Vitamin D and pregnancy outcomes: Overall results of the FEPED study - 31/07/20

Doi : 10.1016/j.jogoh.2020.101883

Alexandre J. Vivanti ^a,⁎ , Isabelle Monier ^a,^b, Eleonora Salakos ^a, Caroline Elie ^c, Vassilis Tsatsaris ^d, Marie-Victoire Senat ^e, Jacques Jani ^f, Jean-Marie Jouannic ^g, Norbert Winer ^h, Jennifer Zeitlin ⁱ, Charlotte Mougneaud ^a, Jean-Claude Souberbielle ^j, Marie Courbebaisse ^k, Alexandra Benachi ^a
^a Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, Clamart, France
^b Université de Paris, CRESS, INSERM, INRA, Paris, France
^c URC/CIC Paris Descartes Necker Cochin, Hôpital Necker-Enfants maladies, Assistance Publique des Hôpitaux de Paris, Paris, France
^d Service de Gynécologie-Obstétrique, Hôpital Cochin Port Royal, Assistance Publique des Hôpitaux de Paris, Université Paris-Descartes, Paris, France
^e Service de Gynécologie-Obstétrique, Hôpital de Bicêtre, Assistance Publique des Hôpitaux de Paris, Université Paris Saclay, Le Kremlin Bicêtre, France
^f Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
^g Département de Médecine Fœtale, Hôpital Armand Trousseau, Assistance Publique des Hôpitaux de Paris, Université UPMC-Sorbonne, Paris, France
^h Service de Gynécologie-Obstétrique, CHU de Nantes, CIC Mère enfant Nantes, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
ⁱ Université de Paris, CRESS, INSERM, INRA, Paris, France
^j Laboratoire d’Explorations Fonctionnelles, Hôpital Necker-Enfants malades, Assistance Publique des Hôpitaux de Paris, Paris, France
^k Service de Physiologie-Explorations Fonctionnelles Rénales, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université de Paris, INSERM U1151, Paris, France

^⁎Corresponding author.

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Abstract

Vitamin D insufficiency is highly prevalent in children and adults including pregnant women. During pregnancy, maternal vitamin D insufficiency could increase risks of several pregnancy complications and adverse birth outcomes. The FEPED study was designed to assess the effects of maternal vitamin D status in the first trimester during pregnancy on risks of preeclampsia, gestational diabetes mellitus (GDM), preterm birth and small-for-gestational age (SGA) at birth. This observational prospective cohort included 3129 women with a singleton pregnancy between April 2012 and July 2014 in six maternity units in France and Belgium. The aim of this review is to summarize the results of the FEPED study. At the first trimester the mean 25(OH)D concentration was 21.9 ± 10.4 ng/mL and 25(OH)D concentration was <20 ng/mL in 46.5 % of patients. After matching 83 cases of preeclampsia with 319 controls, a significant decrease in the risk of preeclampsia was associated with maternal vitamin D levels ≥ 30 ng/mL in the third trimesters (OR = 0.34; 95 % CI: 0.13−0.86. P = 0.023). In the first trimester, the risk for preeclampsia was decreased in these patients, but did not achieve statistical significance (OR = 0.57 95 % CI, 0.30−1.01; p = 0.09). For the 250 cases with GDM matched with 941 controls, no linear relationship was found between GDM and 25OHD levels in the first trimester of pregnancy. Finally, 2813 pregnant women were included in analyses of risks of preterm and SGA birth. No association was found between low maternal vitamin D levels in the first trimester and the risks of preterm birth (aOR = 1.53; 95 % CI: 0.97−2.43) or SGA (aOR = 1.07; 95 % CI: 0.75−1.54). Further investigation is needed to understand the mechanisms behind the association between vitamin D and birth outcomes.

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Keywords : Vitamin D, 25(OH)-vitamin D₃preterm birth, Preeclampsia, Gestational diabetes, FEPED