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Vitamin D Deficiency and Adverse Pregnancy Outcomes – Jan 2015

Regulation of Calcitriol Biosynthesis and Activity: Focus on Gestational Vitamin D Deficiency and Adverse Pregnancy Outcomes

Nutrients 2015, 7(1), 443-480; doi:10.3390/nu7010443
Andrea Olmos-Ortiz, Euclides Avila, Marta Durand-Carbajal and Lorenza Díaz
Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan 14000, Mexico City, Mexico
(This article belongs to the Special Issue Nutrition in Pregnancy)

Vitamin D has garnered a great deal of attention in recent years due to a global prevalence of vitamin D deficiency associated with an increased risk of a variety of human diseases. Specifically, hypovitaminosis D in pregnant women is highly common and has important implications for the mother and lifelong health of the child, since it has been linked to maternal and child infections, small-for-gestational age, preterm delivery, preeclampsia, gestational diabetes, as well as imprinting on the infant for life chronic diseases. Therefore, factors that regulate vitamin D metabolism are of main importance, especially during pregnancy. The hormonal form and most active metabolite of vitamin D is calcitriol. This hormone mediates its biological effects through a specific nuclear receptor, which is found in many tissues including the placenta. Calcitriol synthesis and degradation depend on the expression and activity of CYP27B1 and CYP24A1 cytochromes, respectively, for which regulation is tissue specific. Among the factors that modify these cytochromes expression and/or activity are calcitriol itself, parathyroid hormone, fibroblast growth factor 23, cytokines, calcium and phosphate. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes.

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Table 5. Cholecalciferol supplementation and VD status in randomized clinical trials in healthy pregnant women.


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IU Cumulative Benefit Blood level CofactorsCalcium $*/month
200 Better bones for mom
with 600 mg of Calcium
6 ng/ml increase Not needed No effect $0.10
400 Less Rickets (but not zero with 400 IU)
3X less adolescent Schizophrenia
Fewer child seizures
20-30 ng/ml Not needed No effect $0.20
2000 2X More likely to get pregnant naturally/IVF
2X Fewer dental problems with pregnancy
8X less diabetes
4X fewer C-sections (>37 ng)
4X less preeclampsia (40 ng vs 10 ng)
5X less child asthma
2X fewer language problems age 5
42 ng/ml Desirable < 750 mg $1
4000 2X fewer pregnancy complications
2X fewer pre-term births
49 ng/ml Should have
cofactors
< 750 mg $3
6000 Probable: larger benefits for above items
Just enough D for breastfed infant
More maternal and infant weight
Should have
cofactors
< 750 mg $4

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Vitamin D Deficiency and Adverse Pregnancy Outcomes – Jan 2015        

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5172 Pregnancy RCT - T5B.jpg admin 13 Mar, 2015 14:48 38.87 Kb 634
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5170 GDM studies T4.jpg admin 13 Mar, 2015 14:47 79.61 Kb 1910
5169 Adverse pregnancy outcomes.pdf PDF 2015 admin 13 Mar, 2015 14:47 285.00 Kb 440
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