Could Maternal Vitamin D Concentration Affect Cervical Length in Mid-Pregnancy? A Report From an Iranian Tertiary Center
Objective: This descriptive-analytic cross-sectional study aimed to figure out whether maternal serum vitamin D concentration correlates with cervical length measurement in mid-gestation or not.
Materials and methods: During Jun-Jan 2021, 213 pregnant women at 18-22 weeks of gestation were investigated. First, demographic features were obtained then, maternal serum vitamin D concentration was measured by enzyme-linked immunoassay and cervical length was measured via transvaginal sonography according to fetal maternal foundation guideline and appropriate statistical test was used to analyze the correlation between maternal vitamin D level and cervical length in mid-pregnancy.
Results: It was shown that 29.6% and 25.4% of participants had vitamin D deficiency and insufficiency, respectively. Spearman’s test found no significant correlation between maternal vitamin D level and cervical length in mid-pregnancy. Moreover, cervical length and maternal vitamin D level had no association with maternal BMI.
Conclusion: Although maternal vitamin D level and its sufficiency status was not associated with cervical length in mid- pregnancy, as a trend toward decreased maternal serum vitamin D level by advancing gestational age was observed. It may be concluded that it is prolonged vitamin D deficiency during gestation that may lead to cervical length shortening and subsequent preterm delivery later in gestation.
2. Shakir N, Saffa AH, Al-Hilli AS, Ch Dog MB. Early pregnancy vitamin D deficiency and risk of preterm Birth. Annals of Tropical Medicine and Public Health 2019; 22:20-7.
3. Howson Eds CP, Kinney MV, lawn JE. March of Dimes, PMNCH, Save the children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. Geneva: World health organization 2012.
4. Witwit SJ. The use of vitamin D supplement in prevention of preterm labor. Journal of Babylon University for Pure and Applied Sciences 2017; 25:651-61.
5. Tabatabaei N, Auger N, Herba CM, Wei S, Allard C, Fink GD, Fraser WD. Maternal Vitamin D Insufficiency Early in Pregnancy Is Associated with Increased Risk of Preterm Birth in Ethnic Minority Women in Canada. J Nutr 2017; 147: 1145-51.
6. Panahi Z, Ghalandarpoor-Attar SN, Shabani A, Shariat M, Ghotbizadegh F, Hantoushzadeh S, et al. Maternal vitamin D concentration in mid-pregnancy and its Effect on fetal thymus size: A report from a tertiary center in Iran. Journal of Obstetrics Gynecology and Cancer Research 2022; 7:536-42.
7. Romero R, Espinoza J, Gonçalves LF, Kusanovic JP, Friel LA, Nien JK. Inflammation in preterm and term labour and delivery. Semin Fetal Neonatal Med 2006; 11:317-26.
8. Weisman Y, Harell A, Edelstein S, David M, Spirer Z, Golander A. 1 alpha, 25-Dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 in vitro synthesis by human decidua and placenta. Nature 1979; 281:317-9.
9. Evans KN, Bulmer JN, Kilby MD, Hewison M. Vitamin D and placental-decidual function. J Soc Gynecol Investig 2004; 11: 263-71.
10. Bodnar LM, Platt RW, Simhan HN. Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes. Obstet Gynecol 2015; 125: 439-447.
11. Fernandes S, Chandra S. A study of risk factors for preterm labour. International Journal of Reproduction, Contraception Obstetrics and Gynecology 2015; 4: 1306-1312.
12. Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010; 88: 31-8.
13. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371: 75-84.
14. Norwitz ER, Robinson JN, Challis JR. The control of labor. N Engl J Med 1999; 341: 660-6.
15. Lumley J. Defining the problem: the epidemiology of preterm birth. BJOG 2003;110 Suppl 20:3-7.
16. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012; 379:2162-72.
17. Wagner CL, Baggerly C, McDonnell SL, Baggerly L, Hamilton SA, Winkler J, et al. Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery. J Steroid Biochem Mol
Biol 2015; 148:256-60.
18. Bodnar LM, Rouse DJ, Momirova V, Peaceman AM, Sciscione A, Spong CYet al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Maternal 25-hydroxyvitamin d and preterm birth in twin gestations. Obstet Gynecol 2013; 122: 91-98.
19. Shibata M, Suzuki A, Sekiya T, Sekiguchi S, Asano S, Udagawa Y, Itoh M. High prevalence of hypovitaminosis D in pregnant Japanese women with threatened premature delivery. J Bone Miner Metab 2011; 29:615-20.
20. Thota C, Menon R, Fortunato SJ, Brou L, Lee JE,
Al-Hendy A. 1,25-Dihydroxyvitamin D deficiency is associated with preterm birth in African American and Caucasian women. Reprod Sci 2014; 21:244-50.
21. Yoo HN, Park KH, Jung EY, Kim YM, Kook SY, Jeon SJ. Non-invasive prediction of preterm birth in women with cervical insufficiency or an asymptomatic short cervix (≤25 mm) by measurement of biomarkers in the cervicovaginal fluid. PLoS One 2017;12: e0180878.
22. Thakur M, Mahajan K. Cervical Incompetence. 2022 In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30247829.
23. Kook SY, Park KH, Jang JA, Kim YM, Park H, Jeon SJ. Vitamin D-binding protein in cervicovaginal fluid as a non-invasive predictor of intra-amniotic infection and impending preterm delivery in women with preterm labor or preterm premature rupture of membranes. PLoS One 2018;13: e0198842.
24. Kagan KO, Sonek J. How to measure cervical length. Ultrasound Obstet Gynecol 2015; 45:358-62.
25. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and
prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96:1911-30.
26. Iranian National Guideline for supplementation with mega doses of vitamin D. Ministry of Health, Treatment and Medical Training. 1396. https://arakmu.ac.ir/file/download/regulation/1551769202-.doc (accessed April 2022).
27. Eltemamy EA, Ali MM, Abdel-Rasheed M, Salem SM. Maternal BMI, 25-Hydroxyvitamin D serum level and Cervical Length Measurements: Markers for preterm delivery. Al-Alzahra International Medical Journal 2021; 2: 46-53.
28. Kandil M, Sanad Z, Sayyed T, Ellakwa H. Body mass index is linked to cervical length and duration of pregnancy: An observational study in low risk pregnancy. J Obstet Gynaecol 2017; 37:33-37.
29. Jalal HQ, Ismail SK. Is there an association between body mass index and cervical length? Current Research in Diabetes and Obesity Journal 2019; 12: 555829.
30. Kandeel MS, Sanada ZF, Sayyed TM, Elmenawy SGAE. The effect of body mass index on cervical characteristics and on the length of gestation in
low-risk pregnancies. Menoufia Medical journal 2014; 27: 518-23.
31. Palatnik A, Miller ES, Son M, Kominiarek MA. Association among Maternal Obesity, Cervical Length, and Preterm Birth. Am J Perinatol 2017; 34: 471-479.
|Issue||Vol 16, No 4 (December 2022)|
|Vitamin D Cervical Length Body Mass Index Deficiency Pregnancy Maternal|
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