Maternal Vitamin D Status and Its Associated Environmental Factors: A Cross-Sectional Study.

Background: Vitamin D deficiency is common among women during pregnancy. This study aims to determine the prevalence of vitamin D deficiency and their shared modifiable environmental factors among pregnant women in Indonesia and Malaysia. Methods: Blood samples of 844 third-trimester pregnant women (Indonesians: 311; Malaysians: 533) were collected to determine their serum 25(OH) D levels. Information on sun exposure and sun protection behaviours were obtained through face-to-face interviews. Dietary vitamin D intake was assessed by using a semiquantitative food frequency questionnaire. Results: The prevalence of vitamin D deficiency (<30 nmol/L) among Indonesian and Malaysian pregnant women were 42.4% and 72.0%, respectively. Percentage of exposed body surface area was inversely associated with vitamin D deficiency among Indonesian pregnant women (OR = 0.21, 95% CI = 0.09-0.48). Among Malaysian pregnant women, higher intakes of dietary vitamin D were associated with lower risk of vitamin D deficiency (OR = 0.48, 95% CI = 0.29-0.81). Analysis of the combined cohorts revealed a lower risk of vitamin D deficiency among pregnant women who had a daily intake of at least 15 mcg vitamin D (OR = 0.58, 95% CI = 0.38-0.88) and exposure of more than 27% body surface area to the sunlight (OR = 0.30, 95% CI = 0.16-0.60). Conclusions: Despite abundant sunshine, vitamin D deficiency is prevalent among pregnant women in tropical countries. The present study suggests that nutrition education on vitamin D intake and sun exposure during pregnancy is necessary for primary prevention of vitamin D deficiency in pregnant women living in the tropical countries.

Impact of maternal dietary carbohydrate intake and vitamin D-related genetic risk score on birth length: the Vitamin D Pregnant Mother (VDPM) cohort study.

BACKGROUND: Our objectives were to investigate the relationship between maternal vitamin D status and IGF-1 levels in healthy Minangkabau pregnant mothers and their impact on newborn anthropometry outcomes and to examine whether this relationship was modified by dietary intake using a nutrigenetic approach. METHODS: Healthy singleton pregnant mother and infant pairs (n = 183) were recruited. We created three genetic risk scores (GRSs): a six-SNP GRS based on six vitamin D-related single nucleotide polymorphisms (SNPs) involved in the synthesis of vitamin D (vitamin D-GRS), a two-SNP GRS using SNPs in VDR genes (VDR-GRS) and a four-SNP GRS using SNPs from DHCR7, GC, CYP24A1 and CYP2R1 genes (non-VDR GRS). The effect of the GRSs on IGF-1, vitamin D and newborn anthropometry and the interaction between the GRSs and dietary factors were tested using linear regression analysis. RESULTS: The vitamin D- and non-VDR GRSs were significantly associated with lower 25(OH)D concentration (p = 0.005 and p = 0.001, respectively); however, there was no significant association with IGF-1, and newborn anthropometry outcomes. However, there was a significant interaction of VDR-GRS with carbohydrate intake on birth length outcome (Pinteraction = 0.032). Pregnant mothers who had higher carbohydrate intake (405.88 ± 57.16 g/day) and who carried ≥ 2 risk alleles of VDR-GRS gave birth to babies with significantly lower birth lengths compared to babies born to mothers with < 2 risk alleles (p = 0.008). CONCLUSION: This study identified a novel interaction between VDR-GRS and carbohydrate intake on birth length outcome. These findings suggest that reducing the intake of carbohydrates during pregnancy, particularly for those who have a higher genetic susceptibility, might be an effective approach for preventing foetal growth abnormalities.

Association between pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes: a cohort study in Indonesian pregnant women.

BACKGROUND: Pre-pregnancy BMI (PP BMI) and gestational weight gain (GWG) are prominent anthropometric indicators for maternal nutritional status and are related to an increased risk of adverse pregnancy outcomes. This study aimed to determine the factors affecting total GWG, PP BMI and pregnancy outcomes among pregnant women in West Sumatra, Indonesia. METHODS: This observational analysis was conducted among healthy women in the Vitamin D Pregnant Mother (VDPM) cohort study. A total of 195 pregnant women and their newborn babies were enrolled, and information regarding their socio-demographic characteristics, obstetric history, dietary intake and anthropometric data were assessed through direct interviews. Furthermore, the Institute of Medicine (IOM) 2009 guidelines were used to obtain the total GWG. RESULTS: PP BMI was used to categorise the 195 pregnant women as overweight/obese (43.1%), normal (46.7%) and underweight (10.2%). There were 53.3%, 34.4% and 12.3% of women who had inadequate, adequate and excessive GWG, respectively. The multinomial logistic regression model indicated that overweight or obese women at the pre-pregnancy stage were 4.09 times more likely to have an excessive rate of GWG (AOR = 4.09, 95% CI: 1.38-12.12, p = 0.011) than those whose weight was normal. Furthermore, women with excessive GWG were 27.11 times more likely to have a baby with macrosomia (AOR = 27.11, 95% CI: 2.99-245.14) (p = 0.001) and those with inadequate GWG were 9.6 times more likely to give birth to a baby with low birth weight (LBW) (AOR = 9.60, 95% CI; 0.88-105.2) (p = 0.002). CONCLUSIONS: This study demonstrates that the malnutrition status prior to pregnancy and inadequate or excessive GWG status during pregnancy as significant risk factors for developing adverse pregnancy outcomes. These findings highlight the importance of providing information, preconception counselling and health education on weight management for healthy pregnancies.

Interaction between Vitamin D-Related Genetic Risk Score and Carbohydrate Intake on Body Fat Composition: A Study in Southeast Asian Minangkabau Women.

Metabolic diseases have been shown to be associated with low vitamin D status; however, the findings have been inconsistent. Hence, the objective of our study was to investigate the relationship between vitamin D status and metabolic disease-related traits in healthy Southeast Asian women and examine whether this relationship was modified by dietary factors using a nutrigenetic study. The study included 110 Minangkabau women (age: 25-60 years) from Padang, Indonesia. Genetic risk scores (GRS) were constructed based on five vitamin D-related single nucleotide polymorphisms (SNPs) (vitamin D-GRS) and ten metabolic disease-associated SNPs (metabolic-GRS). The metabolic-GRS was significantly associated with lower 25-hydroxyvitamin D (25(OH)D) concentrations (p = 0.009) and higher body mass index (BMI) (p = 0.016). Even though the vitamin D-GRS had no effect on metabolic traits (p > 0.12), an interaction was observed between the vitamin D-GRS and carbohydrate intake (g) on body fat percentage (BFP) (pinteraction = 0.049), where those individuals who consumed a high carbohydrate diet (mean ± SD: 319 g/d ± 46) and carried >2 vitamin D-lowering risk alleles had significantly higher BFP (p = 0.016). In summary, we have replicated the association of metabolic-GRS with higher BMI and lower 25(OH)D concentrations and identified a novel interaction between vitamin D-GRS and carbohydrate intake on body fat composition.

A genetic approach to study the relationship between maternal Vitamin D status and newborn anthropometry measurements: the Vitamin D pregnant mother (VDPM) cohort study.

PURPOSE: Adverse effects of maternal vitamin D deficiency have been linked to adverse pregnancy outcomes. We investigated the relationship between maternal vitamin D status and newborn anthropometry measurements using a genetic approach and examined the interaction between genetic variations in involved in vitamin D synthesis and metabolism and maternal vitamin D concentrations on newborn anthropometry. METHODS: The study was conducted in 183 pregnant Indonesian Minangkabau women. Genetic risk scores (GRSs) were created using six vitamin D-related single nucleotide polymorphisms and their association with 25-hydroxyvitamin D [25(OH)D] levels and newborn anthropometry (183 infants) were investigated. RESULTS: There was no significant association between maternal 25(OH)D concentrations and newborn anthropometry measurements (P > 0.05, for all comparisons). After correction for multiple testing using Bonferroni correction, GRS was significantly associated with 25(OH)D in the third trimester (P = 0.004). There was no association between GRS and newborn anthropometric measurements; however, there was an interaction between GRS and 25(OH)D on head circumference (P = 0.030), where mothers of neonates with head circumference < 35 cm had significantly lower 25(OH)D if they carried ≥4 risk alleles compared to those who carried ≤3 risk alleles. CONCLUSION: Our findings demonstrate the impact of vitamin D-related GRS on 25(OH)D and provides evidence for the effect of vitamin D-related GRS on newborn anthropometry through the influence of serum 25(OH)D levels among Indonesian pregnant women. Even though our study is a prospective cohort, before the implementation of vitamin D supplementation programs in Indonesia to prevent adverse pregnancy outcomes, further large studies are required to confirm our findings.

The Association between Vitamin D-Related Gene Polymorphisms and Serum 25-Hydroxyvitamin D Concentration: A Prospective Cohort Study in Pregnant Minangkabau Women, Indonesia.

Several candidate genes in vitamin D synthesis and metabolism have been reported to have a significant association with 25-hydroxyvitamin D (25(OH)D) in Caucasians and African Americans. Few studies have indicated this relationship among Asians, especially in pregnant Minangkabau women, Indonesia. This study was conducted among 180 singleton pregnant women of West Sumatran Vitamin D Pregnant Mother (VDPM) cohort study. Serum 25(OH)D obtained in the third trimester (T3). Genetic risk scores (GRS) were created based on six vitamin D-related SNPs and their association with 25(OH)D levels were tested. Informations on demographics, lifestyle, pregnancy profile, and physical activity were collected using questionnaire. The average of 25(OH)D concentration was 21.21±10.41 ng/mL respectively. Vitamin D-GRS has significantly associated with serum 25(OH)D levels in the third trimester (p=0.006). However, the synthesis-GRS and metabolism-GRS group of vitamin D-related gene polymorphisms had no association with 25(OH)D concentration at T3 (p>0.05). A high prevalence of insufficient-deficient vitamin D status at T3 was common. We observed an association between vitamin D-GRS and 25(OH)D concentration. The results of this study provides additional support for possible role of genetic variants in vitamin D-related gene polymorphisms on 25(OH)D concentration during pregnancy. Further replication studies with larger sample sizes are needed to confirm thefindings.

The Association of Maternal Vitamin D Status during Pregnancy and Neonatal Anthropometric Measurements: A Longitudinal Study in Minangkabau Pregnant Women, Indonesia.

The prevalence of vitamin D deficiency (VDD) appears to be increasing. VDD during pregnancy has been associated with several adverse pregnancy outcomes. This study aimed to investigate the association between VDD and fetal anthropometric measurement. This prospective cohort study consisted of 232 pregnant women in their first trimester who were recruited at the antenatal clinics and they maintained to be subjects of the study until their delivery time. Serum 25-hydroxyvitamin D (25(OH)D) concentration was measured at first and third trimester using enzyme-linked immunosorbent assay. The prevalence of VDD in the first-trimester was 82.8%. Mean of 25(OH)D concentration in the third-trimester was significantly higher than in the first trimester (14.00 (6.98) vs. 21.22 (10.17) ng/mL). After adjusting age, pre-pregnancy BMI, and gestational age at delivery, it was found that VDD during pregnancy was not significantly associated with neonatal anthropometry (p>0.05). It was concluded that VDD was common in a tropical country. Large, well designed, multicentre observational studies are required to determine whether VDD enhances the risk of adverse pregnancy outcomes.

Low Maternal Vitamin D and Calcium Food Intake during Pregnancy Associated with Place of Residence: A Cross-Sectional Study in West Sumatran Women, Indonesia.

BACKGROUND: There is a high prevalence of vitamin D deficiency in pregnancy worldwide, and variable availability of vitamin D-rich foods may affect the adequacy of vitamin D food intake in different regions. AIM: We analysed the relationship between place of residence and maternal food intake of vitamin D and calcium in West Sumatra, Indonesia. METHODS: This cross-sectional study was conducted in 203 pregnant women. Data collection was carried out in four districts in West Sumatra - two in coastal locations and two in mountainous locations - with subjects divided into groups based on their place of residence. The dietary intakes of pregnant women were assessed through a semi-quantitative food-frequency questionnaire (SQ-FFQ). RESULTS: The means of maternal vitamin D and calcium food intake were 7.92 ± 5.26 µg/day and 784.88 ± 409.77 mg/day, respectively. There were no reports of vitamin D supplement intake during pregnancy. A total of 86.7% and 89.7% of the study subjects had low vitamin D and calcium food intake status, respectively. There was a significant association between maternal vitamin D intake and place of residence (p = 0.02) and significant different mean levels of vitamin D food intake with the place of residence (9.04 vs 6.55 µg/day; p = 0.01). Mothers who had higher education levels had adequate calcium food intake (p = 0.015; OR: 0.295; 0.116-0.751). CONCLUSION: Low maternal vitamin D and calcium food intake were found to be common in West Sumatra, Indonesia and their differed between those residents in mountainous and in coastal areas.

Vitamin D deficiency status and its related risk factors during early pregnancy: a cross-sectional study of pregnant Minangkabau women, Indonesia.

BACKGROUND: Vitamin D deficiency (VDD) is a common problem in reproductive-aged women and has become a major public health problem worldwide. The effect of VDD in pregnancy has been associated with several adverse pregnancy outcomes. This study aims to assess the serum levels of 25-hydroxyvitamin D (25(OH)D) in the first trimester and its associated factors (socio-demographics, pregnancy profiles, dietary intake, and maternal anthropometry measurements) for the determination of vitamin D deficiency status in early pregnancy. METHODS: A cross-sectional study of 239 pregnant mothers in West Sumatra, Indonesia was conducted. We measured lifestyle, socio-demographics and pregnancy profile through a structured questionnaire and interview process. A semi quantitative-food frequency questionnaire (SQ-FFQ) was used to analyse the dietary intake of the pregnant women. Serum 25(OH)D concentrations were measured at < 13 weeks gestation using ELISA and logistic regression models were employed to identify the predictors of low vitamin D status. RESULTS: The prevalence of first-trimester maternal VDD and sufficiency were 82.8 and 17.2% respectively. The median 25(OH)D was 13.15 ng/mL (3.00-49.29 ng/mL). The significant independent predictors were no working status (OR: 0.029;0.001-0.708) (p = 0.030); nulliparous parity status (OR: 7.634;1.550-37.608) (p = 0.012); length of outdoor activity status of less than an hour (OR: 9.659;1.883-49.550) (p = 0.007); and no consumption of supplements before pregnancy (OR: 4.49;1.081-18.563) (p = 0.039). CONCLUSIONS: The prevalence of VDD is common in early pregnancy among Minangkabau women. Recommendations and policies to detect and prevent such insufficiency during pregnancy should be developed by considering the associated factors.

The association between lifestyle and maternal vitamin D during pregnancy in West Sumatra, Indonesia.

BACKGROUND AND OBJECTIVES: An adequate level of maternal vitamin D is essential for maternal and fetal health during pregnancy. We examined the relationship between lifestyle, maternal vitamin D intake and the vitamin D status of pregnant women. Methods and Study designs: The sample of the cross-sectional study was 203 third trimester pregnant women in September-November 2016 in four different districts of West Sumatra, Indonesia. Questionnaire was used to assess lifestyles, dietary intake, anthropometry, maternal characteristics, demography and socioeconomic data. The Vitamin D serum level was measured by the ELISA method and the data were analyzed using descriptive statistics, chi-squared tests, Pearson's correlation and logistic regression. RESULTS: 160 blood serum samples of pregnant women were collected. The means of 25-hydroxyvitamin D and maternal vitamin D intake were 29.06±11.39 ng/mL and 7.92±5.26 µg/day respectively. The prevalence of vitamin D deficiency- insufficiency was 61.25%, and more than 85% of the women had inadequate vitamin D intake. We found that living in mountainous areas (p=0.03) and low physical activity (p=0.02) were significantly associated with maternal vitamin D levels as a prediction factor. In addition, younger who had lower pre-pregnancy weight had a higher prevalence of vitamin D deficiency. CONCLUSIONS: Low levels of vitamin D were common among pregnant women in West Sumatra, Indonesia. Additional intake of vitamin D from supplements may be important to meet the recommended dietary level for pregnant women.