Abstract
Pregnancy is a time of tremendous growth and physiological changes for mother and her developing fetus with lifelong implications for the child. The concert of actions that must occur so mother does not reject the foreign tissue of the fetus is substantial. There must be exquisite balance between maternal tolerance to these foreign proteins of paternal origin but also immune surveillance and function such that the mother is not immunocompromised. When this process goes awry, the mother may experience such pregnancy complications as preeclampsia and infections. Vitamin D deficiency affects these processes. Controversy continues with regard to the optimal daily intake of vitamin D, when sunlight exposure should be taken into account, and how to define sufficiency during such vulnerable and critical periods of development. The importance of vitamin D supplementation during pregnancy in preventing some of the health risks to the mother and fetus appears linked to achieving 25(OH)D concentrations >40 ng/mL, the beginning point of the plateau where conversion of the vitamin D metabolite 25(OH)D, the pre-hormone, to 1,25(OH)2D, the active hormone, is optimized. Throughout pregnancy, the delivery of adequate vitamin D substrate—through sunlight or supplement—is required to protect both mother and fetus, and when in sufficient supply, favorably impacts the epigenome of the fetus, and in turn, long term health. There is a growing need for future research endeavors to focus not only on critical period(s) from pre-conception through pregnancy, but throughout life to prevent certain epigenetic changes that adversely affect health. There is urgency based on emerging research to correct deficiency and maintain optimal vitamin D status. The impact of vitamin D and its metabolites on genetic signaling during pregnancy in both mother and fetus is an area of great activity and still in its early stages. While vitamin D repletion during pregnancy minimizes the risk of certain adverse outcomes (e.g., preterm birth, asthma, preeclampsia, and gestational diabetes), the mechanisms of how these processes occur are not fully understood. As we intensify our research efforts in these areas. it is only a matter of time that such mechanisms will be defined.
Highlights
Three decades later, the established doctrine of the “Barker Hypothesis,” first described by David Barker in 1986, noting a connection between neonatal growth restriction and small for gestational age status with the risk of heart disease later in adult life [1] has become mainstream thinking, but when first proposed was a startling revelation
The findings provide some insight into asthma pathogenesis and the mechanistic effects of vitamin D in perinatally vitamin D-deficient offspring, and further suggest that vitamin D could play a role in the prevention of childhood asthma through perinatal vitamin D supplementation, as has been suggested by Litonjua et al and others [38,39,40]
Through vitamin D’s effect on gene regulation, vitamin D supplementation during pregnancy appears to alter genes related to systemic inflammation and immune responses. The aberration of these genes and processes suggests that there is a specific immune cascade of events associated with vitamin D deficiency that occurs early-on in pregnancy in women destined to develop preeclampsia [16, 65], and likewise, in other comorbidities states of pregnancy such as gestational diabetes [90, 92, 98] and infection [99, 100]
Summary
The established doctrine of the “Barker Hypothesis,” first described by David Barker in 1986, noting a connection between neonatal growth restriction and small for gestational age status with the risk of heart disease later in adult life [1] has become mainstream thinking, but when first proposed was a startling revelation. The focus of this review is to shed light on the potential impact of dietary vitamin D during the prenatal and perinatal periods as a contributor to maternal/infant afflictions, and its role in instituting examples of the Barker hypothesis at both the genetic and phenotypic levels. These afflictions include but are not limited to autoimmune disorders, complications of pregnancy, immune function and respiratory disease. RELEVANT DATA SURROUNDING VITAMIN D DEFICIENCY DURING PREGNANCY: ANIMAL MODELS AND HUMAN STUDIES
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