Effects of maternal antioxidant supplementation on maternal and fetal antioxidant levels: a randomized, double-blind study

OBJECTIVE: We sought to determine whether vitamins C and E could be delivered to the fetal-placental unit through maternal oral supplementation. STUDY DESIGN: In a randomized, double-blind study, 20 women received a daily prenatal vitamin with or without 400 IU of vitamin E and 500 mg of vitamin C, starting at 35 weeks' gestation. At randomization, a nutritional questionnaire, plasma vitamin C and E and red blood cell (RBC) vitamin E levels were determined. At delivery, concentrations of maternal and fetal plasma vitamin C and E, maternal and fetal RBC vitamin E, amniotic fluid vitamin C, and chorioamnion vitamin E and tensile strength were determined. RESULTS: Maternal plasma vitamin E levels increased in the supplemented women but not in the control subjects. No changes in maternal vitamin C levels were noted. Maternal plasma vitamin C concentrations at delivery correlated closely with amniotic fluid vitamin C levels. Similarly, maternal plasma vitamin E levels at delivery correlated with the chorioamnion concentration of vitamin E. CONCLUSIONS: Maternal plasma vitamin E levels are increased by oral supplementation. Maternal plasma vitamin C and E concentrations correlate with the concentration of vitamin C in the amniotic fluid and vitamin E in the chorioamnion, respectively.     

Prevalence of vitamin D deficiency in pregnant mothers in Tehran and investigating its association with serum glucose and insulin

Purpose: (1) To determine the prevalence of vitamin D deficiency in pregnant women. (2) To identify any correlations between maternal vitamin D levels and maternal and newborns’ glucose and insulin levels.

Methods: This observational cohort study followed 149 healthy pregnant women visiting a hospital in Tehran, Iran in 2014 until the delivery of their term babies. Maternal serum vitamin D levels, and fasting blood glucose and insulin levels in both mothers and newborns were measured at delivery. Mothers’ weight before pregnancy and right before delivery and babies’ birth weight were measured.

Results: Of sample population, 27% had vitamin D deficiency, while 73% had insufficient vitamin D. No mother had sufficient vitamin D level. Maternal weight right before delivery negatively correlated with maternal serum vitamin D level (p?=?.04). Vitamin D deficiency is more prevalent in mothers who deliver a male infant (p?=?.03). Maternal serum vitamin D levels did not correlate with maternal or neonatal serum glucose or insulin levels or newborns’ birth weight. Gestational age, maternal weight right before delivery, parity and maternal serum glucose predict infant’s birth weight.

Conclusion: Vitamin D deficiency/insufficiency is prevalent among pregnant women. Factors causing this epidemic need investigation. Promoting consumption of vitamin D-fortified foods and supplements among pregnant women is suggested.     

Vitamin D and pregnancy

Significant numbers of pregnant women do not meet the recommended levels of vitamin D. Neonates whose mothers had low vitamin D levels during pregnancy have a lower bone density at birth and are at risk of rickets. The consequences of vitamin D deficiency beyond calcium homoeostasis are not yet completely understood, however, there is growing evidence that vitamin D plays a role in the optimal function of many systems that influence pregnancy outcomes such as glucose homoeostasis, inflammation and vascular function.     

Maternal serum 25(OH)D levels in the third trimester of pregnancy during the winter season

Objective. To measure serum 25(OH)D levels of pregnant women in the last trimester during the winter season and to determine the factors affecting their serum levels.

Methods. In all, 79 pregnant women in the third trimester were examined between November 2008 and March 2009. Serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25(OH)D levels were measured. Maternal age, education, socioeconomic status (SES), nutrition, dressing habits, and level of sunlight exposure were determined and their correlation with serum 25(OH)D levels were statistically compared.

Results. The mean serum 25(OH)D level of the study group was 11.95 ± 7.20 ng/ml, and the prevalence of severe vitamin D deficiency [25(OH)D < 10 ng/ml] in pregnant women was 45.6%. No association was detected between severe vitamin D deficiency and maternal age, gravidity, skin phototype, benefiting from ultraviolet index, and educational status of the cases. Also in patients who used multivitamin supplements and good SES, 25(OH)D levels were significantly higher (p?=?0.046, p?=?0.025, respectively).

Conclusions. This study showed a remarkable high rate of vitamin D deficiency in pregnant women during the winter season and we have found high levels of vitamin D in patients supplemented with multivitamins and in ones with good SES.     

Evidence of an Association Between Vitamin D Deficiency and Preterm Birth and Preeclampsia: A Critical Review

Vitamin D deficiency has been associated with adverse pregnancy and birth outcomes such as increased risk for preterm birth and preeclampsia. This state of the science review analyzed recently published meta‐analyses and relevant studies that have evaluated the association between vitamin D deficiency and preeclampsia or preterm birth. The results suggest that a positive association between vitamin D deficiency and preterm birth exists. However, the findings of the relationship between vitamin D deficiency and preeclampsia were inconclusive, possibly because of the need for supplementation to occur prior to placentation. This may be because of a lack of studies with ethnic minority populations, who are more likely to experience vitamin D deficiency, and inadequate supplementation doses used for treatment of vitamin D deficiency. Health care providers should screen pregnant women at risk for vitamin D deficiency and supplement women accordingly based on their vitamin D status. Lastly, well‐designed and standardized clinical trials need to include large cohorts of minority pregnant women to establish the impact of vitamin D supplementation on improving preterm birth and preeclampsia risk in pregnancy.     

Anaphylactic shock due to vitamin K in a newborn and review of literature

Abstract

Newborn infants are born with an immature innate immunity. They are less likely to develop anaphylaxis since their immune system is weaker than older infants and children. There are only a few reports of side effects after vitamin K injection in neonates although prophylaxis against hemorrhagic disease of the newborn with this drug has been in routine practice in all over the world for many years. We herein report a case of anaphylactic shock developing after the intramuscular administration of vitamin K1 in a newborn. To our knowledge, this patient is the first case of neonatal anaphylactic shock developing due to intramuscular administration of vitamin K1. We suggest the clinicians should be aware of this possibility of potentially fatal adverse effect occurring with intramuscular administration of vitamin K1.     

Vitamin D deficiency in Egyptian mothers and their neonates and possible related factors

Abstract

Objective: To correlate vitamin D level in Egyptian mothers with that of their newborns, and examine risk factors related to maternal vitamin D deficiency.

Methods: A cross-sectional study was carried out at the university teaching hospital in Cairo, Egypt. Serum 25(OH) D levels were measured by enzyme-linked immunosorbent assay in 135 pregnant women at ≥37 weeks’ gestation immediately before delivery and in cord blood of their newborns.

Results: The levels of serum 25(OH) D were 32.6?±?21.4?ng/ml in mothers and 16.7?±?10?ng/ml in their newborns. Maternal vitamin D level was strongly correlated with that of the newborns (r?=?0.7, p?<?0.0001). Maternal vitamin D deficiency/insufficiency and neonatal vitamin D deficiency/insufficiency were encountered in (40%, 28.9% and 60%, 32.6% respectively). Maternal vitamin D levels showed significant correlations with maternal body mass index (BMI; r?=??0.201, p?=?0.021), gestational age at delivery (r?=?0.315, p?≤?0.0001), fish consumption (r?=?0.185, p?=?0.032), educational level (r?=?0.29, p?=?0.001), and skin exposure (r?=?0.247, p?=?0.004).

Conclusion: Maternal vitamin D levels strongly correlate with neonatal levels. Maternal vitamin D deficiency is a real problem in Egypt; this is generally related to high BMI, low fish consumption, low educational level, and limited skin exposure.     

Prevention of Vitamin K Deficiency Bleeding

The risk that a newborn will develop vitamin K deficiency bleeding is 1700/100,000 (one out of 59) if vitamin K is not administered. When intramuscular vitamin K is administered, the risk of vitamin K deficiency bleeding is reduced to 1/100,000. While women may have misconceptions about vitamin K prophylaxis for their newborns, health care providers should be prepared with factual information. Prophylaxis is needed even for healthy newborns without risk factors for bleeding. Other forms of vitamin K supplementation, including oral administration of Food and Drug Administration‐approved vitamin K preparations and maternal supplements during pregnancy or lactation, do not have the same effectiveness as the parenteral form. The formulations of vitamin K approved for use in the United States have not been associated with childhood leukemia or other childhood health problems. Care providers need to give accurate information to families regarding the risks and benefits of vitamin K prophylaxis. An interprofessional approach to education can be effective in increasing acceptance of vitamin K prophylaxis and decreasing the incidence of vitamin K deficiency bleeding. This article uses a case study approach to highlight common misconceptions about vitamin K prophylaxis and discuss a recent interprofessional collaboration to prevent vitamin K deficiency bleeding.     

早产儿维生素A营养不良及其补充治疗的临床研究

目的　评价早产儿基础维生素A营养状况、与疾病的关系及常规补充的效果。方法　高效液相色谱法检测2006年1月至2007年2月北京大学第一医院出生24 h 内的早产儿（147名）血浆视黄醇浓度,足月儿（40名）脐血作为对照。根据临床治疗常规,早产儿静脉（1650 U/d）和（或）口服（750 U/d）补充维生素A,随 访早产儿血浆视黄醇浓度。结果　出生时,早产儿血浆视黄醇浓度低于足月儿,差异有统计学意义,分别为（0.161±0.051）μg/mL 和 （0.187±0.055） μg/mL（P = 0.005）。早产儿维生素A 缺乏（VAD）发生率高于足月儿,但差异无统计学意义。多元线性回归分析显示出生体重与血浆视黄醇浓度呈正相关。31 例早产儿补充维生素A 2周后,随访血浆视黄醇浓度显著升高,分别为（0.168±0.046） μg/mL和 （0.203±0.063）μg/mL（P = 0.014）;VAD发生率显著下降 ,分别为100%和48%（P < 0.001）。未发现补充剂量、方式对随访维生素A浓度的影响,未发现出生时血浆视黄醇浓度与新生儿期疾病的关系。结论　早产儿基础 维生素A营养状况不良,常规补充可在一定程度上改善2周时维生素A营养状况。     

Vitamin D and neonatal immune function

Abstract

Vitamin D deficiency is widespread in the neonatal and paediatric population of northern latitudes, particularly in children of African, Middle Eastern and Asian ethnicity. This is associated with diminished immune function and increases the risk of Th1 autoimmune diseases like type 1 diabetes. Epidermiological studies have also shown a link between vitamin D deficiency in children and a more severe course of illness with lower respiratory tract infection or Respiratory Syncitial Virus (RSV) bronchiolitis. The mechanism by which vitamin D enhances immunity is complex. It acts through the innate immune system by inducing antimicrobial peptides in epithelial cells, neutrophils and macrophages. The role of Vitamin D in neonatal and paediatric immunomodulation requires further study.     

Severe vitamin D deficiency among pregnant women and their newborns in Turkey

Objectives: Vitamin D deficiency is an important health problem in pregnant women and their infants in sunny countries. Low socio-economic status (LSES), covered dressing style, pregnancies in winter season and having dark skin are the major risk factors for vitamin D deficiency. The present study evaluated serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations in pregnant women and in their newborns and determined the risk factors in LSES cities in Turkey.

Methods: Ninety-seven pregnant women and their newborns were included in the study between December 2012 and February 2013. All of the pregnant women had irregular follow-up or had received no antenatal care, were pregnant during summer, had presented to the hospital after 37 weeks of gestation (WG) and had received no vitamin D supplementation. A detailed history was obtained, which included mothers’ age, number of births and dressing sytle. Maternal and cord blood samples were taken to measure 25(OH)D3 levels.

Results: All of the pregnant women were predominantly LSES, had covered dressing style and none of them had received vit D3 supplementation during pregnancy. The mean serum 25(OH)D3 level and mean cord blood level of of 97 mothers were 4.97?±?3.27?ng/ml and 4.29?±?2.44?ng/ml, respectively. There was a strong positive correlation between maternal serum and umbilical cord 25(OH)D3 levels (r: 0.735, p?<?0.05). Ninety-five mothers had serum 25(OH)D3 below 20?ng/ml and all cord blood serum 25(OH)D3 levels were below 20?ng/ml. Level of 25(OH)D3 was not correlated with mother age, WG or newborn weight. Serum 25(OH)D3 concentrations in primigravida and multigravida were 3.71?±?1.88 and 5.2?±?3.4?ng/ml, respectively, with a significant difference between them (p?<?0.05).

Conclusion: Severe vitamin D deficiency is common in reproductive women and their newborns in LSES cities of Turkey. Covered dressing style, not receiving any vitamin D supplementation and primigravida women are at greatest risk. Vitamin D supplementation campaigns which should cover pregnant women and the newborn to prevent maternal and perinatal vitamin D deficiency should be implemented especially in risk areas.     

Maternal vitamin D levels and the risk of perinatal death

Objective: To determine the association between maternal vitamin D levels and perinatal death.

Methods: A retrospective cross-sectional study of all non-anomalous, singleton births (≥24 weeks) with perinatal death compared to a matched control group. Only pregnancies with a recorded vitamin D level at booking (8–19 weeks gestation) were included for analysis. Maternal vitamin D levels were categorized into normal, deficient and insufficient cohorts and variables compared between the three groups.

Results: There were 31 perinatal deaths which were compared to 111 controls. Median vitamin D levels were lower in the perinatal death cohort compared to the control group (55?nmol/L versus 64?nmol/L, p?=?0.43). There was no significant increase in deaths between the normal and deficient (p?=?0.33) or insufficient (p?=?0.09) groups.

Conclusions: Low maternal vitamin D levels at booking were not associated with an increased risk of perinatal demise.     

Supplementation during pregnancy: beliefs and science

Pregnancy represents a challenge from a nutritional perspective, because micronutrient intake during the periconceptional period and in pregnancy affects fetal organ development and the mother’s health. Inappropriate diet/nutrition in pregnancy can lead to numerous deficiencies including iron deficiency and may impair placental function and play a role in miscarriage, intrauterine growth restriction, preterm delivery, and preeclampsia. This article reviews the risks associated with nutrient deficiencies in pregnant women and presents an overview of recommendations for dietary supplementation in pregnancy, focusing on oral iron supplementation. Risk factor detection, including dietary patterns and comorbidities, is paramount in optimal pregnancy management. Dietary habits, which can lead to deficiencies (e.g., iron, folate, vitamin D, and calcium) and result in negative health consequences for the mother and fetus/newborn, need to be investigated. Prenatal care should be personalized, accounting for ethnicity, culture, education, information level about pregnancy, and dietary and physical habits. Clinicians should make a plan for appropriate supplementation and prophylaxis/treatment of nutritional and other needs, and consider adequate intake of calcium, iodine, vitamin D, folate, and iron. Among the available oral iron supplements, prolonged-released ferrous sulfate (ferrous sulfate–polymeric complex) presents the lowest incidence of overall and gastrointestinal adverse events, with positive implications for compliance.     

Nutritional practice effectiveness to achieve adequate plasma vitamin A,E and D during the early postnatal life in Tunisian very low birth weight infants

Objective: To look at changes in plasma vitamin A, E and D concentrations during the early postnatal life and to study their link with growth and mortality in Tunisian very low birth weight (VLBW) infants.

Patients and methods: A cohort of 607 VLBW infants had been followed from birth until hospital discharge or death. Blood was collected at birth, at time of maximal weight loss and at time of recovering birth weight. Retinol and α-tocopherol were analyzed using HPLC and 25 hydroxy vitamin D using radioimmunoassay.

Results: Vitamin A, D and E deficiencies were very common at birth (75.9%, 74.1% and 65.2%, respectively). The prevalence’s have decreased throughout hospital stay, but remained high at time of recovering birth weight (59.4%, 31.2% and 28.8%, respectively). Vitamin A deficiency was associated with longer hospital stay [OR (95% CI), 1.66 (1.03–2.93)] and vitamin E deficiency was associated with increased neonatal mortality [1.44 (1.01–2.23)].

Conclusions: Current nutritional practices are ineffective to achieve adequate vitamins A, E and D status in Tunisian VLBW infants during the early postnatal life and should be revised. Further work is needed to establish recommended doses of vitamins supplements in these preterm infants.     

Micronutrients and women of reproductive potential: required dietary intake and consequences of dietary deficiency or excess. Part I – Folate,Vitamin B12, Vitamin B6

This two-part review highlights micronutrients for which either public health policy has been established or for which new evidence provides guidance as to recommended intakes during pregnancy. One pivotal micronutrient is folate, the generic name for different forms of a water-soluble vitamin essential for the synthesis of thymidylate and purines and, hence, DNA. For non-pregnant adult women the recommended intake is 400?μg/day dietary folate equivalent. For women capable of becoming pregnant an additional 400?μg/day of synthetic folic acid from supplements or fortified foods is recommended to reduce the risk of neural tube defects (NTD). The average amount of folic acid received through food fortification (grains) in the US is only 128?μg/day, emphasising the need for the supplemental vitamin for women of reproductive age. Vitamin B12 (cobalamin) is a cofactor required for enzyme reactions, including generation of methionine and tetrahydrofolate. B12 is found almost exclusively in foods of animal origin (meats, dairy products); therefore, vegetarians are at greatest risk for dietary vitamin B12 deficiency and should be supplemented. Vitamin B6 is required for many reactions, primarily in amino acid metabolism. Meat, fish and poultry are good dietary sources. Supplementation beyond routine prenatal vitamins is not recommended.     

Vitamin D status and thyroid autoimmunity in Korean pregnant women

Objective: There is increasing interest in the role of vitamin D (vitD) during pregnancy. We prospectively evaluated the vitD status in Korean pregnant women and evaluated the levels of vitD according to thyroid-specific autoimmunity during pregnancy.

Methods: We included pregnant 531 women who visited for prenatal care and 238 age-matched, non-pregnant women as a control population. The levels of thyrotropin, FT4, thyroid peroxidase (TPO), thyroglobulin (Tg) antibody (Ab) and 25-hydroxy vitamin D [25(OH)D] were measured by electrochemiluminescence immunoassays.

Results: The mean levels of 25(OH)D at trimester 1, 2 and 3 were 13.6, 15.6 and 19.3?ng/mL, respectively; and the prevalence of vitD insufficiency was 83.6%, 75.1% and 55.9%, respectively. The mean 25(OH)D levels were not significantly different between Tg and TPO Ab-positive and negative pregnant women (14.9 versus 16.1, and 14.9 versus 16.1?ng/mL, respectively).

Conclusions: vitD insufficiency was exceptionally high, especially in the first trimester, in Korean pregnant women. The mean 25(OH)D levels were not significantly different according to autoimmunity. Further studies on this relationship could provide important information to assess the vitD status in patients with thyroid autoimmunity during pregnancy.