Abstract
Observational studies suggest an adverse effect of maternal hypovitaminosis D during pregnancy. However, intervention studies failed to show convincing benefit from vitamin D supplementation during pregnancy. With analytical advances, vitamin D can now be measured in ten forms—including as epimers—which were thought to be biologically inactive, but can critically impair immunoassays. The aim of this commentary is to highlight the potential clinical and analytical significance of vitamin D epimers in the interpretation of vitamin D roles in pregnancy. Epimers may contribute a considerable proportion of total vitamin D—especially in the neonate—which renders the majority of common assays questionable. Furthermore, epimers have been suggested to have activity in laboratory studies, and evidence suggests that the fetus contributes significantly to epimer production. Maternal epimer levels contribute significantly to predict neonate circulating 25-hydroxyvitamin D concentrations. In conclusion, the existence of various vitamin D forms (such as epimers) has been established, and their clinical significance remains obscure. These results underscore the need for accurate measurements to appraise vitamin D status, in order to understand the current gap between observational and supplementation studies on the field.
Highlights
Vitamin D has gained in clinical significance, since its presence has been associated with multiple health outcomes, mostly with the maintenance of bone preservation across the lifespan [1]
This study found the C-3 epimer of 25(OH)D2 in 88 (7.7%) of the subjects in Thailand
Specific and accurate assays highlight that a considerable proportion of vitamin D exists as epimers
Summary
Vitamin D has gained in clinical significance, since its presence has been associated with multiple health outcomes, mostly with the maintenance of bone preservation across the lifespan [1]. New emerging theories [8,9,10] highlight the need to further investigate the analytical and clinical significance of epimers during pregnancy, since under specific conditions there is a potent correlation between those compounds and the health status of an ongoing pregnancy, as well as foetal birth parameters or potential adverse outcomes [12,13]. The aim of this commentary is to highlight the potential clinical and analytical significance of vitamin D epimers in the interpretation of maternal vitamin D status It will be based on results focused on the physiological and pathophysiological aspects of the roles of the epimer forms during pregnancy, in the context of the current gap between observational and supplementation studies on the field
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