Association between plasma concentrations of vitamin D metabolites and depressive symptoms throughout pregnancy in a prospective cohort of Brazilian women

Maternal Iron and Vitamin D Status during the Second Trimester Is Associated with Third Trimester Depression Symptoms among Pregnant Participants in the APrON Cohort

BACKGROUND

The maternal status of multiple micronutrients during pregnancy and postpartum and their potential associations with maternal health outcomes are largely undescribed.

OBJECTIVES

This study aimed to examine associations between maternal iron and vitamin D status, individually and in combination, on depression symptoms in pregnant individuals.

METHODS

The Alberta Pregnancy Outcomes and Nutrition cohort study included pregnant participants and their children from Calgary and Edmonton, Canada. Iron biomarkers (serum ferritin [SF], soluble transferrin receptor, and hepcidin) were measured via immunoassays and vitamin D [25-hydroxyvitamin D3 (25(OH)D3) and 3-epi-25-hydoxyvitamin D3 (3-epi-25(OH)D3)] metabolites were quantifed using liquid chromatography with tandem mass spectroscopy. Four categories of maternal iron and vitamin D status during the second trimester were conceptualized using concentrations of SF and total 25-hydoxyvitamin D [25(OH)D], respectively. Maternal Edinburgh Postnatal Depression Scale (EPDS) scores during the third trimester (n = 1920) and 3 mo postpartum (n = 1822) were obtained.

RESULTS

Concentrations of maternal 25(OH)D3, 3-epi-25(OH)D3, and the ratio of both metabolites were significantly higher during the second trimester compared with their status at 3 mo postpartum. Higher second trimester maternal concentrations of SF (β: -0.8; 95% confidence interval [CI]: -1.5, -0.01), hepcidin (β: -0.5; 95% CI: -0.9, -0.2), and 25(OH)D3 (β: -0.01; 95% CI: -0.02, -0.004) predicted lower maternal EPDS scores during the third trimester. Pregnant individuals with a low iron (SF <15 μg/L) and replete vitamin D (25(OH)D ≥75 nmol/L) (β: 1.1; 95% CI: 0.03, 2.1) or low iron (SF <15 μg/L) and vitamin D (25(OH)D <75 nmol/L) (β: 2.2; 95% CI: 0.3, 4.2) status during midpregnancy had higher third trimester EPDS scores compared with those that were replete in both micronutrients.

CONCLUSIONS

A higher midpregnancy maternal iron and vitamin D status, independently or in combination, predicted fewer maternal depression symptoms in the third trimester. Concentrations of maternal 25(OH)D3 and 3-epi-25(OH)D3 may be lower in the postpartum period compared with midpregnancy.

Perinatal depression and serum vitamin D status: A cross-sectional study in urban China

BACKGROUND

Although vitamin D has been found to be associated with perinatal depression, the results are inconsistent. The aim of this cross-sectional study was to examine the association between vitamin D and PND in Chinese pregnant women and lactating women.

METHODS

A total of 1773 participants were included, including 907 lactating women and 866 pregnant women. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PND, and those with scores ≥13 were considered to have PND. Serum 25-hydroxyvitamin D concentrations were assessed with high-performance liquid chromatography.

RESULTS

The prevalence of postpartum depression (PPD) and antenatal depression (AD) were 15.9 % and 9.8 %, respectively. Compared with individuals with sufficient vitamin D, those with vitamin D deficiency were associated with a higher prevalence of PPD in lactating women (OR = 1.71, 95%CI: 1.01-2.88, p = 0.044). The serum 25(OH)D of lactating women was inversely associated with the scores of the factor "depressive mood" of the EPDS (ORper 5 ng/mL = -0.10, 95%CI: -0.19 to -0.01, p = 0.032). No significant association between serum 25-hydroxyvitamin D and AD was observed.

LIMITATIONS

First, this study is a cross-sectional design, which can only determine associations but not causality. Secondly, this study only included participants from urban areas. Thirdly, there are still some possible confounding factors that have not been considered.

CONCLUSION

In conclusion, this study suggested a significant association between vitamin D status and PPD; however, the association between vitamin D status and AD was not significant.

Deficiency and Insufficiency of Vitamin D in Women of Childbearing Age: A Systematic Review and Meta-analysis

OBJECTIVE

 To estimate the prevalence of inadequate vitamin D level and its associated factors for women of childbearing age in Brazil.

METHODS

 A systematic review was conducted (last updated May 2020). Meta-analyses were performed using the inverse-variance for fixed models with summary proportion calculation by Freeman-Tukey double arcsine. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies.

RESULTS

 Our review identified 31 studies, comprising 4,006 participants. All the studies had at least one weakness, mainly due to the use of convenience sampling and small sample size. The overall prevalence of vitamin D deficiency, insufficiency, and both deficiency and insufficiency were 35% (confidence interval, 95%CI: 34-37%), 42% (95%CI: 41-44%), and 72% (95%CI: 71-74%), respectively.

CONCLUSION

 Although the magnitude of the prevalence of inadequate levels of vitamin D is uncertain, the evidence suggests that presence of vitamin D deficiency or insufficiency in women of reproductive age can cause moderate to severe problems.

Relationship between vitamin D status in the first trimester of the pregnancy and gestational weight gain: a mediation analysis

PURPOSE

To evaluate the total, and direct effects of vitamin D, measured by circulating 25-hydroxyvitamin D [25(OH)D] levels, on GWG after adjustment for confounding variables, and then assess the indirect effects by demonstrating the role of gestational age at birth as a mediator in this association.

METHODS

Data collected in "Khuzestan Vitamin D Deficiency Screening Program in Pregnancy" were used for the present study; it included the data of 900 pregnant women referred to the health centers of Shushtar (Khuzestan Province, Iran), whose vitamin D status during the third trimester of pregnancy was available. A mediation analysis was applied to detect the causal relationship between serum level of 25(OH)D, covariates (maternal age, parity, education level, and baseline maternal weight), mediator (gestational age), and outcome (GWG).

RESULTS

Of 900 pregnant women referred to the health centers, a total of 726 eligible participants were analyzed for the study. The adjusted total effect of vitamin D on GWG was estimated 0.07 (95% CI 0.06, 0.09; P = 0.000). This study also revealed adjusted direct effect of vitamin D on GWG was statistically significant 0.02 (95% CI: 0.003, 0.04; P = 0.021). In addition, the adjusted indirect effect of this micronutrient on GWG by considering gestational age as a mediator was found to be significant [0.05 (95% CI 0.04, 0.06; P  = 0.000)]. This study revealed an increase in the trend of weight gain during pregnancy trimesters for women with different levels of 25(OH)D; however, women with severe vitamin D deficiency had the lowest speed as compared to moderate and normal levels.

CONCLUSION

This study shows that maternal vitamin D status directly affects the gestational weight gain independent of gestational age. Therefore, the detection and treatment of women with vitamin D inadequacy can directly improve the trend of their weight gain in addition to its indirect effect on reducing the risk of preterm delivery.

Maternal mental health and gestational weight gain in a Brazilian Cohort

Depression and anxiety are common during pregnancy, but little is known about the influence of these disorders on gestational weight gain (GWG). Data from a prospective cohort of pregnant women followed in a public healthcare center in Rio de Janeiro, Brazil, were used to evaluate the association of depression, anxiety, and suicide risk with GWG. GWG was evaluated at 5-13, 20-26, 30-36, and 37-42 weeks, and GWG adequacy was determined. Statistical analyses included linear mixed-effect models and Poisson regression. We evaluated 206 women, in which 15% (n = 31) presented major depressive disorder, 19.4% (n = 34) suicide risk and 10% (n = 21) generalized anxiety disorder at baseline. Women with depression at the first trimester, persistent depressive symptoms, and anxiety symptoms at the second trimester presented significantly lower rates of GWG per week compared to those without depression or anxiety, respectively. Persistent depressive symptoms represented a 2.40 (95% CI 1.20; 4.81; p = 0.013) increase in the risk of insufficient GWG. There was no significant association between generalized anxiety disorder or suicide risk with GWG. The presence of depression, depressive symptoms, and anxiety during pregnancy were associated with lower GWG rates. Persistent depressive symptoms during pregnancy were directly associated with insufficient GWG.

The Use of 25-hydroxyvitamin D Saliva Test to Replace Vitamin D Serum Blood Test in Healthy People

BACKGROUND: Routine examination of Vitamin D levels is carried out by checking serum 25-hydroxyvitamin D (25[OH]D) levels which indicate circulating Vitamin D levels. While serum 1.25(OH)D levels are less frequently performed, although serum 1.25(OH)D levels represent the active form of Vitamin D be a substitute for checking Vitamin D levels. AIMS: This study aims to see the correlation between Vitamin D levels, namely, 25(OH)D and 1.25(OH)D saliva, which correlate with serum 25(OH)D and 1.25(OH)D levels so that the examination of salivary Vitamin D levels can be a substitute for checking serum Vitamin D levels. MATERIAL AND METHODS: This study is a cross-sectional study involving healthy men and women, aged 20–50 years, sampling in Lima Puluh Village, Batubara District, North Sumatra Province, Indonesia. The parameters studied were 25(OH)D and 1.25(OH)D levels of saliva and serum. RESULTS: This study involved 56 study subjects, male and female, with a percentage of deficiencies of 78.6% by examining 25(OH)D saliva and 76.8% by examining 25(OH)D serum. As for the 1.25(OH)D examination of saliva and serum, all were within normal limits. The analysis showed that a moderate correlation was obtained for levels of 25(OH)D saliva with serum 25(OH)D (p = 0.424) and a weak correlation for levels of 1.25(OH)D saliva with serum 25(OH)D (p = 0.339). CONCLUSIONS: Salivary 25(OH)D assay can be used to replace serum 25(OH)D assay in healthy people as a non-invasive alternative.

The Moderate Correlation Between 25(OH)D Serum and Saliva in Healthy People with Low Vitamin D Intake

Purpose

The routine examination of vitamin D levels is carried out by checking serum 25(OH)D levels, while serum 1.25(OH)D levels are less frequently utilized. The proposition that testing for salivary vitamin D can show a correlation with serum levels in healthy people is questionable, especially with low vitamin D intake. This study aimed to find the correlation between vitamin D levels, which were assessed as 25(OH)D and 1.25(OH)D in saliva, and serum 25(OH)D and 1.25(OH)D levels in people with low vitamin D intake.

Patients and Methods

This study is a cross-sectional study involving healthy men and women, aged 18–60 years, carried out from August to November, 2020, in North Sumatra Province, Indonesia. The parameters studied were the 25(OH)D and 1.25(OH)D levels in saliva and serum, and vitamin D intake. The statistical analysis used was the Spearman correlation test, performed to determine the correlation between each parameter.

Results

This study involved 56 study subjects, who were rural adults (male or female) with a 78.6% deficiency in 25(OH)D found by examining saliva, and a 76.8% deficiency found by examining the serum. All of the subjects were categorized as having low vitamin D intake (less than 15 micrograms per day). The analysis showed a moderate correlation between levels of saliva 25(OH)D and serum 25(OH)D (p = 0.424), and a weak correlation between levels of saliva 1.25(OH)D and serum 25(OH)D (p = 0.339).

Conclusion

In people with low vitamin D intake, there was a moderate correlation between serum 25(OH)D and saliva, but a weak correlation was found in the 1.25(OH)D assay. The use of saliva 25(OH)D levels to detect 25(OH)D in the circulation is a possible non-invasive alternative to serum testing.

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Poor vitamin D status and the risk of maternal depression: a dose-response meta-analysis of observational studies

OBJECTIVE

The association between 25-hydroxyvitamin D (25(OH)D) and maternal depression (MD) is deemed to be inconclusive. The current analysis aimed to quantify the relationship between 25(OH)D serum concentrations, the main indicator of vitamin D nutritional status, and MD.

DESIGN

Dose-response meta-analysis.

SETTING

A systematic search in PubMed, Embase and Web of Science from inception to June 2019.

PARTICIPANTS

Relevant observational studies reporting risk estimates and 95 % CI of random effects for 25(OH)D concentration on MD were identified.

RESULTS

Twelve observational studies with thirteen independent reports involving 10 317 pregnant women were included. Compared with the lowest category of 25(OH)D, the pooled OR for the highest category of MD was 0·49 (95 % CI 0·35, 0·63); a high heterogeneity was observed (P = 0·001, I2 = 82·1 %). A non-linear association between 25(OH)D and MD was found (P for non-linearity = 0·001); the dose-response analysis indicated that the lowest pooled OR was at blood 25(OH)D concentrations of 90-110 nmol/l. Subgroup analyses suggested a stronger association between 25(OH)D and MD in summer time (OR 0·25, 95 % CI 0·08, 0·43) than in other seasons (OR 0·68, 95 % CI 0·52, 0·83) (P for interaction = 0·008). A visual inspection of funnel plot and Begg's and Egger's tests did not indicate any evidence of publication bias.

CONCLUSIONS

Low circulating 25(OH)D is associated with MD, and our analysis suggests that they influence each other. Further randomised controlled trials would be needed to determine the direction of causation.

Association between vitamin D status during pregnancy and total gestational weight gain and postpartum weight retention: a prospective cohort

OBJECTIVES

To evaluate the association between vitamin D status during pregnancy and total gestational weight gain (GWG), GWG rates and postpartum weight retention.

METHODS

Prospective cohort of 163 women from Rio de Janeiro was followed at 5^th-13^th (baseline), 20^th-26^th, 30^th-36^th gestational weeks and at 30-62 days postpartum. Plasma 25-hydroxyvitamin D [25(OH)D] was evaluated during each trimester and was categorized as adequate (≥50 nmol/L) or inadequate (<50 nmol/L). GWG (kg) was calculated as the difference between the weight measured at baseline and 36^th-42^th gestational weeks. GWG rates (kg/week) were calculated between each visit. Postpartum weight retention (kg) was analysed as the difference between weights measured at 30-62 days postpartum and 5^th-13^th gestational weeks. Statistical analyses were performed using linear regression models that included interaction terms between vitamin D status and first trimester body mass index (BMI) (<25/≥25 kg/m²). Confounders were selected based on a directed acyclic graph.

RESULTS

The prevalence of vitamin D inadequacy was 16.6%, 9.9% and 10.6% in the first, second and third trimesters, respectively. Overweight women with vitamin D inadequacy in the first (β = 3.70; 95% CI 0.09; 7.31, p-value = 0.045) and third trimester (β = 4.59, 95% CI 0.07; 9.10, p-value = 0.047) presented higher increases in total GWG than did women with vitamin D adequacy. This association was also observed between first trimester vitamin D status and GWG rates between visits 1 and 2 (β = 0.17; 95% CI 0.13; 0.36, p-value = 0.07).

CONCLUSIONS

There was an interaction effect of first trimester BMI (≥25 kg/m²) on the association between first and third trimester vitamin D status and GWG.

Association of antepartum vitamin D deficiency with postpartum depression: a clinical perspective

OBJECTIVE

Postpartum depression affects up to 20 % of new mothers within the first 12 months of parturition. 25-Hydroxyvitamin D (25(OH)D) has known importance in bone health, but it may also play an important role in other functions, including reproduction and fertility, immune function and mental health. This clinical commentary reviews literature evaluating 25(OH)D deficiency during pregnancy and the incidence of postpartum depressive symptomatology.

DESIGN

Narrative review, summary and recommendations.

SETTING/PARTICIPANTS

A literature search revealed five relevant studies of antepartum women, three based in the USA, one in Turkey and one in Iran.

RESULTS

Three of the five studies measured serum 25(OH)D concentrations during the first or second trimester and discovered an association with 25(OH)D deficiency and depressive symptoms postpartum. One study determined an almost significant (P=0·058) inverse relationship with first-trimester 25(OH)D concentration and depressive symptoms postpartum, and the last study, which was a secondary analysis, did not find an association.

CONCLUSIONS

The Endocrine Society recommends routine vitamin D supplementation during pregnancy and lactation due to increased metabolic demand in the mother, but a recent Cochrane review recommended against screening. Vitamin D should be the target of more studies during pregnancy and the postpartum period since it appears to have an important role for both medical and mental health. Vitamin D supplementation is a relatively safe and cost-effective intervention during pregnancy, and it may prove to be important in the prevention of postpartum depression.

Association between vitamin D deficiency and antepartum and postpartum depression: a systematic review and meta-analysis of longitudinal studies

PURPOSE

The two previous reviews performed on the association of vitamin D deficiency in pregnancy with antepartum and postpartum depression were limited in reporting forms as they were both systematic reviews and the conclusions were also deemed to be inconclusive. Considering the high prevalence of vitamin D deficiency and depression during and after pregnancy as well as their numerous hazards to pregnancy outcomes, it is of great need to synthesize existing evidence in a more accurate statistical method, so that reliable guidance related to vitamin D supplementation during pregnancy could be provided for clinical decision making.

METHODS

We performed a systematic review and meta-analysis to investigate the association of vitamin D deficiency with antepartum and postpartum depression.

RESULTS

Nine longitudinal studies with 8470 participants were included in the meta-analysis. We found serum 25(OH)D levels < 50 nmol/l was associated with 2.67 times (OR 3.67; 95% CI 1.72-7.85) increased risk of postpartum depression than those 25(OH)D levels ≥ 50 nmol/l, but we did not find a significant association between low vitamin D levels and depressive symptoms during pregnancy with a serum 25(OH)D cut-off level of 30 nmol/l (OR 1.47; 95% CI 0.92-2.36).

CONCLUSIONS

The low status of maternal vitamin D could be an adverse factor for postpartum depression, but the available evidence suggested no association between vitamin D deficiency and depressive symptoms during pregnancy. However, this result should be interpreted with caution owning to the small number of studies. Well-designed intervention studies are also needed to further evaluate the benefits of vitamin D supplementation during pregnancy.

Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D?

Studies have shown a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening of cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) in new-borns. Prematurity and immaturity are the leading causes of prenatal and infant mortality and is a major public health problem around the world. Inflamed periodontal tissues generate significantly high levels of proinflammatory cytokines that may have systemic effects on the host mother and the fetus. In addition, the bacteria that cause PDs produce endotoxins which can harm the fetus. Furthermore, studies have shown that microorganisms causing PDs can get access to the bloodstream, invading uterine tissues, to induce PBLBW. Another likely mechanism that connects PDs with adverse pregnancy outcome is maternal vitamin D status. A role of inadequate vitamin D status in the genesis of PDs has been reported. Administration of vitamin D supplementation during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes. As maternal PDs are significant risk factors for adverse pregnancy outcome, preventive antenatal care for pregnant women in collaboration with the obstetric and dental professions are required.

Maternal Vitamin D Status and the Relationship with Neonatal Anthropometric and Childhood Neurodevelopmental Outcomes: Results from the Seychelles Child Development Nutrition Study

Vitamin D has an important role in early life; however, the optimal vitamin D status during pregnancy is currently unclear. There have been recent calls for pregnant women to maintain circulating 25-hydroxyvitamin D (25(OH)D) concentrations >100 nmol/L for health, yet little is known about the long-term potential benefits or safety of achieving such high maternal 25(OH)D concentrations for infant or child health outcomes. We examined maternal vitamin D status and its associations with infant anthropometric and later childhood neurocognitive outcomes in a mother-child cohort in a sun-rich country near the equator (4.6° S). This study was conducted in pregnant mothers originally recruited to the Seychelles Child Development Nutrition Study. Blood samples (n = 202) taken at delivery were analysed for serum 25-hydroxyvitamin D (25(OH)D) concentrations. Multiple linear regression models assessed associations between maternal 25(OH)D and birth weight, infant head circumference, and neurocognitive outcomes in the children at age 5 years. Mothers were, on average, 27 years of age, and the children’s average gestational age was 39 weeks. None of the women reported any intake of vitamin D supplements. Maternal 25(OH)D concentrations had a mean of 101 (range 34–218 nmol/L) and none were deficient (<30 nmol/L). Maternal 25(OH)D concentrations were not associated with child anthropometric or neurodevelopmental outcomes. These findings appear to indicate that a higher vitamin D status is not a limiting factor for neonatal growth or neurocognitive development in the first 5 years of life. Larger studies with greater variability in vitamin D status are needed to further explore optimal cut-offs or non-linear associations (including for maternal health) that might exist among populations with sub-optimal exposure.