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Gallbladder performs poorly during pregnancy if low vitamin D – May 2015

Vitamin-D Deficiency Is Associated with Gallbladder Stasis Among Pregnant Women

Digestive Diseases and Sciences, May 2015
Rimpi Singla, Usha Dutta, Neelam Aggarwal, Sanjay Kumar Bhadada, Rakesh Kochhar, Lakhbir K. Dhaliwal

VitaminDWiki Summary

20% of pregnant women with low vitamin D had Gallbladder Statis
0% of pregnant women with adequate vitamin D had Gallbladder Stasis

See also VitaminDWiki
Gallbladder removal and vitamin D deficiency


Background
Pregnant women are at increased risk of gallbladder (GB) stasis, an important risk factor for gallstones (GS). In non-pregnant women, Vitamin-D deficiency (VDD) is associated with GB stasis, which improves on supplementation. Relationship of VDD with GB stasis among pregnant women is not known.

Methods
This is a prospective study in tertiary care centre. Consecutive healthy pregnant women (12–16 weeks gestation) were enrolled. Serum 25(OH) vitamin-D was estimated, and levels <20 ng ml−1 were considered as VDD. Risk factors and clinical features of VDD were assessed. Gallbladder ejection fraction (GBEF) was assessed by ultrasound after a standard fatty meal, and <40 % was defined as stasis. Statistical analysis was performed to assess relationship of GB stasis and vitamin-D levels and identify factors associated with VDD.

Key Results
Median serum vitamin-D in 304 women was 7.9 ng ml−1 (IQR 5.7, 12). VDD afflicted 92 % of them. Women with VDD more often had GB stasis (20 % vs 0 %; p = 0.015) and had lower GBEF [53.7 ± 17 % vs 59 ± 10 %; p = 0.026] compared to those with normal vitamin-D. GBEF showed positive correlation with vitamin-D levels (r = 0.117; p = 0.042). Risk factors for low vitamin-D levels were urban residence (p = 0.001), lower sun-exposure time (p = 0.005), limited skin exposure (p < 0.001), higher BMI (p = 0.05) and higher socioeconomic status (p = 0.02). Vitamin-D deficiency was associated with low serum calcium (ρ = 0.457; p < 0.001).

Conclusions
Vitamin D deficiency is highly prevalent among pregnant Indian women. It is associated with GB stasis and lower GBEF. The risk factors for VDD were reduced sun exposure, inadequate dietary intake and urban lifestyle.

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References

  1. Maringhini, A, Ciambra, M, Baccelliere, P, Raimondo, M, Orlando, A, Tine, F (1993) Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med 119: pp. 116-120 CrossRef
  2. Maringhini, A, Marceno, MP, Lanzarone, F, Caltagirone, M, Fusco, G, Cuonzo, G (1987) Sludge and stones in gallbladder after pregnancy. J Hepatol 5: pp. 218-223 CrossRef
  3. Braverman, DZ, Johnson, ML, Ker, F (1980) Effects of pregnancy and contraceptive steroids on gallbladder function. N Engl J Med 302: pp. 362-364 CrossRef
  4. Everson, GT, McKinley, C, Lawson, M, Johnson, M, Kern, F (1982) Gallbladder function in the human female: effect of the ovulatory cycle, pregnancy, and contraceptive steroids. Gastroenterology 82: pp. 711-719
  5. Bolukbas, FF, Bolukbas, C, Horoz, M, Ince, AT, Uzunkoy, A, Ozturk, A (2006) Risk factors associated with gallstone and biliary sludge formation during pregnancy. Gastroenterol Hepatol 21: pp. 1150-1153 CrossRef
  6. Lee, SP, Maher, K, Nicholls, JF (1988) Origin and fate of biliary sludge. Gastroenterology 94: pp. 170-176
  7. Janowitz, P, Kratzer, W, Zemmier, T, Tudyka, J, Wechsler, JG (1994) Gallbladder sludge: spontaneous course and incidence of complication in patients without stones. Hepatology 20: pp. 291-294 CrossRef
  8. Ros, E, Navarro, S, Bru, C, Garcia-Puges, A, Valderama, R (1991) Occult microlithiasis in ‘idiopathic’ acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology 101: pp. 1701-1709
  9. Lee, SP, Nicholls, JF, Park, HZ (1992) Biliary sludge as a cause of pancreatitis. NEJM 326: pp. 589-593 CrossRef
  10. Kern, F, Everson, GT, DeMark, B (1981) Biliary lipids, bile acids, and gallbladder function in the human female. Effects of pregnancy and the ovulatory cycle. J Clin Invest 68: pp. 1229-1242 CrossRef
  11. Valdivieso, V, Covarrubias, C, Siegel, F, Cruz, F (1993) Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early peurperium. Hepatology 17: pp. 1-4
  12. Basso, L, McCollum, PT, Darling, MR, Tocchi, A, Tanner, WA (1992) A study of cholelithiasis during pregnancy and its relationship with age, parity, menarche, breast-feeding, dysmenorrhea, oral contraception and a maternal history of cholelithiasis. Surg Gynecol Obstet 175: pp. 41-46
  13. Stauffer, RA, Adams, A, Wygal, J (1982) Gallbladder disease in pregnancy. Am J Obstet Gynecol 144: pp. 661-664
  14. Jorgensen, T (1988) Gall stones in a Danish population: fertility period, pregnancies, and exogenous female sex hormones. Gut 29: pp. 433-439 CrossRef
  15. Scragg, RKR, McMichael, AJ, Seamark, RF (1984) Oral contraceptives, pregnancy, and endogenous oestrogen in gall stone disease—a case–control study. Br Med J 288: pp. 1795-1799 CrossRef
  16. Tsimoyiannis, EC, Antoniou, NC, Tsaboulas, C, Papanikolaou, N (1994) Cholelithiasis during pregnancy and lactation. Prospective study. Eur J Surg 160: pp. 627-631
  17. Schjoldager, BT (1994) Role of CCK in gallbladder function. Ann N Y Acad Sci 713: pp. 207-218 CrossRef
  18. Upp, JR, Nealon, WH, Singh, P, Fagan, CJ, Jonas, AS, Greeley, GH, Thompson, JC (1987) Correlation of cholecystokinin receptors with gallbladder contractility in patients with gallstones. Ann Surg 205: pp. 641-648 CrossRef
  19. Marzio, L (2003) Factors affecting gall bladder motility: drugs. Dig Liver Dis 35: pp. 17-19 CrossRef
  20. Petluri, G, Dutta, U, Bhattacharya, A, Bhadada, SK, Singh, K (2013) Vitamin-D deficiency in patients with gallstones: prevalence and effect of supplementation of parenteral vitamin-D on gallbladder ejection fraction. Indian J Gastroenterol 32: pp. A1-A132
  21. Hollis, BW, Johnson, D, Hulsey, TC, Ebeling, M, Wagner, CL (2011) Vitamin-D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 26: pp. 2341-2357 CrossRef
  22. Holick, MF, Binkley, NC, Bischoff-Ferrari, HA, Gordon, CM, Hanley, DA, Heaney, RP (2011) Evaluation, treatment, and prevention of vitamin-D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96: pp. 1911-1930 CrossRef
  23. Vieth, R (1999) Vitamin-D supplementation, 25-hydroxyvitamin-D concentrations, and safety. Am J Clin Nutr 69: pp. 842-856
  24. Bodnar, LM, Catov, JM, Simhan, HN, Holick, MF, Powers, RW, Roberts, JM (2007) Maternal vitamin-D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 92: pp. 3517-3522 CrossRef
  25. Zhang, C, Qiu, C, Hu, FB (2008) Maternal plasma 25-hydroxyvitamin-D concentrations and the risk for gestational diabetes mellitus. PLoS One 3: pp. e3753 CrossRef
  26. Goswami, R, Mishra, SK, Kochupillai, N (2008) Prevalence & potential significance of vitamin-D deficiency in Asian Indians. Indian J Med Res 127: pp. 229-238
  27. Holick, MF (2007) Vitamin-D deficiency. N Engl J Med 357: pp. 266-281 CrossRef
  28. Farrant, HJ, Krishnaveni, GV, Hill, JC, Boucher, BJ, Fisher, DJ, Noonan, K (2009) Vitamin-D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J Clin Nutr 63: pp. 646-652 CrossRef
  29. Goswami, R, Kochupillai, N, Gupta, N, Goswami, D, Singh, N, Dudha, A (2008) Presence of 25(OH) D deficiency in a rural North Indian village despite abundant sunshine. J Assoc Physicians India 56: pp. 755-757
  30. Sachan, A, Gupta, R, Das, V, Agarwal, A, Awasthi, PK, Bhatia, V (2005) High prevalence of vitamin-D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr 81: pp. 1060-1064
  31. Sahu, M, Bhatia, V, Aggarwal, A, Rawat, V, Saxena, P, Pandey, A, Das, V (2009) Vitamin-D deficiency in rural girls and pregnant women despite abundant sunshine in northern India. Clin Endocrinol 70: pp. 680-684 CrossRef
  32. Jani, R, Palekar, S, Munipally, T, Ghugre, P, Udipi, S (2014) Widespread 25-hydroxyvitamin d deficiency in affluent and nonaffluent pregnant Indian women. Biomed Res Int 2014: pp. 892162 CrossRef
  33. Kumar, N, Gupta, N, Kishore, J (2012) Kuppuswamy’s socioeconomic scale: updating income ranges for the year 2012. Indian J Public Health 56: pp. 103-104 CrossRef
  34. Mishra, A, Shrivastava, U (2013) Obesity and dyslipidemia in South Asians. Nutrients 5: pp. 2708-2733 CrossRef
  35. Dodds, WJ, Groh, WJ, Darweesh, RMA, Lawson, TL, Kishk, SMA, Kern, MK (1985) Sonographic measurement of gallbladder volume. Am J Roentgenol 145: pp. 1009-1011 CrossRef
  36. Al-Muqbel, Kusai M (2010) Gallbladder ejection fraction measured by fatty meal cholescintigraphy: is it affected by extended gallbladder emptying data acquisition time?. Ann Nucl Med 24: pp. 29-34 CrossRef
  37. Yap, L, Wycherley, AG, Morphett, AD, Toouli, J (1991) Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy. Gastroenterology 101: pp. 786-793
  38. Girgis, CM, Clifton-Bligh, RJ, Hamrick, MW, Holick, MF, Gunton, JE (2013) The roles of vitamin-D in skeletal muscle: form, function, and metabolism. Endocr Rev 34: pp. 33-83 CrossRef
  39. Pfeifer, M, Begerow, B, Minne, HW (2002) Vitamin-D and muscle function. Osteoporos Int 13: pp. 187-194 CrossRef
  40. Pedrosa, MA, Castro, ML (2005) Role of vitamin D in the neuro-muscular function. Arq Bras Endocrinol Metabol 49: pp. 495-502 CrossRef
  41. Ceglia, L (2008) Vitamin D and skeletal muscle tissue and function. Mol Asp Med 29: pp. 407-414 CrossRef
  42. Boyan, BD, Dean, DD, Sylvia, VL, Schwartz, Z (2003) Steroid hormone action in musculoskeletal cells involves membrane receptor and nuclear receptor mechanisms. Connect Tissue Res 44: pp. 130-135 CrossRef
  43. Ceglia, L (2009) Vitamin D and its role in skeletal muscle. Curr Opin Clin Nutr Metab Care 12: pp. 628-633 CrossRef
  44. Barut, I, Tarhan, OR, Baykal, B, Demir, M, Celikbas, B (2007) Higher incidence of cholelithiasis in chronic renal failure patients with secondary hyperparathyroidism undergoing peritoneal dialysis. Ren Fail 29: pp. 453-457 CrossRef
  45. Mok, LL, Nickols, GA, Thompson, JC, Cooper, CW (1989) Parathyroid hormone as a smooth muscle relaxant. Endocrinol Rev 10: pp. 420-436 CrossRef
  46. Kazama, JJ, Kazama, S, Koda, R (2009) The risk of gallbladder stone formation is increased in patients with predialysis chronic kidney disease but not those undergoing chronic hemodialysis therapy. Nephron Clin Pract 111: pp. c167-c172 CrossRef
  47. Li Vecchi, M, Soresi, M, Cusimano, R (2003) Prevalence of biliary lithiasis in a Sicilian population of chronic renal failure patients. Nephrol Dial Transplant 18: pp. 2321-2324 CrossRef
  48. Bikle, DD (2007) Vitamin-D insufficiency/deficiency in gastrointestinal disorders. J Bone Miner Res 22: pp. V50-V54 CrossRef
  49. Kaplan, MM, Elta, GH, Furie, B, Sadowski, JA, Russell, RM (1988) Fat-soluble vitamin nutrition in primary biliary cirrhosis. Gastroenterology 95: pp. 787-792
  50. Pandey, M, Shukla, VK (2003) Lifestyle, parity, menstrual and reproductive factors and risk of gallbladder cancer. Eur J Cancer Prev 12: pp. 269-272 CrossRef

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