of gestational diabetes: a systematic review and dose-response meta-analysis. Endocrine 70, 36–47.CrossRefGoogle ScholarPubMed
Vivanti, AJ, Monier, I, Salakos, E, et al. (2020) Vitamin D and pregnancy outcomes: overall results of the FEPED study. J Gynecol Obstet Hum Reprod 49, 101883. CrossRefGoogle ScholarPubMed
Agüero-Domenech, N, Jover, S, Sarrión, A, et al. (2021) Vitamin D deficiency and gestational diabetes mellitus in relation to body mass index. Nutrients 14, 102.CrossRefGoogle ScholarPubMed
Rouhani, P, Mokhtari, E, Lotfi, K, et al. (2023) The association between circulating 25-hydroxyvitamin D levels and preeclampsia: a systematic review and dose-response meta-analysis of epidemiologic studies with GRADE assessment. Nutr Rev 81, 1267–1289.CrossRefGoogle ScholarPubMed
Zhao, R, Zhou, L, Wang, S, et al. (2022) Effect of maternal vitamin D status on risk of adverse birth outcomes: a systematic review and dose-response meta-analysis of observational studies. Eur J Nutr 61, 2881–2907.CrossRefGoogle ScholarPubMed
Bialy, L, Fenton, T, Shulhan-Kilroy, J, et al. (2020) Vitamin D supplementation to improve pregnancy and perinatal outcomes: an overview of 42 systematic reviews. BMJ Open 10, e032626. CrossRefGoogle ScholarPubMed
Levy, B, O’Callaghan, KM, Qamar, H, et al. (2021) Basal vitamin D status and supplement dose are primary contributors to maternal 25-hydroxyvitamin D response to prenatal and postpartum cholecalciferol supplementation. J Nutr 151, 3361–3378.CrossRefGoogle ScholarPubMed
Vimaleswaran, KS, Berry, DJ, Lu, C, et al. (2013) Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med 10, e1001383. CrossRefGoogle ScholarPubMed
Pereira-Santos, M, Costa, PR, Assis, AM, et al. (2015) Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev 16, 341–349.CrossRefGoogle ScholarPubMed
McAree, T, Jacobs, B, Manickavasagar, T, et al. (2013) Vitamin D deficiency in pregnancy – still a public health issue. Matern Child Nutr 9, 23–30.CrossRefGoogle Scholar
Bodnar, LM, Catov, JM, Roberts, JM, et al. (2007) Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates. J Nutr 137, 2437–2442.CrossRefGoogle ScholarPubMed
Drincic, AT, Armas, LA, Van Diest, EE, et al. (2012) Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity (Silver Spring) 20, 1444–1448.CrossRefGoogle ScholarPubMed
Walsh, JS, Bowles, S & Evans, AL (2017) Vitamin D in obesity. Curr Opin Endocrinol Diabetes Obes 24, 389–394.CrossRefGoogle ScholarPubMed
Moon, RJ, Harvey, NC, Cooper, C, et al. (2016) Determinants of the maternal 25-hydroxyvitamin D response to vitamin D supplementation during pregnancy. J Clin Endocrinol Metab 101, 5012–5020.CrossRefGoogle ScholarPubMed
Alhomaid, RM, Mulhern, MS, Strain, J, et al. (2021) Maternal obesity and baseline vitamin D insufficiency alter the response to vitamin D supplementation: a double-blind, randomized trial in pregnant women. Am J Clin Nutr 114, 1208–1218.CrossRefGoogle ScholarPubMed
Devlieger, R, Benhalima, K, Damm, P, et al. (2016) Maternal obesity in Europe: where do we stand and how to move forward?: A scientific paper commissioned by the European Board and College of Obstetrics and Gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 201, 203–208.CrossRefGoogle Scholar
Chen, C, Xu, X & Yan, Y (2018) Estimated global overweight and obesity burden in pregnant women based on panel data model. PLoS One 13, e0202183. CrossRefGoogle ScholarPubMed
NMPA Project Team (2022) National Maternity and Perinatal Audit: Clinical Report 2022. Based on births in NHS maternity services in England and Wales between 1 April 2018 and 31 March 2019. London: RCOG.Google Scholar
Relph, S & NMPA Project Team (2021) National Maternity and Perinatal Audit: NHS Maternity Care for Women with a Body Mass Index of 30 kg/m2 or Above. Births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland. London: RCOG.Google Scholar
Richard, A, Rohrmann, S & Quack Lötscher, KC (2017) Prevalence of vitamin D deficiency and its associations with skin color in pregnant women in the first trimester in a sample from Switzerland. Nutrients 9, 260. CrossRefGoogle Scholar
Vinkhuyzen, AAE, Eyles, DW, Burne, TH, et al. (2016) Prevalence and predictors of vitamin D deficiency based on maternal mid-gestation and neonatal cord bloods: the Generation R Study. J Steroid Biochem Mol Biol 164, 161–167.CrossRefGoogle ScholarPubMed
Kiely, ME, Zhang, JY, Kinsella, M, et al. (2016) Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. Am J Clin Nutr 104, 354–361.CrossRefGoogle Scholar
Eggemoen, ÅR, Falk, RS, Knutsen, KV, et al. (2016) Vitamin D deficiency and supplementation in pregnancy in a multiethnic population-based cohort. BMC Pregnancy Childbirth 16, 7.CrossRefGoogle Scholar
Briley, AL, Barr, S, Badger, S, et al. (2014) A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial. BMC Pregnancy Childbirth 14, 74.CrossRefGoogle ScholarPubMed
Poston, L, Bell, R, Croker, H, et al. (2015) Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 3, 767–777.CrossRefGoogle ScholarPubMed
The Met Office (2021) When Does Summer Start? https://www.metoffice.gov.uk/weather/learn-about/weather/seasons/summer/when-does-summer-start (accessed January 2022).Google Scholar
White, SL, Lawlor, DA, Briley, AL, et al. (2016) Early antenatal prediction of gestational diabetes in obese women: development of prediction tools for targeted intervention. PLoS One 11, e0167846.CrossRefGoogle ScholarPubMed
Emmen, JM, Wielders, JP, Boer, AK, et al. (2012) The new Roche Vitamin D Total assay: fit for its purpose? Clin Chem Lab Med 50, 1969–1972.CrossRefGoogle ScholarPubMed
Bjerg, LN, Halgreen, JR, Hansen, SH, et al. (2019) An evaluation of total 25-hydroxyvitamin D assay standardization: where are we today? J Steroid Biochem Mol Biol 190, 224–233.CrossRefGoogle ScholarPubMed
Armitage, P, Berry, G & Matthews, JNS (2008) Statistical Methods in Medical Research. John Wiley & Sons. Google Scholar
Goldacre, M, Hall, N & Yeates, DG (2014) Hospitalisation for children with rickets in England: a historical perspective. Lancet 383, 597–598.CrossRefGoogle Scholar
Julies, P, Lynn, RM, Pall, K, et al. (2020) Nutritional rickets under 16 years: UK surveillance results. Arch Dis Child 105, 587. CrossRefGoogle ScholarPubMed
Munns, CF, Shaw, N, Kiely, M, et al. (2016) Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab 101, 394–415.CrossRefGoogle ScholarPubMed
Department of Health (1998) Nutrition and Bone Health: With Particular Reference to Calcium and Vitamin D. Report on the Subgroup on Bone Health, Working Group on the Nutritional Status of the Population of the Committee on Medical Aspects of Food and Nutrition Policy. Report on Health and Social Subjects 49. London: TSO. Google Scholar
National Institute for Health and Care Excellence (NICE) (2014) Vitamin D: Supplement Use in Specific Population Groups. https://www.nice.org.uk/guidance/ph56 (accessed November 2023).Google Scholar
Specker, BL, Tsang, RC & Hollis, BW (1985) Effect of race and diet on human-milk vitamin D and 25-hydroxyvitamin D. Am J Dis Child 139, 1134–1137.Google ScholarPubMed
Hollis, BW, Roos, BA, Draper, HH, et al. (1981) Vitamin D and its metabolites in human and bovine milk. J Nutr 111, 1240–1248.CrossRefGoogle ScholarPubMed
Creo, AL, Thacher, TD, Pettifor, JM, et al. (2017) Nutritional rickets around the world: an update. Paediatr Int Child Health 37, 84–98.CrossRefGoogle ScholarPubMed
Crozier, SR, Harvey, NC, Inskip, HM, et al. (2012) Maternal vitamin D status in pregnancy is associated with adiposity in the offspring: findings from the Southampton Women’s Survey. Am J Clin Nutr 96, 57–63.CrossRefGoogle ScholarPubMed
O’Callaghan, KM, Hennessy, Á, Hull, GLJ, et al. (2018) Estimation of the maternal vitamin D intake that maintains circulating 25-hydroxyvitamin D in late gestation at a concentration sufficient to keep umbilical cord sera ≥ 25–30 nmol/l: a dose-response, double-blind, randomized placebo-controlled trial in pregnant women at northern latitude. Am J Clin Nutr 108, 77–91.CrossRefGoogle Scholar
Grant, CC, Stewart, AW, Scragg, R, et al. (2014) Vitamin D during pregnancy and infancy and infant serum 25-hydroxyvitamin D concentration. Pediatrics 133, e143–153.CrossRefGoogle ScholarPubMed
March, KM, Chen, NN, Karakochuk, CD, et al. (2015) Maternal vitamin D3 supplementation at 50 μg/d protects against low serum 25-hydroxyvitamin D in infants at 8 weeks of age: a randomized controlled trial of 3 doses of vitamin D beginning in gestation and continued in lactation. Am J Clin Nutr 102, 402–410.CrossRefGoogle Scholar
Clemens, TL, Adams, JS, Henderson, SL, et al. (1982) Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1, 74–76.CrossRefGoogle ScholarPubMed
Cashman, KD, Dowling, KG, Škrabáková, Z, et al. (2016) Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr 103, 1033–1044.CrossRefGoogle ScholarPubMed
Martin, CA, Gowda, U & Renzaho, AM (2016) The prevalence of vitamin D deficiency among dark-skinned populations according to their stage of migration and region of birth: a meta-analysis. Nutrition 32, 21–32.CrossRefGoogle ScholarPubMed
O’Callaghan, KM & Kiely, ME (2018) Ethnic disparities in the dietary requirement for vitamin D during pregnancy: considerations for nutrition policy and research. Proc Nutr Soc 77, 164–173.CrossRefGoogle ScholarPubMed
Jessiman, T, Cameron, A, Wiggins, M, et al. (2013) A qualitative study of uptake of free vitamins in England. Arch Dis Child 98, 587–591.CrossRefGoogle ScholarPubMed
McFadden, A, Green, JM, McLeish, J, et al. (2015) Healthy start vitamins—a missed opportunity: findings of a multimethod study. BMJ Open 5, e006917. CrossRefGoogle ScholarPubMed
Yaribeygi, H, Maleki, M, Sathyapalan, T, et al. (2020) The molecular mechanisms by which vitamin D improve glucose homeostasis: a mechanistic review. Life Sci 244, 117305. CrossRefGoogle ScholarPubMed
Lips, P, Eekhoff, M, van Schoor, N, et al. (2017) Vitamin D and type 2 diabetes. J Steroid Biochem Mol Biol 173, 280–285.CrossRefGoogle ScholarPubMed
Mirhosseini, N, Vatanparast, H, Mazidi, M, et al. (2017) The effect of improved serum 25-hydroxyvitamin D status on glycemic control in diabetic patients: a meta-analysis. J Clin Endocrinol Metab 102, 3097–3110.CrossRefGoogle ScholarPubMed
Palacios, C, Kostiuk, LK & Peña-Rosas, JP (2019) Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 2019 issue 7, CD008873.CrossRefGoogle Scholar
Roth, DE, Leung, M, Mesfin, E, et al. (2017) Vitamin D supplementation during pregnancy: state of the evidence from a systematic review of randomised trials. BMJ 359, j5237. CrossRefGoogle ScholarPubMed
Corcoy, R, Mendoza, LC, Simmons, D, et al. (2020) The DALI vitamin D randomized controlled trial for gestational diabetes mellitus prevention: no major benefit shown besides vitamin D sufficiency. Clin Nutr 39, 976–984.CrossRefGoogle ScholarPubMed
Kjalarsdottir, L, Tersey, SA, Vishwanath, M, et al. (2019) 1,25-Dihydroxyvitamin D(3) enhances glucose-stimulated insulin secretion in mouse and human islets: a role for transcriptional regulation of voltage-gated calcium channels by the vitamin D receptor. J Steroid Biochem Mol Biol 185, 17–26.CrossRefGoogle ScholarPubMed
Mendoza, LC, Harreiter, J, Desoye, G, et al. (2022) The weak relationship between vitamin D compounds and glucose homeostasis measures in pregnant women with obesity: an exploratory sub-analysis of the DALI study. Nutrients 14, 3256.CrossRefGoogle ScholarPubMed
Carter, GD, Jones, JC, Shannon, J, et al. (2016) 25-Hydroxyvitamin D assays: potential interference from other circulating vitamin D metabolites. J Steroid Biochem Mol Biol 164, 134–138.CrossRefGoogle ScholarPubMed
Digitale, JC, Martin, JN & Glymour, MM (2022) Tutorial on directed acyclic graphs. J Clin Epidemiol 142, 264–267.CrossRefGoogle ScholarPubMed
Hemmingway, A, Kenny, LC, Malvisi, L, et al. (2018) Exploring the concept of functional vitamin D deficiency in pregnancy: impact of the interaction between 25-hydroxyvitamin D and parathyroid hormone on perinatal outcomes. Am J Clin Nutr 108, 821–829.CrossRefGoogle ScholarPubMed
Davis, S, Lyles, E, Shary, JR, et al. (2023) Post hoc analysis of national institute of child health and human development vitamin-D Pregnancy cohort and the role of functional vitamin-D deficiency in pregnancy. Am J Perinatol (Epublication ahead of print version 28 June 2023).CrossRefGoogle Scholar
Scholl, TO, Chen, X & Stein, TP (2014) Maternal calcium metabolic stress and fetal growth. Am J Clin Nutr 99, 918–925.CrossRefGoogle ScholarPubMed
Scholl, TO, Chen, X & Stein, TP (2013) Vitamin D, secondary hyperparathyroidism, and preeclampsia. Am J Clin Nutr 98, 787–793.CrossRefGoogle ScholarPubMed
Supplementary material: File

O’Callaghan et al. supplementary material

O’Callaghan et al. supplementary material
Download O’Callaghan et al. supplementary material(File)
File 189.3 KB