The relationship between maternal vitamin D deficiency and glycolipid metabolism and adverse pregnancy outcome

Effect of vitamin D adjuvant therapy on the proportion of regulatory T cells in peripheral blood and pregnancy outcome of patients with recurrent miscarriage

BACKGROUND

Recurrent miscarriage (RM) is influenced by immune factors, particularly regulatory T cells, which can impact immune function and miscarriage risk. Vitamin D (VD) is known to regulate the immune system, potentially improving pregnancy outcomes in RM patients. This study aims to assess the effect of VD adjuvant therapy on regulatory T cells and pregnancy outcomes in RM patients.

METHODS

Clinical data from 104 individuals with RM admitted to our hospital between March 2022 and February 2023 were allocated at random to either the VD group (VDG) or the control group (CG), with 52 patients in each group. Both groups received standard treatment; the CG was treated with aspirin, while the VDG received additional VD therapy. Outcomes measured included regulatory T cell proportion, metabolic factors, immune inflammatory markers, and pregnancy outcomes.

RESULTS

After treatment, the proportion of regulatory T cells in VDG was considerably higher (p < 0.05). Additionally, triglyceride levels, leptin, fasting blood glucose, and fasting insulin were lower in the VDG, whereas adiponectin levels were higher (p < 0.05). Levels of progesterone, luteinizing hormone, and 25-hydroxy VD were also higher in the VDG (p < 0.05). Furthermore, interleukin-17, gamma interferon, tumor necrosis factor-α, and C-reactive protein were lower in the VDG (p < 0.05). The pregnancy success rate in the VDG was higher, and the preterm birth rate was lower (p < 0.05).

CONCLUSION

Adjuvant treatment with VD can increase the proportion of regulatory T cells in peripheral blood of individuals with recurrent abortion, regulate metabolic disorder, alleviate immune inflammation, and improve pregnancy outcome.

Clinical Value of Circ-PNPT1 on Adverse Pregnancy Outcomes of Patients with Gestational Diabetes Mellitus

OBJECTIVE

Several circular RNAs are associated with important pathophysiological characteristics of gestational diabetes mellitus (GDM). This study intended to measure the expression of circ-PNPT1 in sera of GDM patients and to expound on its values on pregnancy outcomes.

METHODS

Totally 104 GDM patients and 71 healthy controls were recruited. The expression pattern of serum circ-PNPT1 was measured by reverse transcription-quantitative polymerase chain reaction. The diagnostic efficacy of circ-PNPT1 and fasting blood glucose (FBG) on GDM was evaluated by receiver operating characteristic (ROC) analysis. Parameters of glycolipid metabolism were determined using automatic biochemical analyzers. The correlation between circ-PNPT1 and glycolipid metabolism parameters was analyzed using Pearson analysis. GDM patients were divided into a high expression group and a low expression group based on the median value of circ-PNPT1 expression. Curves of adverse neonatal outcomes were drawn by Log Rank analysis.

RESULTS

GDM patients exhibited higher circ-PNPT1 expression than healthy controls. The area under the ROC curve of circ-PNPT1 diagnosing GDM was 0.9184 and the cut-off value was 1.435 (90.38% sensitivity, 85.92% specificity). Serum circ-PNPT1 expression was positively correlated with FBG, total cholesterol, and triglyceride in GDM patients. Neonates born to GDM patients with high circ- PNPT1 expression were prone to adverse outcomes.

CONCLUSION

Circ-PNPT1 was highly-expressed in the sera of GDM patients. Circ-PNPT1 affected glycolipid metabolism and its expression had certain reference values on adverse pregnancy outcomes.

The effect of maternal vitamin D deficiency during pregnancy on glycolipid metabolism of offspring rats and the improvement of vitamin D intervention after weaning

Background

Vitamin D deficiency during pregnancy is common, but whether maternal vitamin D status affects glycolipid metabolism of offspring remains unclear.

Objective

To evaluate the effect of maternal vitamin D deficiency during pregnancy on the glycolipid metabolism of offspring at different life-cycles (from birth to adulthood) and to explore the improvement of different dosages of vitamin D supplementation.

Methods

Sprague-Dawley rats were fed vitamin D-deprived (VDD group) or standard vitamin D diets (SC group) during pregnancy, and their diets were changed to standard vitamin D diets during lactation (the offspring were sorted into VDDoffspring and SCoffspring groups). After weaning, rats in the VDDoffspring group were randomly assigned to the VDDoffspring, VDDoffspring-S3300 and VDDoffspring-S10000 groups with diets containing standard, medium and high dosages of vitamin D for 12 wk. Serum was collected for biochemical analyses at postnatal Day 21, postnatal Day 56 and postnatal Day 84. Oral glucose tolerance test (OGTT) was performed at postnatal Day 70.

Results

Compared to SCoffspring, rats in the VDDoffspring group had significantly lower birth weight with faster weight gain and higher levels of lipid metabolism in early life. After near adulthood, the differences in weight and lipid metabolism between the two groups disappeared. OGTT showed significantly higher blood glucose levels in the VDDoffspring group at 30 min, 60 min, and 90 min. The continuation of vitamin D supplementation at medium and high dosages after weaning did not cause any obvious changes in weight or glycolipid metabolism (except for postprandial hyperglycemia). OGTT demonstrated that the glucose levels in the VDDoffspring-S3300 group were lowest at all the time points and that those in the VDDoffspring-S10000 group were the highest at 30 min, 60 min, and 90 min among the three groups.

Conclusion

The adverse effects of vitamin D deficiency during pregnancy on glycolipid metabolism in offspring vary in different stages. Over a long time period, adequate vitamin D supplementation is beneficial to glycolipid metabolism for the offspring of subjects with vitamin D deficiency during pregnancy; however, further improvement is required.

Influence of hypovitaminosis D during pregnancy on glycemic and lipid profile, inflammatory indicators and anthropometry of pregnant and newborn

BACKGROUND & AIMS

Hypovitaminosis D currently represents a public health problem and is related to the emergence of chronic diseases. Furthermore, this vitamin deficiency has been associated with pregnancy complications, and it can also influence newborn's growth and development. The purpose of this review is to understand the effects of vitamin D nutritional status on women during pregnancy, as well as its impact on newborn's health.

METHODS

Review of observational studies, published between 2020 and 2021. The research was carried out in the following databases: Pubmed and SciELO. The search terms used to select the articles were: vitamin D, 25(OH)D, serum levels, pregnancy, lactation, gene expression, maternal results, complications, pre-eclampsia, obesity, gestational diabetes, and children. As inclusion criteria, were considered observational studies that addressed the topic and answered the review aims.

RESULTS

52 articles were identified and at the end of the selection process, 19 articles were considered, in which they met all the established eligibility criteria. According to the findings in this review, hypovitaminosis D is related to gestational diabetes, pre-eclampsia and gestational weight gain, changes in laboratory parameters as well as outcomes in newborns.

CONCLUSIONS

Hypovitaminosis D can adversely influence pregnancy and newborn's health, evidencing the need to assess the nutritional status of vitamin D, as well as the existence, or not, of a clinic during pregnancy. It is important that new scientific evidence is published to support this hypothesis.

The Role of Maternal Vitamin D Deficiency in Offspring Obesity: A Narrative Review

Currently, vitamin D (VD) deficiency during pregnancy is widespread globally, causing unfavorable pregnancy outcomes for both mothers and infants for a longer time than expected, based on the Developmental Origins of Health and Disease (DOHaD) theory. As VD plays a key role in maintaining normal glucose and lipid metabolism, maternal VD deficiency may lead to obesity and other obesity-related diseases among offspring later in life. This review mainly focuses on the effect of maternal VD deficiency on offspring lipid metabolism, reviewing previous clinical and animal studies to determine the effects of maternal VD deficit on offspring obesity and potential mechanisms involved in the progression of offspring obesity. Emerging clinical evidence shows that a low VD level may lead to abnormal growth (either growth restriction or largeness for gestational age) and lipid and glucose metabolism disorders in offspring. Here, we also outline the link between maternal VD deficiency and life-long offspring effects, including the disorder of adipogenesis, the secretion of adipocytokines (including leptin, resistin, and adiponectin), activated systemic inflammation, increased oxidative reactions in adipose tissue, insulin resistance, and abnormal intestinal gut microbiota. Thus, there is an urgent need to take active steps to address maternal VD deficiency to relieve the global burden of obesity.

Prevalence of Vitamin D and Calcium Deficiency and Insufficiency in Women of Childbearing Age and Associated Risk Factors: A Systematic Review and Meta-Analysis

Vitamin D deficiency and insufficiency as well as low serum calcium levels can trigger negative health outcomes in women of childbearing age. Therefore, we aimed to estimate the prevalence of serum vitamin D and calcium deficiencies and insufficiencies and associated risk factors in Brazilian women of childbearing age and to assess whether there are differences in prevalence according to regions of the country and the presence or absence of pregnancy. The systematic literature review was performed using the following databases: PubMed, LILACS, Embase, Scopus, and Web of Science. Cross-sectional, cohort, and intervention studies were included. Among pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 27% and of vitamin D insufficiency from 33.9% to 70.4%. Among non-pregnant women, the prevalence of vitamin D deficiency ranged from 0% to 41.7% and of vitamin D insufficiency from 38.5% to 69.3%. We found a high prevalence of vitamin D deficiency and insufficiency in women of childbearing age, with insufficiency affecting more than half of these women. The highest prevalence of vitamin D deficiency and insufficiency was observed in the South region. It was not possible to assess the prevalence and factors associated with calcium deficiency.

High Maternal Triglyceride Levels Mediate the Association between Pre-Pregnancy Overweight/Obesity and Macrosomia among Singleton Term Non-Diabetic Pregnancies: A Prospective Cohort Study in Central China

This study aimed at examining the risk of macrosomia, in relation to maternal pre-pregnancy overweight/obesity mediated via high maternal triglyceride (mTG) levels. In this prospective study, 24,730 singleton term non-diabetic pregnancies were finally included. Serum mTG levels were measured using fasting blood samples that were collected after 28 weeks of gestation. High mTG levels were defined as values ≥ the 90th percentile. The outcome of interest was macrosomia (≥4000 g). Log-binomial regression was used to assess the mediation path between overweight/obesity, high mTG levels, and macrosomia. The mediation analysis found a total effect of overweight on macrosomia of 0.006 (95% CI, 0.001–0.010), including a direct effect of 0.005 (95% CI, 0.001, 0.009) and indirect effect of 0.001 (95% CI, 0.000–0.001), with an estimated proportion of 11.1% mediated by high mTG levels. Additionally, we also found a total effect of obesity on macrosomia of 0.026 (95% CI, 0.018–0.036), including a direct effect of 0.025 (95% CI, 0.017–0.036) and indirect effect of 0.001 (95% CI, 0.000–0.001), with an estimated proportion of 3.8% mediated by high mTG levels. In conclusion, non-diabetic women with overweight or obesity had an increased risk of macrosomia, and this positive association was partly mediated by high mTG levels.

Vitamin D status and vitamin D deficiency risk factors among pregnancy of Shanghai in China

Background

There is increasing awareness that vitamin D deficiency in pregnant women may be associated with several adverse effects for the mother and newborn. The risks for vitamin D deficiency are unclear. This study was to assess vitamin D nutritional status and vitamin D deficiency risk factors among pregnant women in Shanghai in China.

Methods

This study is a cross-sectional study conducted in the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University. A total of 953 healthy pregnant women participated, serological examinations and other variables included serum 25-hydroxyvitamin D [25(OH)D], total blood cholesterol (TCh), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) cholesterol, triglycerides at the first antenatal visit (12–14 weeks) pregnancy parity and age, body mass index (BMI) before pregnancy, and completed OGTTs test. Associations between vitamin D deficiency and possible predictors (age group, pre-pregnancy BMI, parity, and gestational hyperlipemia) were assessed with a multinomial logistic regression analysis. And also used to investigate the effects of 25(OH)D and the other variables on the occurrence of gestational diabetes mellitus.

Results

The mean vitamin D level of pregnancy was 16 (a range from 11 to 21) ng/ml, and severe vitamin D deficiency was 31.8% (303); vitamin D deficiency was 40.7% (388); vitamin D insufficiency was 25.1% (239); normal vitamin D was 2.4%(23). Vitamin D deficiency risk factors were age over 30, parity over 2, overweight, obese, and hyperlipemia. The increasing level of vitamin D nutritional status in pregnancy is significantly related to reducing gestational diabetes mellitus. Vitamin D deficiency is a risk factor for gestational diabetes mellitus.

Conclusions

It is a high prevalence of vitamin D deficiency in Chinese pregnancy in Shanghai. Aging more than 30 years, the parity of more than 2, overweight and obesity, and hyperlipemia are risk factors for vitamin D deficiency. Vitamin D deficiency is a risk factor for gestational diabetes mellitus. Public health strategies to prevent vitamin D deficiency should focus on those risks to promote health pregnancy of Shanghai in China.

The relationship between maternal vitamin D deficiency and glycolipid metabolism and adverse pregnancy outcome

OBJECTIVE

Maternal vitamin D deficiency is associated with glucose and lipid metabolism in the mother and offspring. Meanwhile, it can also lead to adverse pregnancy outcomes. The aim of this case-control study was to document maternal, umbilical arterial glucose and lipid metabolic levels and correlations in pregnancies with or without vitamin D deficiency, while also investigating adverse pregnancy outcomes.

DESIGN/PARTICIPANTS/MEASUREMENTS

A total of 425 pregnant women who received antenatal care and delivered at Wenzhou People's Hospital were enrolled. According to their serum 25-hydroxyvitamin D [25(OH)D] level, the pregnant women were divided into the vitamin D deficiency group [25(OH)D < 20 ng/mL, 185 participants] and the control group [25(OH)D ≥ 20 ng/mL, 240 participants]. Maternal blood samples were collected at 24-28 weeks of gestation and delivery for 75-g oral glucose tolerance test (OGTT), and measurements of glucose and lipid metabolite levels and 25(OH)D levels. Umbilical arterial samples were collected during delivery (33.57-41.43 gestational weeks).

RESULTS

Compared with control participants, vitamin D deficiency women had significantly higher concentrations of fasting blood-glucose (P < .01), 1-h OGTT plasma glucose (P < .01), 2-h OGTT plasma glucose (P < .01), insulin (P < .01), HOMA-IR (P < .01), LDL (P < .01) and triglycerides (P = .02) and lower concentrations of HOMA-S (P < .01). Compared with the control group, vitamin D deficiency women had higher concentrations of triglycerides (P < .01) and lower concentrations of HDL-C (P < .01) and HOMA-β (P = .01) in infant umbilical arterial blood. Pearson's correlation analysis demonstrated that the maternal 25(OH)D level was negatively correlated with maternal plasma glucose, insulin, LDL-C, cholesterol, triglyceride and HOMA-IR (r = -.38, -.27, -.2, -.11, -.11, -.33 and .11; P < .01, <.01, <.01, <.05, <.05 and <.01, respectively), while there was a positive correlation between maternal serum 25(OH)D and HOMA-S (r = .11, P < .05). The triglyceride level in the umbilical artery was negatively correlated with maternal serum 25(OH)D concentration (r = -.286, P < .01), while the HDL-C and HOMA-β in umbilical artery were positively related (r = .154, .103, P < .01). Compared with the control group, the incidences of pre-eclampsia [4.8% (9/185) vs 1.25% (3/240), P = .03], gestational diabetes mellitus [19.45% (36/185) vs 12.08% (29/240), P = .04] and premature rupture of membranes [15.68% (29/185) vs 5.42% (13/240), P < .01] were higher in the vitamin D deficiency group.

CONCLUSION

Vitamin D deficiency during pregnancy is associated with maternal glucose and lipid metabolism and pregnancy outcomes. Therefore, it is worth recommending to maintain vitamin D status at an optimal level in pregnant women to prevent metabolic disorders and pregnancy complications.