Abstract
ObjectivesThe aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS) and birth asphyxia, in a population based sample of women in Sweden.MethodsPregnant women were recruited at the antenatal care in Sweden and 1832 women were included after exclusion of miscarriages, terminated pregnancies and missing data on vitamin D status. Mode of delivery was retrieved from medical records. EMCS was defined as caesarean section after onset of labour. Birth asphyxia was defined as either 5 min Apgar score < 7 or arterial umbilical cord pH < 7.1. Serum was sampled in the third trimester of pregnancy (T3) and 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography tandem mass spectrometry. Vitamin D deficiency was defined as 25OHD < 30 nmol/L, and associations were studied using logistic regression analysis and expressed as adjusted odds ratios (AOR).ResultsIn total, 141 (7.7%) women had an EMCS and 58 (3.2%) children were born with birth asphyxia. Vitamin D deficiency was only associated with higher odds of EMCS in women without epidural anaesthesia (AOR = 2.01, p = 0.044). Vitamin D deficiency was also associated with higher odds of birth asphyxia (AOR = 2.22, p = 0.044).Conclusions for PracticeIn this Swedish prospective population-based cohort study, vitamin D deficiency in late pregnancy was associated with doubled odds of birth asphyxia and with EMCS in deliveries not aided by epidural anaesthesia. Prevention of vitamin D deficiency among pregnant women may reduce the incidence of EMCS and birth asphyxia. The mechanism behind the findings require further investigation.
Highlights
Vitamin D status has received increasing attention for its role in healthy pregnancy
We have previously shown that poor maternal vitamin D status, measured as 25-hydroxyvitamin D (25OHD) in serum, is associated with increased risk of preeclampsia (Barebring et al 2016a, b), small for gestational age, preterm delivery and low birth weight (Barebring et al 2018)
The results of this study show that vitamin D deficiency, defined as 25OHD < 30 nmol/L, in late pregnancy is associated with doubled odds of birth asphyxia, and emergency C-section (EMCS) in deliveries where epidural anaesthesia was not administered
Summary
Vitamin D status has received increasing attention for its role in healthy pregnancy. We have previously shown that poor maternal vitamin D status, measured as 25-hydroxyvitamin D (25OHD) in serum, is associated with increased risk of preeclampsia (Barebring et al 2016a, b), small for gestational age, preterm delivery and low birth weight (Barebring et al 2018). Poor maternal vitamin D status has been linked to an increased risk of delivery by caesarean section (C-section). Low maternal 25OHD concentration has been linked to increased risk of primary C-section (Merewood et al 2009), C-section due to prolonged labour (Scholl et al 2012) or fetal distress and birth asphyxia (Lindqvist et al 2016). Delivery by C-section is associated with increased maternal and fetal risks (Karlstrom et al 2013). Risk factors for EMCS are prolonged labour, fetal distress, fetal malpresentation, multifetal delivery, macrosomia (Caughey et al 2014), high maternal age, high body mass index (BMI) and nulliparity (Mhaske et al 2015)
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