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J Behav Med. 2018 Oct;41(5):680-689. doi: 10.1007/s10865-018-9924-9. Epub 2018 Apr 18.

Vitamin D deficiency and depressive symptoms in pregnancy are associated with adverse perinatal outcomes.

Author information

1
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Eynav.accortt@cshs.org.
2
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
3
Cedars-Sinai Biostatistics Core, Research Institute, Clinical and Translational Science Institute (CTSI), Clinical and Translational Research Center (CTRC), Los Angeles, CA, USA.
4
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Calvin.Hobel@cshs.org.

Abstract

Prenatal vitamin D deficiency and prenatal depression are both separately associated with adverse perinatal outcomes; however, to our knowledge no studies have investigated the effects of having both risk factors. Our objective was to determine to what extent vitamin D deficiency predicts adverse perinatal outcomes and whether elevated depressive symptoms in pregnancy places women at additional increased risk. This study was a secondary data analysis of prospective data collected from a cohort of pregnant women (N = 101) in an obstetric clinic of a large medical center. Maternal vitamin D deficiency (serum 25(OH)D ≤ 20 ng/ml) and depressive symptoms (Edinburgh Postnatal Depression Scale, EPDS) were assessed in early pregnancy. A composite of four adverse perinatal outcomes (low birth weight, preterm birth, small-for-gestational age, and preeclampsia) were abstracted from medical charts. Nineteen of the 101 women had one or more adverse perinatal outcome and 84% with an adverse outcome (16/19) were not White. Both prenatal and time of delivery vitamin D deficiency were associated with developing an adverse outcome compared to those vitamin D sufficient (prenatal relative risk 3.43; 95% CI 1.60-7.34, p = 0.004; delivery time relative risk 5.14, 95% CI 2.68-9.86, p = 0.004). These both remained significant after adjusting for BMI. A higher rate of adverse outcome was found when women had both prenatal vitamin D deficiency and elevated depressive symptoms (EPDS ≥ 10). Sixty percent with both risk factors had an adverse perinatal outcome versus 17% with only one or neither risk factor (relative risk 3.60; 95% CI 1.55-8.38, p = 0.045), worthy of investigation with larger samples. Together, prenatal vitamin D deficiency and elevated depressive symptoms in pregnancy may increase risk for adverse perinatal outcomes, especially in racial minorities. Obstetric providers should consider routine prenatal depression screening. The impact of vitamin D supplementation to reduce risk for adverse perinatal outcomes should be studied in prospective trials. Our results suggest that supplementation early in pregnancy might be especially beneficial for depressed women.

KEYWORDS:

25(OH)D; Adverse pregnancy outcome; Depression; Prenatal; Vitamin D deficiency

PMID:
29671167
DOI:
10.1007/s10865-018-9924-9
[Indexed for MEDLINE]

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