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Preeclampsia risk reduced 7X by 4,000 IU of Vitamin D daily – RCT March 2018

Effect of vitamin D3 supplementation in pregnancy on risk of pre-eclampsia - Randomized controlled trial.

Clin Nutr. 2018 Mar 2. pii: S0261-5614(18)30088-8. doi: 10.1016/j.clnu.2018.02.023. [Epub ahead of print]

VitaminDWiki

Pages listed in BOTH the categories Pregnancy and Hypertension (proxie for preeclampsia)


Ali AM1, Alobaid A1, Malhis TN1, Khattab AF2.
1 Women Specialized Hospital, King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Saudi Arabia.
2 Women Specialized Hospital, King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Saudi Arabia. Electronic address: akhattab at kfmc.med.sa.

BACKGROUND:
Vitamin D plays pivotal role in decidualization and implantation of the placenta. Recent researches have shown that low level of vitamin D3 "25-hydroxyvitamin D (25[OH]D)" in serum is a risk factor for pre-eclampsia. Latest evidence supports role of vitamin D3 deficiency treatment in reducing the risk of pre-eclampsia. The aim of this study is to determine the effect of antenatal supplementation of vitamin D3 on the risk of pre-eclampsia and to explore the dose effect in attaining the vitamin D3 normal level.

METHOD:
An open labelled randomized controlled study was conducted on 179 pregnant women presenting in King Fahad Medical City antenatal clinic from Oct 2012-Oct 2015. Patients with age less than 20 years or more than 40 years, pregnancy with fetal anomalies, history of hypertension, pre-eclampsia, recurrent miscarriage, chronic renal or hepatic disease and malignancy were excluded from the study. Serum 25[OH]D was analysed during the first trimester (between 6 and 12 weeks of pregnancy). Patients with vitamin D3 deficiency (serum levels <25 nmol/L) were included in the study and randomized for vitamin D3 supplementation 400 IU (Group 1) versus 4000 IU (Group 2). Both groups were compared for the prevalence of pre-eclampsia and dose effect on vitamin D level.

RESULTS:
Of 179 gravidae enrolled, 164 completed the trial. Mean maternal 25[OH]D was significantly increased in group 2 from 16.3 ± 5 nmol/mL to 72.3 ± 30.9 nmol/mL compared with group 1 from 17.5 ± 6.7 nmol/mL to 35.3 ± 20.7 nmol/mL (p > 0.0001). The relative risk reduction (RRR) for attaining ≥75 nmol/L before delivery was significantly higher (RRR 93.2 [CI 79-98] when treated with 4000 IU. The total incidence of pre-eclampsia in the study population was 4.3%. In comparison to group 1, the group 2 reported fewer pre-eclampsia events during the study period (8.6% versus 1.2%; p < 0.05). The total number of IUGRs was lesser in the group 2 (9.6%) versus group 1 (22.2%); p = 0.027. However, other obstetric outcomes were comparable between both groups.

CONCLUSION:
Vitamin D supplementation in the deficient group reduces the risk of pre-eclampsia and IUGR in a dose dependant manner. However larger clinical trials are essential to investigate optimum dosage of vitamin D3 in this group.

PMID: 29550150 DOI: 10.1016/j.clnu.2018.02.023

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