Vitamin D is a fat soluble vitamin that is involved in bone metabolism and calcium homeostasis(1).It has been emerging over recent years that vitamin D may have a role in disorders outside the skeletal system including immune disorders, diabetes, hypertension, cardiovascular disease, infectious diseases, and cancer. (2)

Vitamin D deficiency is very prevalent worldwide, as people adopt sedentary indoor lifestyles and use sunscreen and protective clothing to reduce skin cancer risk. (3)Serum 25-hydroxyvitamin D (25[OH]D) concentration is widely accepted as the functional indicator of vitamin D status in the body. Investigators in the field of vitamin D research generally agree that a serum 25(OH) D level of at least 50 to 80nmol/L (20-32 ng/mL) is required for optimal bone-health.(4)Vitamin D's role in preventing adverse health outcomes may begin as early as the first trimester of intra-uterine development; low maternal vitamin D intake during pregnancy has been linked with increased risk of asthma and diabetes later in the offspring's life.(5,6,7)However, only few studies have assessed the relationship of new-born vitamin D levels with pregnancy outcome and neonatal health. In a population that already has a high prevalence of vitamin D deficiency and poor dietary calcium intake, the problem is likely to worsen during pregnancy because of the active transplacental transport of calcium to the developing fetus. Moreover, the lack of consensus on guidelines for vitamin D supplementation during pregnancy may be contributing to the lack of adequate maternal vitaminD supplementation.(8)

Because vitamin D crosses the placenta, the vitamin D level of the new-born is entirely dependent on the maternal vitamin D level(9). Therefore, a high prevalence of vitamin D deficiency or insufficiency in pregnant women correlates with a correspondingly high prevalence of vitamin D deficiency or insufficiency in new-borns.

AIMS & OBJECTIVES:

• To evaluate the prevalence of vitamin D deficiency in pregnancy
• To measure vitamin D levels in 1st or 2nd trimester
• To reassess level of vit D in 3rd trimester after supplementation of vit D for 8 weeks.
• To evaluate its correlation with fetomaternal outcomes.

with 60000 IU of cholecalciferol and were compared with 50 antenatal patients who came during emergency (concluded in control group) for their foetal & maternal outcomes.

Sample collection: Blood sample from peripheral venous blood was taken for all patients included in the study during their hospitalisation for delivery. Samples were immediately fractionated and stored at 2-8℃ until analysis. The ElecsysVit D total assay was used for the quantitative determination of total 25-OH vit D and 3-70 ng/ml was the measuring range of this assay. Based on lab standards, we divided patients into 2 groups:

• Vit D </= 30 ng/ml
• Vit D > 30 ng/ml

Statistical analysis:  Statistical analysis of data was conducted by using SPSS software (version 15.0; SPSS). Data presented as mean +/-SD. For categorical variables t test was used and for comparison of percentages and proportions chi-square test was used, p-value. Categorical variables were presented as number and percentage, whereas continuous variables were presented as mean and standard deviation. Bivariate analysis was carried out by using the Chi-square for comparing categorical variables.

Table 1: SOCIO-DEMOGRAPHIC PROFILE

Table 2: OBSTETRIC PROFILE

Table 3: NEONATAL PROFILE

Prevalence of vitamin D deficiency in our study population is 90.7%, while only 9.23% patients had optimal levels of vitamin D. This high prevalence of vitamin D deficiency has been revealed in various studies. A studyshows in-spite of receiving ample sunlight throughout the year Vitamin D deficiency in Indian pregnant women is ranging from 42-93%10.

A study has shown the prevalence of vitamin D deficiency to be 74.1% and 56% in North eastern part of India despite abundant sunshine in our country11. The high prevalence of vitamin D deficiency might be due to darker skin with melanin preventing the entry of UV rays in the skin, people remaining indoors, use of sunscreens, malabsorption, less intake of calcium in the form of milk and other dairy products.

Among Vit D deficient patients 72% were between 20-30 years of age. Among 310 pregnant womenmean age of ofVit D deficient patients was found to be 24.3.12

Socio-economic status, reflected by education, occupation, and household income, is a risk factor for low level of Vit D because low socio-economic status families are less likely to consume sufficient Vit D, Calcium and calories in their diets.13.

Among vitamin D deficient patients 47.4% were primigravida, 50.8% were multigravida and 10.1% were grand multipara, showing multiparity as a risk factor for vitamin D deficiency, due to depletion of the vitamin D during each pregnancy especially if there is a lack of vitamin D supplementation or faulted dietary behaviours with the pregnancy spacing periods14.

A significant rise was seen in mean vitamin D level in deficient group, after 8 weeks supplementation of 60000 IU of oral cholecalciferol. In a similar study 41 reported successful normalization of serum 25(OH)D at 8 weeks after supplementing with 60,000IU orally cholecalciferol each week to vitamin D deficient patients15.

In our study 100% pts of GDM were vitamin D deficient, while 91.6% of PET/ECLAMPSIA patients were vitamin D deficient. Although 8.2% more Gestational diabetes cases were identified in control group in comparison to study group, but it was not statistically significant (p value 0.12)

In our study, Control group had 17.9% more cases affected with eclampsia/preeclampsia which is statistically significant (p value<0.05) (chi squared-6.387).Similarily According to the studies done vitamin D supplementation associated with significant reduction in the risk of preeclampsia.

This study, after summarizing existing data show high prevalence of Vitamin D deficiency in pregnant women. Complication of pregnancy like PROM, rate of Caesarean section, Diabetes were not prominently seen with pregnancy in Vitamin D deficiency, although all the diabetic pregnant females were vitamin D deficient.

PET/Eclampsia, Preterm labour and Low birth weight are significantly associated with vitamin D deficiency.

Prevalence of vitamin D deficiency in our study population is 90.7%, while only 9.23% patientshad optimal levels of vitamin D.Majority of vitamin D deficient women were 20 -30 years of age, multigravida and belong to lower middle-class families. After supplementing 60000 IU of vitamin D for 8 weeks in antenatal women, mean vitamin D level of deficient group significantly increased. Investigation during first trimester to diagnose deficient patients and timely supplementation during pregnancy can significantly reduce the chance of preeclampsia and low birth weight babies. No associations were found between vitamin D deficiency and caesarean-section. Vitamin D supplementation does not significantly reduce the incidence of GDM. Cases of preeclampsia/ eclampsia were significantly low in study group, showing vitamin D deficiency as an individual risk factor of preeclampsia/eclampsia. Decreased incidence of low birth weight and preterm babies was noted in study group. There is no significant relation between Obstetric outcome in view of APGAR, NICU admission, delivery complications and mode of delivery in different groups.

LIMITATIONS OF THE STUDY:

• Smaller sample size
• Role of this large dose of Vitamin D during first trimester of pregnancy is not yet established

STRENGTHS OF THE STUDY:

• The study attempted to find relationship between Vitamin D supplementation with maternal complications related to pregnancy and neonatal outcome andhelp clinicians and policy makers empower pregnant women to optimize their vitamin D status.
• Our findings have added more information in the limited knowledge on this subject.

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