Association Between Vitamin D Deficiency and Primary Cesarean Section

Department of Pediatrics, Division of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, and Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts 02118, USA.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.21). 12/2008; 94(3):940-5. DOI: 10.1210/jc.2008-1217
Source: PubMed


At the turn of the 20th century, women commonly died in childbirth due to rachitic pelvis. Although rickets virtually disappeared with the discovery of the hormone vitamin D, recent reports suggest vitamin D deficiency is widespread in industrialized nations. Poor muscular performance is an established symptom of vitamin D deficiency. The current U.S. cesarean birth rate is at an all-time high of 30.2%. We analyzed the relationship between maternal serum 25-hydroxyvitamin D [25(OH)D] status, and prevalence of primary cesarean section.
Between 2005 and 2007, we measured maternal and infant serum 25(OH)D at birth and abstracted demographic and medical data from the maternal medical record at an urban teaching hospital (Boston, MA) with 2500 births per year. We enrolled 253 women, of whom 43 (17%) had a primary cesarean.
There was an inverse association with having a cesarean section and serum 25(OH)D levels. We found that 28% of women with serum 25(OH)D less than 37.5 nmol/liter had a cesarean section, compared with only 14% of women with 25(OH)D 37.5nmol/liter or greater (P = 0.012). In multivariable logistic regression analysis controlling for race, age, education level, insurance status, and alcohol use, women with 25(OH)D less than 37.5 nmol/liter were almost 4 times as likely to have a cesarean than women with 25(OH)D 37.5 nmol/liter or greater (adjusted odds ratio 3.84; 95% confidence interval 1.71 to 8.62).
Vitamin D deficiency was associated with increased odds of primary cesarean section.

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    • "Therefore, excessive mechanical forces do not fully explain all CML-like injuries in these cases. Interestingly, breech fetal position may be associated with lower levels of maternal vitamin D [10]. Breech is also associated with lower bone mineral density, perhaps through constraint of fetal movement and decreased fetal bone loading [11]. "

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    • "Vitamin D deficiency was also associated with increased risk for pregnancy complications and serious health problems in the offspring.5,15-17 Higher risks of preeclampsia and cesarean section ratios were shown in pregnants with low levels of Vitamin D.16,17 Moreover supplementation of vitamin D has been demonstrated to decrease the risk of preeclampsia by 27% in a study.18 "
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    ABSTRACT: Objective: To find out the frequency of vitamin D deficiency and its relation with glucose parameters and the incidence of gestational diabetes (GDM). Methodology: Gestational diabetes was diagnosed with 75 gram oral glucose tolerance test. Forty-four pregnant women diagnosed with GDM and 78 non-GDM pregnant women were enrolled as case and control group, respectively in this descriptive study. Vitamin D status was classified as deficiency at ≤20 ng/ml for serum 25(OH)D concentrations. Results: The mean ages were 33.4±5.2 (18-44) years and 29.7±4.1 (21-39) years, mean BMI was 30.6±5.9 kg/m² (19.5-46.1) and 25.9±4.4 kg/m2 (16.5-38) in case and control groups, respectively. The frequency of GDM was found 9.38%. The mean serum vitamin D levels in GDM group were significantly lower than in non-GDM subjects (p=0.07). A total of 56.8% of GDM patients were compared with 35.8% of control group which had Vitamin D deficiency and the difference was significant (p= 0.02). There was no significant association between vitamin D levels and fasting glucose, insulin and HbA1c. Vitamin D levels were inversely correlated with clothing style, parathyroid hormone levels, dental problems and muscle cramps. Conclusions: The association of maternal Vitamin D status with the markers of glucose metabolism in pregnancy needs prospective studies.
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    • "populations, vitamin D deficiency is common in many populations lacking adequate diet or exposure to sunlight , and has been associated with increased risk of caesarean delivery (Merewood et al., 2009). No such association of vitamin D deficiency and caesarean risk was observed in a Pakistani study, however, in this population almost all women (83 of 117) were vitamin D deficient (Brunvand et al., 1998). "
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    ABSTRACT: The difficult birth process of humans, often described as the "obstetric dilemma," is commonly assumed to reflect antagonistic selective pressures favoring neonatal encephalization and maternal bipedal locomotion. However, cephalo-pelvic disproportion is not exclusive to humans, and is present in some primate species of smaller body size. The fossil record indicates mosaic evolution of the obstetric dilemma, involving a number of different evolutionary processes, and it appears to have shifted in magnitude between Australopithecus, Pleistocene Homo, and recent human populations. Most attention to date has focused on its generic nature, rather than on its variability between populations. We re-evaluate the nature of the human obstetric dilemma using updated hominin and primate literature, and then consider the contribution of phenotypic plasticity to variability in its magnitude. Both maternal pelvic dimensions and fetal growth patterns are sensitive to ecological factors such as diet and the thermal environment. Neonatal head girth has low plasticity, whereas neonatal mass and maternal stature have higher plasticity. Secular trends in body size may therefore exacerbate or decrease the obstetric dilemma. The emergence of agriculture may have exacerbated the dilemma, by decreasing maternal stature and increasing neonatal growth and adiposity due to dietary shifts. Paleodemographic comparisons between foragers and agriculturalists suggest that foragers have considerably lower rates of perinatal mortality. In contemporary populations, maternal stature remains strongly associated with perinatal mortality in many populations. Long-term improvements in nutrition across future generations may relieve the dilemma, but in the meantime, variability in its magnitude is likely to persist. Am J Phys Anthropol, 2012. © 2012 Wiley Periodicals, Inc.
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