Relationship of maternal obesity and vitamin D concentrations with fetal growth in early pregnancy

Qianqian Zhang,Zhiwei Liu,Fengxiu Ouyang,Xiaoli Wang,Jiuru Zhao,Meng Ni,Hao Chen,Qianwen Shen,Angela Vinturache,Yi Wang,Haiyuan Li,Chen Zhang

doi:10.1007/s00394-021-02695-w

Abstract

PurposeTo evaluate the effects of the association between first trimester vitamin D (VitD) concentrations and increased prepregnancy body mass index (BMI) on early fetal growth restriction (FGR).MethodsThis retrospective cohort study included 15,651 women with singleton pregnancy who delivered at the International Peace Maternity and Child Health Hospital between January 2015 and November 2016. Women were classified in two groups based on their serum 25(OH)D vitamin levels status: VitD sufficient (SUFF) group and VitD insufficient or deficient (INSUFF/DEF). The cut-off point for VitD concentration was 50.00 nmol/L. Comparisons were made between women with normal prepregnancy body weight (BMI 18.5–23.9 kg/m2) and overweight and obese (OWO) women (BMI > 24.0 kg/m2). Early FGR was defined as first-trimester gestational age-adjusted crown-rump length (CRL) in the lowest 20th centile of the population. Multivariate logistic regression was used to evaluate the association between maternal serum 25(OH)D levels and prepregnancy BMI with first trimester CRL and early FGR.ResultsIn VitD INSUFF/DEF group, the first trimester CRL was decreased (P = 0.005), and the risk of early FGR was increased by 13% (95% CI 1.04–1.24, P = 0.004) compared to the VitD SUFF group. In OWO group, the first trimester CRL was also significantly decreased (P < 0.0001), and the risk of early FGR was significantly increased by 58% (95% CI 1.40–1.78, P < 0.001) compared with normal weight group. Furthermore, there was a significant combined effect of maternal VitD concentrations and OWO on CRL (P for interaction = 0.02) and the risk of early FGR (P for interaction = 0.07).ConclusionSufficient first trimester serum 25(OH)D concentration was a protective factor for early fetal growth, especially among OWO mothers. Chinese Clinical Trial Registry (Registration number: ChiCTR1900027447 with date of registration on November 13, 2019-retrospectively registered).

Highlights

Maternal vitamin D (VitD) deficiency is a worldwide public health problem, with an estimated prevalence ranging from 18 to 84% among pregnant women [1]
The seasonal distribution of VitD testing was almost equal between Winter, Fall and Spring season, with Summer having the lowest percentage of testing, of 23.44%
Comparing maternal characteristics between VitD groups, we found that the number of women with raised prepregnancy body mass index (BMI) was significantly higher in VitD INSUFF/DEF group than in SUFF group (20.71 vs 21.09; P < 0.001)

Summary

Introduction

Maternal vitamin D (VitD) deficiency is a worldwide public health problem, with an estimated prevalence ranging from 18 to 84% among pregnant women [1]. There is an association between VitD deficiency during pregnancy and an increased risk of preeclampsia [2], gestational diabetes [3, 4], primary caesarean section [5], preterm birth [6] and low birthweight [7]. A recent overview of systematic reviews on the effectiveness of VitD supplementation on perinatal outcomes showed no significant benefit from VitD in terms of preeclampsia, gestational diabetes, preterm birth, stillbirth, low birthweight, and cesarean section [8]. A Cochrane review published a year prior found that supplementing pregnant women with VitD alone may potentially reduce the risk of preeclampsia, gestational diabetes, low birthweight, and postpartum hemorrhage while having little or no effect on the risk of preterm birth [9, 10]. VitD deficiency associates with reduced infant birth size [4], and with other adverse offspring health consequences such as rickets, skeletal problems, type 1 diabetes, schizophrenia, and asthma [13]

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