Details
Category: Volume 10 Issue 06 June 2022
Hits: 536

Title: Association of vitamin D deficiency during pregnancy with pre-eclampsia and eclampsia- A Case control study

Authors: Santosh Kumar, Chandrawati, Indramani Prakash, Renu Kumari

 DOI: https://dx.doi.org/10.18535/jmscr/v10i6.09

Abstract

Background: The etiology of pre-eclampsia (PE) is not yet fully known, although current literature indicates an inflammatory mediators produced by the placenta as a potential causal mechanism. Vitamin D is emerging as a promising agent for pre-eclampsia prevention. This study was done to determine whether vitamin D deficiency is an independent risk factor for pre-eclampsia/eclampsia.

Methods:  A prospective case-control study was conducted on 60 cases and 60 controls (with same age and sex matched without risk of pre-eclampsia) groups pregnant women admitted to our tertiary care hospital between July 2016 and august 2017. Detailed history and complete physical examination was done in all patients. It was recorded on a pre planned record sheet. All the Investigations carried out at were recorded in this record sheet throughout the duration of the study. Hypertension is diagnosed when 2 B.P. (Blood pressure) readings of 140/90 mm Hg or greater are noted 6 hours apart within a 1-week period.

Results: This study showed a very high prevalence of vitamin D deficiency in pregnant women, 90% women with preeclampsia and eclampsia had Vitamin D deficiency (vit D<20ng/ml) as compared to 3.33% in the control group, which was statistically significant (p value < 0.05). Mean serum vit. D concentration was lower in women who subsequently developed preeclampsia and eclampsia (12.65±5.112) compared with controls (51.15±16.357), statistically significant (p<0.05). Mean S.calcium level was lower in pre eclampsia and eclampsia (7.65±0.732) as compared to control (8.87±1.186) which was also statistically significant (p<0.05).

Conclusion: Maternal vitamin D deficiency may be an independent risk factor for preeclampsia. Vitamin D and calcium supplementation in early pregnancy should be given for preventing pre-eclampsia /eclampsia and to promote neonatal well-being.

Keywords: Pre eclampsia , Eclampsia, Vitamin D, Pregnancy.

References

  1. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1-S22.
  2. Andersgaard AB, Herbst A, Johansen M, Ivarsson A, Ingemarsson I, Langhoff-Roos J, et al. Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases. Acta Obstet Gynecol Scand 2006;85:929-36.
  3. Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ 1994;26; 309:1395-400.
  4. Sibai BM, el-Nazer A, Gonzalez-Ruiz A. Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis. Am J Obstet Gynecol 1986;155:1011-6
  5. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA, and the World Bank. Geneva: World Health Organization. 2007.
  6. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010;375:1609-23.
  7. Cruikshank DP, Chan GM, Doerrfeld D 1993 Alterations in vitamin D and calcium metabolism with magnesium sulfate treatment of preeclampsia. Am J Obstet Gynecol 168:1170–1176; discussion 1176–1177.
  8. Seely EW, Wood RJ, Brown EM, Graves SW 1992 Lower serum ionized calcium and abnormal calciotropic hormones levels in preeclampsia. J Clin Endocrinol Metab 74:1436–1440.
  9. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM 2007 Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 92:3517–3522
  10. Taru G, Sonika W, Nupur G, Sarika A, Sangeeta G, et al. Correlation of Vitamin D Levels in Term Normotensive and Pre-eclamptic Patients in Labor. J Obstetr Gynecol India. 2016;66:154159. PubMed: https://pubmed.ncbi.nlm.nih.gov/27298523/
  11. Sadin B, Gargari BP, Tabrizi FPF. Vitamin D Status in Preeclamptic and Non-preeclamptic Pregnant Women: A Case-Control Study in the North West of Iran. Health Promot Perspect. 2015;5: 183190.
  12. Abedi P, Mohaghegh Z, Afshary P, Latifi M. The relationship of serum vitamin D with pre-eclampsia in the Iranian women. Matern Child Nutr. 2014; 10: 206–212.
  13. Bakacak M, Serin S, Ercan O, Köstü B, Avci F, et al. Comparison of Vitamin D levels in cases with preeclampsia, eclampsia and healthy pregnant women. Int J Clin Exp Med.2015;8:1628016286.
  14. Mohaghegh Z, Abedi P, Dilgouni T, Namvar F, Ruzafza S. The relation of preeclampsia and serum level of 25-hydroxyvitamin D in mothers and their neonates: a case control study in Iran. Horm Metab Res.2015; 47: 284-288.
  15. Mehmood S, Karim SA. Vitamin D Defi ciency during Pregnancy and its Relationship with Pre-Eclampsia, Eclampsia and Gestational Hypertension. Austin J Nutr Metab. 2016; 3: 1040.
  16. Sahu M, Das V, Agarwal A, Rawat V, Saxena P, et al. Vitamin D replacement in pregnant women in rural north India: a pilot study. Eur J Clin Nutr.2009;63:1157–1159.
  17. Dhillon MK, Bedi GK, Kaur K. Signifi cance of 25 hydroxy vitamin D and calcium in pregnancy induced hypertension. Int J Health Sci Res. 2017; 7: 80-85.
  18. Holick MF, Binkley NC, Bischoff-Ferrari HA. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911- 30.
  19. ACOG Committee. Vitamin D: screening and supplementation during pregnancy. Obstet Gynecol. 2011;118:197-8
  20. Al Kalbani M, Elshafie O, Rawahi M. Vitamin D status in pregnant Omanis: a disturbingly high proportion of patients with low vitamin D stores. Sultan Qaboos Univ Med J. 2011;11:52-5.
  21. Asemi Z, Taghizadeh M, Sarahroodi S. Assessment of the relationship of vitamin D with serum antioxidant vitamins E and A and their deficiencies in Iranian pregnant women. Saudi Med J. 2010;31:1119.

Corresponding Author

Dr Chandrawati

Assistant Professor, Department of Pathology, M. L. N. Medical College, Prayagraj, (UP) -211002