Effectiveness of Prenatal Vitamin D Deficiency Screening and Treatment Program: A Stratified Randomized Field Trial

被引:119
作者
Rostami, Maryam [1 ,2 ]
Tehrani, Fahimeh Ramezani [1 ]
Simbar, Masoumeh [3 ]
Yarandi, Razieh Bidhendi [1 ,4 ]
Minooee, Sonia [1 ]
Hollis, Bruce W. [5 ]
Hosseinpanah, Farhad [6 ]
机构
[1] Shahid Beheshti Univ Med Sci, Res Inst Endocrine Sci, Reprod Endocrinol Res Ctr, 24 Parvaneh,Yaman St,POB 19395-4763, Tehran 1985717413, Iran
[2] Islamic Azad Univ, Dept Med Sci, Masjed Soleyman Branch, Masjed Soleyman 6491796581, Khuzestan, Iran
[3] Shahid Beheshti Univ Med Sci, Sch Nursing & Midwifery, Midwifery & Reprod Hlth Res Ctr, Dept Midwifery & Reprod Hlth, Tehran 1985717443, Iran
[4] Univ Tehran Med Sci, Sch Publ Hlth, Dept Epidemiol & Biostat, Tehran 1417613151, Iran
[5] Med Univ South Carolina, Dept Pediat, Charleston, SC 29425 USA
[6] Shahid Beheshti Univ Med Sci, Res Inst Endocrine Sci, Obes Res Ctr, Tehran 1985717413, Iran
关键词
SERUM 25-HYDROXYVITAMIN D; D SUPPLEMENTATION; INSULIN-RESISTANCE; EARLY-PREGNANCY; RISK;
D O I
10.1210/jc.2018-00109
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Despite evidence on the association between hypovitaminosis D and adverse pregnancy outcomes and the positive impact of vitamin D supplementation, no evidence exists supporting a universal screening program in pregnancy as part of routine prenatal care. Objective: We sought to determine the effectiveness of a prenatal screening program on optimizing 25-hydroxyvitamin D [25(OH)D] levels and preventing pregnancy complications. Also, to identify a safe regimen, we compared several regimens in a subgroup of vitamin D-deficient pregnant women. Design: Two cities of Masjed-Soleyman and Shushtar from Khuzestan province, Iran, were selected as the screening and nonscreening arms, respectively. Within the screening arm, a randomized controlled trial was conducted on 800 pregnant women. Setting: Health centers of Masjed-Soleyman and Shushtar cities. Patients or Participants: Pregnant women aged 18 to 40 years. Intervention: Women with moderate [25(OH)D, 10 to 20 ng/mL] and severe [25(OH)D, <10 ng/mL] deficiency were randomly divided into four subgroups and received vitamin D-3 (D3) until delivery. Main Outcome Measure: Maternal concentration of 25(OH)D at delivery and rate of pregnancy complications Results: After supplementation, only 2% of the women in the nonscreening site met the sufficiency level (>20 ng/mL) vs 53% of the women in the screening site. Adverse pregnancy outcomes, including preeclampsia, gestational diabetes mellitus, and preterm delivery, were decreased by 60%, 50%, and 40%, respectively, in the screening site. A D3 injection in addition to monthly 50,000 IU maintenance therapy contributed the most to achievement of sufficient levels at delivery. Conclusions: A prenatal vitamin D screening and treatment program is an effective approach in detecting deficient women, improving 25(OH)D levels, and decreasing pregnancy adverse outcomes.
引用
收藏
页码:2936 / 2948
页数:13
相关论文
共 44 条
[1]   Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies [J].
Aghajafari, Fariba ;
Nagulesapillai, Tharsiya ;
Ronksley, Paul E. ;
Tough, Suzanne C. ;
O'Beirne, Maeve ;
Rabi, Doreen M. .
BMJ-BRITISH MEDICAL JOURNAL, 2013, 346
[2]   The Role of Vitamin D in the Transcriptional Program of Human Pregnancy [J].
Al-Garawi, Amal ;
Carey, Vincent J. ;
Chhabra, Divya ;
Mirzakhani, Hooman ;
Morrow, Jarrett ;
Lasky-Su, Jessica ;
Qiu, Weiliang ;
Laranjo, Nancy ;
Litonjua, Augusto A. ;
Weiss, Scott T. .
PLOS ONE, 2016, 11 (10)
[3]   Maternal vitamin D insufficiency and risk of adverse pregnancy and birth outcomes: A systematic review and meta-analysis of longitudinal studies [J].
Amegah, A. Kofi ;
Klevor, Moses K. ;
Wagner, Carol L. .
PLOS ONE, 2017, 12 (03)
[4]  
[Anonymous], 2012, Guideline: Vitamin D supplementation in pregnant women
[5]   A Systematic Review: Influence of Vitamin D Supplementation on Serum 25-Hydroxyvitamin D Concentration [J].
Autier, Philippe ;
Gandini, Sara ;
Mullie, Patrick .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2012, 97 (08) :2606-2613
[6]   High-dose oral vitamin D3 supplementation in the elderly [J].
Bacon, C. J. ;
Gamble, G. D. ;
Horne, A. M. ;
Scott, M. A. ;
Reid, I. R. .
OSTEOPOROSIS INTERNATIONAL, 2009, 20 (08) :1407-1415
[7]   Screening for Preeclampsia US Preventive Services Task Force Recommendation Statement [J].
Bibbins-Domingo, Kirsten ;
Grossman, David C. ;
Curry, Susan J. ;
Barry, Michael J. ;
Davidson, Karina W. ;
Doubeni, Chyke A. ;
Epling, John W., Jr. ;
Kemper, Alex R. ;
Krist, Alex H. ;
Kurth, Ann E. ;
Landefeld, C. Seth ;
Mangione, Carol M. ;
Phillips, William R. ;
Phipps, Maureen G. ;
Silverstein, Michael ;
Simon, Melissa A. ;
Tseng, Chien-Wen .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2017, 317 (16) :1661-1667
[8]   Seasonality of UV-radiation and vitamin D status at 69 degrees north [J].
Brustad, Magritt ;
Edvardsen, Kare ;
Wilsgaard, Tom ;
Engelsen, Ola ;
Aksnes, Lage ;
Lund, Eiliv .
PHOTOCHEMICAL & PHOTOBIOLOGICAL SCIENCES, 2007, 6 (08) :903-908
[9]  
Chiu KC, 2004, AM J CLIN NUTR, V79, P820
[10]   Randomized Controlled Trial (RCT) of Vitamin D Supplementation in Pregnancy in a Population With Endemic Vitamin D Deficiency [J].
Dawodu, Adekunle ;
Saadi, Hussein F. ;
Bekdache, Gharid ;
Javed, Yasin ;
Altaye, Mekibib ;
Hollis, Bruce W. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2013, 98 (06) :2337-2346