2023, Número 10
<< Anterior Siguiente >>
Ginecol Obstet Mex 2023; 91 (10)
Déficit de vitamina D y alto riesgo obstétrico: revisión narrativa
Molina GS, Tijerina A, Torres VN
Idioma: Español
Referencias bibliográficas: 84
Paginas: 736-752
Archivo PDF: 276.80 Kb.
RESUMEN
Antecedentes: Existe interés creciente en los efectos de la vitamina D en el embarazo
y en la función placentaria, homeostasis de la glucosa, infección y respuesta
inflamatoria, además de la asociación de su deficiencia con enfermedades de alto
riesgo obstétrico.
Objetivo: Identificar los aspectos relevantes conocidos y controvertidos del déficit de
vitamina D y de su suplementación en pacientes con alto riesgo obstétrico que permitan
aportarle al lector herramientas para la toma de decisiones en la práctica clínica.
Metodología: Se llevó a cabo una revisión de la bibliografía registrada en las bases
de datos de MEDLINE vía PubMed, EBSCO y OVID del 2016 al 2022. Se consultaron
artículos publicados en inglés y español, con los términos MeSH “Vitamin D”, “preeclampsia”,
“premature birth”, "diabestes, gestational" y “fetal growth retardation”.
Resultados: La búsqueda inicial arrojó 685 artículos de los que se descartaron
364 por falta de pertinencia, 248 por falta del recurso completo y 44 por duplicaciones.
De acuerdo con el objetivo planteado, al final quedaron 29 artículos que se
complementaron con 55 textos clásicos encontrados en una búsqueda manual para
contextualización de la revisión.
Conclusiones: La evidencia respecto de la asociación entre deficiencia de vitamina
D y pobres desenlaces obstétricos, en términos de tasas de preeclampsia, parto
pretérmino, diabetes gestacional y restricción del crecimiento fetal no es concluyente.
Sin embargo, el análisis de los estudios mencionados muestra una relación entre el
déficit de vitamina D y el aumento del riesgo, desenlaces impactantes y consistentes
con el riesgo de resultar con diabetes gestacional.
REFERENCIAS (EN ESTE ARTÍCULO)
Bouillon R, Manousaki D, Rosen C, Trajanoska K, RivadeneiraF, Brent J. The health effects of vitamin D supplementation:Evidence from human studies. Nature Reviews Endocrinology 2022; 18 (2): 96-110. doi: 10.1038/s41574-021-00593-z
Saraf R, Morton SM, Camargo Jr CA, Grant CC. Globalsummary of maternal and newborn vitamin D status -asystematic review. Maternal & Child Nutrition 2016; 12(4): 647-68. doi: 10.1111/mcn.12210
Palacios C, González L. Is vitamin D deficiency a major globalpublic health problem? J Steroid Biochem Mol Biol 2014;144: 138-45. doi: 10.1016/j.jsbmb.2013.11.003
Dawodu A, Wagner CL. Mother-child vitamin D deficiency:an international perspective. ADC 2007; 92 (9): 737-40. doi:10.1136/adc.2007.122689
Heyden E, Wimalawansa S. Vitamin D: Effects on humanreproduction, pregnancy, and fetal well-being. J SteroidBiochem Mol Biol 2018; 180: 41-50. doi: 10.1016/j.jsbmb.2017.12.011
Karras SN, Wagner CL, Castracane VD. Understandingvitamin D metabolism in pregnancy: From physiology topathophysiology and clinical outcomes. Metabolism 2018;86: 112-23. doi: 10.1016/j.metabol.2017.10.001
Javaid M, Crozier S, Harvey N, Gale CR, Dennison EM,Boucher BJ, et al. Maternal vitamin D status during pregnancyand childhood bone mass at age 9 years: a longitudinalstudy. Lancet 2006; 367 (9504): 36-43. doi: 10.1016/S0140-6736(06)67922-1
Viljakainen HT, Saarnio E, Hytinantti T, Miettinen M, SurcelH, Makitie O, et al. Maternal vitamin D status determinesbone variables in the newborn. J Clin Endocrinol Metab2010; 95 (4): 1749-57. doi: 10.1210/jc.2009-1391
Gallo S, McDermid JM, Al-Nimr RI, Hakeem R, Moreschi JM,Pari-Keener M, et al. Vitamin D supplementation duringpregnancy: an evidence analysis center systematic reviewand meta-analysis. J Acad Nutr Diet 2020; 120 (5): 898-924.e4.doi 10.1016/j.jand.2019.07.002
Guideline W. Vitamin D supplementation in pregnantwomen. Geneva: World Health Organization.2012;2012. http://apps.who.int/iris/bitstream/handLe/10665/85313/9789241504935_eng.pdf;jsessionid=F3B78CF8153E2C40A328F987128D9302?sequence=1
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM,Hanley DA, Heaney RP, et al. Evaluation, treatment, andprevention of vitamin D deficiency: an Endocrine Societyclinical practice guideline. J Clin Endocrinol Metab 2011;96 (7): 1911-30. doi: 10.1210/jc.2011-0385
Gynecologists ACOG. Vitamin D: screening and supplementationduring pregnancy. Committee Opinion No.495. Obstet Gynecol 2011; 118: 197-8. doi: 10.1097/AOG.0b013e318227f06b
Calvo MS, Whiting SJ, Barton CN. Vitamin D intake: a globalperspective of current status. J Nutr 2005; 135 (2): 310-6.doi: 10.1093/jn/135.2.310
Lips P. Vitamin D physiology. Progress in biophysics andmolecular biology. Prog Biophys Mol Biol 2006; 92 (1): 4-8.doi: 10.1016/j.pbiomolbio.2006.02.016
Qin LL, Lu FG, Yang SH, Xu HL, Luo BA. Does maternalvitamin D deficiency increase the risk of preterm birth: ameta-analysis of observational studies. Nutrients 2016; 8(5): 301. doi: 10.3390/nu8050301
Bikle DD. Vitamin D and the skin: Physiology and pathophysiology.Reviews in Endocrine and Metabolic Disorders.2012;13(1):3-19. doi: 10.1007/s11154-011-9194-0
Heaney RP. Vitamin D endocrine physiology. Journal ofBone and Mineral Research. 2007;22(S2):V25-V7. doi:10.1359/jbmr.07s205
Strugnell SA, DeLuca HF. The vitamin D receptor—structureand transcriptional activation. Proceedings of the Societyfor Experimental Biology and Medicine. 1997;215(3):223-8.doi: 10.3181/00379727-215-44131
Pike J, Kesterson R, Scott R, Kerner S, McDonnelll DP,O´Malley B. Vitamin D3 receptors: molecular structure ofthe protein and its chromosomal gene. Vitamin D, Molecular,Cellular and Clinical Endocrinology: Proceedings of theSeventh Workshop on Vitamin D, eds Norman AW, SchaeferK, Grigoleit HG, Herrath D (de Gruyter, New York); 1988.doi: 10.1515/9783110846713.215
Karras SN, Fakhoury H, Muscogiuri G, Grant WB, VanDen Ouweland JM, Colao AM, et al. Maternal vitamin Dlevels during pregnancy and neonatal health: evidenceto date and clinical implications. Therapeutic advancesin musculoskeletal disease. 2016;8(4):124-35. doi:10.1177/1759720X16656810
Kovacs CS. The role of vitamin D in pregnancy and lactation:insights from animal models and clinical studies. Annualreview of nutrition. 2012;32:97-123. doi: 10.1146/annurevnutr-071811-150742
Kumar R, Cohen W, Silva P, Epstein F. Elevated 1, 25-dihydroxyvitaminD plasma levels in normal human pregnancyand lactation. The Journal of clinical investigation.1979;63(2):342-4. doi: 10.1172/JCI109308
Steichen JJ, Tsang RC, Gratton TL, Hamstra A, DeLuca HF.Vitamin D homeostasis in the perinatal period: 1, 25-dihydroxyvitaminD in maternal, cord, and neonatal blood.New England Journal of Medicine. 1980;302(6):315-9. doi:10.1056/NEJM198002073020603
Tamblyn J, Hewison M, Wagner C, Bulmer J, Kilby MD.Immunological role of vitamin D at the maternal–fetalinterface. Journal of Endocrinology. 2015;224(3):R107-R21.doi: 10.1530/JOE-14-0642
Díaz L, Sánchez I, Avila E, Halhali A, Vilchis F, Larrea F. Identificationof a 25-hydroxyvitamin D3 1α-hydroxylase genetranscription product in cultures of human syncytiotrophoblastcells. The Journal of Clinical Endocrinology & Metabolism.2000;85(7):2543-9. doi: 10.1210/jcem.85.7.6693
Shin JS, Choi MY, Longtine MS, Nelson DM. VitaminD effects on pregnancy and the placenta. Placenta.2010;31(12):1027-34. doi: 10.1016/j.placenta.2010.08.015
Barrera D, Avila E, Hernández G, Halhali A, Biruete B, LarreaF, et al. Estradiol and progesterone synthesis in humanplacenta is stimulated by calcitriol. The Journal of steroidbiochemistry and molecular biology. 2007;103(3-5):529-32. doi: 10.1016/j.jsbmb.2006.12.097
Chan S, Susarla R, Canovas D, Vasilopoulou E, Ohizua O,McCabe CJ, et al. Vitamin D promotes human extravilloustrophoblast invasion in vitro. Placenta. 2015;36(4):403-9.doi: 10.1016/j.placenta.2014.12.021
Tamblyn J, Susarla R, Jenkinson C, Jeffery L, Ohizua O, ChunRF, et al. Dysregulation of maternal and placental vitamin Dmetabolism in preeclampsia. Placenta. 2017;50:70-7. doi:10.1016/j.placenta.2016.12.019
Kovacs CS, WoodLand ML, Fudge NJ, Friel JK. The vitamin Dreceptor is not required for fetal mineral homeostasis or forthe regulation of placental calcium transfer in mice. AmericanJournal of Physiology-Endocrinology and Metabolism.2005;289(1):E133-E44. doi: 10.1152/ajpendo.00354.2004
Young BE, Cooper EM, McIntyre AW, Kent T, Witter F, HarrisZL, et al. Placental vitamin D receptor (VDR) expression isrelated to neonatal vitamin D status, placental calciumtransfer, and fetal bone length in pregnant adolescents.The FASEB journal. 2014;28(5):2029-37. doi: 10.1096/fj.13-246736
Bouillon R, Van Assche FA, Van Baelen H, Heyns W, De MoorP. Influence of the vitamin D-binding protein on the serumconcentration of 1, 25-dihydroxyvitamin D 3: significanceof the free 1, 25-dihydroxyvitamin D 3 concentration. TheJournal of clinical investigation. 1981;67(3):589-96. doi:10.1172/JCI110072
Narchi H, Kochiyil J, Zayed R, Abdulrazzak W, Agarwal M.Maternal vitamin D status throughout and after pregnancy.Journal of Obstetrics and Gynaecology. 2010;30(2):137-42.doi: 10.3109/01443610903315652
Fernández-Alonso AM, Dionis-Sánchez EC, Chedraui P,González-Salmerón MD, Perez-Lopez FR. First-trimestermaternal serum 25-hydroxyvitamin D3 status and pregnancyoutcome. Int J Gynaecol Obstet 2012; 116 (1): 6-9.doi: 10.1016/j.ijgo.2011.07.029
Holmes VA, Barnes MS, Alexander HD, McFaul P, WallaceJM. Vitamin D deficiency and insufficiency inpregnant women: a longitudinal study. British Journalof Nutrition. 2009;102(6):876-81. doi: 10.1017/S0007114509297236
Markestad T, Aksnes L, Ulstein M, Aarskog D. 25-HydroxyvitaminD and 1, 25-dihydroxyvitamin D of D2 and D3 originin maternal and umbilical cord serum after vitamin D2supplementation in human pregnancy. The American journalof clinical nutrition. 1984;40(5):1057-63. doi: 10.1093/ajcn/40.5.1057
Zhang JY, Lucey AJ, Horgan R, Kenny LC, Kiely M. Impact ofpregnancy on vitamin D status: a longitudinal study. BritishJournal of Nutrition. 2014;112(7):1081-7. doi: 10.1017/S0007114514001883
Marzolo M-P, Farfán P. New insights into the roles ofmegalin/LRP2 and the regulation of its functional expression.Biological research. 2011;44(1):89-105. doi: 10.4067/S0716-97602011000100012
Ma R, Gu Y, Zhao S, Sun J, Groome LJ, Wang Y. Expressionsof vitamin D metabolic components VDBP, CYP2R1,CYP27B1, CYP24A1, and VDR in placentas from normal andpreeclamptic pregnancies. American Journal of Physiology-Endocrinology and Metabolism. 2012;303(7):E928-E35.doi: 10.1152/ajpendo.00279.2012
Powe CE, Seely EW, Rana S, Bhan I, Ecker J, Kurumanchi A, etal. First trimester vitamin D, vitamin D binding protein, andsubsequent preeclampsia. Hypertension. 2010;56(4):758-63. doi: 10.1161/HYPERTENSIONAHA.110.158238
Liong S, Di Quinzio M, Fleming G, Permezel M, Rice GE,Georgiou HM. New biomarkers for the prediction of spontaneouspreterm labour in symptomatic pregnant women:a comparison with fetal fibronectin. BJOG 2015; 122 (3):370-9. doi: 10.1111/1471-0528.12993
Liong S, Di Quinzio MK, Fleming G, Permezel M, GeorgiouHM. Is vitamin D binding protein a novel predictor of labour?PloS one 2013; 8 (10): e76490. doi: 10.1371/journal.pone.0076490
Bodnar LM, Platt RW, Simhan HN. Early-pregnancy vitaminD deficiency and risk of preterm birth subtypes.Obstet Gynecol 2015; 125 (2): 439. doi: 10.1097/AOG.0000000000000621
Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR. Calciumsupplementation during pregnancy for preventing hypertensivedisorders and related problems. Cochrane databaseof systematic reviews. 2018(10). doi: 10.1002/14651858.CD001059.pub5
Del Valle HB, Yaktine AL, Taylor CL, Ross AC. Dietaryreference intakes for calcium and vitamin D. 2011. doi:10.17226/13050
Holick MF. Vitamin D status: measurement, interpretation,and clinical application. Annals of epidemiology.2009;19(2):73-8. doi: 10.1016/j.annepidem.2007.12.001
Ross AC. The 2011 report on dietary reference intakesfor calcium and vitamin D. Public health nutrition.2011;14(5):938-9. doi: 10.1017/S1368980011000565
Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. VitaminD supplementation during pregnancy: Double‐blind,randomized clinical trial of safety and effectiveness. JBMR2011; 26 (10): 2341-57. doi: 10.1002/jbmr.463
Choi R, Kim S, Yoo H, Cho Y, Kim SW, Chung JH, et al. Highprevalence of vitamin D deficiency in pregnant Koreanwomen: The first trimester and the winter season as riskfactors for vitamin D deficiency. Nutrients 2015; 7: 3427-48.doi: 10.3390/nu7053427
Wei S-Q, Qi H-P, Luo Z-C, Fraser WD. Maternal vitaminD status and adverse pregnancy outcomes: a systematicreview and meta-analysis. J Matern Fetal Neonatal Med2013; 26 (9): 889-99. doi: 10.3109/14767058.2013.765849
Ghulmiyyah L, Sibai B, editors. Maternal mortality frompreeclampsia/eclampsia. Seminars in perinatology; 2012:Elsevier. doi: 10.1053/j.semperi.2011.09.011
Momentti AC, Estadella D, Pisani LP. Role of vitamin Din pregnancy and Toll-like receptor pathway. Steroids.2018;137:22-9. doi: 10.1016/j.steroids.2018.07.009
Wagner CL, Taylor SN, Dawodu A, Johnson DD, Hollis BW.Vitamin D and its role during pregnancy in attaining optimalhealth of mother and fetus. Nutrients. 2012;4(3):208-30.doi: 10.3390/nu4030208
Hollis BW, Wagner CL. Vitamin D and pregnancy: skeletaleffects, nonskeletal effects, and birth outcomes. Calcifiedtissue international. 2013;92(2):128-39. doi: 10.1007/s00223-012-9607-4
Barrera D, Díaz L, Noyola-Martínez N, Halhali A. Vitamin Dand inflammatory cytokines in healthy and preeclampticpregnancies. Nutrients. 2015;7(8):6465-90. doi: 10.3390/nu7085293
Woo J, Giurgescu C, Wagner CL. Evidence of an associationbetween vitamin D deficiency and preterm birth and preeclampsia:a critical review. Journal of midwifery & women'shealth. 2019;64(5):613-29. doi: 10.1111/jmwh.13014
Pérez-López FR, Pasupuleti V, Mezones-Holguin E, Benites-Zapata VA, Thota P, Deshpande A, et al. Effect of vitaminD supplementation during pregnancy on maternal andneonatal outcomes: a systematic review and meta-analysisof randomized controlled trials. Fertility and Sterility 2015;103 (5): 1278-88. e4. doi: 10.1016/j.fertnstert.2015.02.019
Roth DE, Leung M, Mesfin E, Qamar H, et al. Vitamin Dsupplementation during pregnancy: state of the evidencefrom a systematic review of randomised trials. Bmj.2017;359. doi: 10.1136/bmj.j5237
Harvey NC, Holroyd C, Ntani G, Javaid K, Cooper P, Moon R,et al. Vitamin D supplementation in pregnancy: a systematicreview. Health technology assessment (Winchester,England). 2014;18(45):1-190. doi: 10.3310/hta18450
Tabesh M, Salehi-Abargouei A, Tabesh M, EsmaillzadehA. Maternal vitamin D status and risk of pre-eclampsia:a systematic review and meta-analysis. J Clin EndocrinolMetab 2013; 98 (8): 3165-73. doi: 10.1210/jc.2013-1257
Khaing W, Arj-Ong Vallibhakara S, Tantrakul V, VallibhakaraO, Rattanasiri S, McEvoy M, et al. Calcium and VitaminD Supplementation for Prevention of Preeclampsia: ASystematic Review and Network Meta-Analysis. Nutrients2017. doi: 10.3390/nu9101141
De‐Regil LM, Palacios C, Lombardo LK, Peña‐Rosas JP.Vitamin D supplementation for women during pregnancy.Cochrane database of systematic reviews. 2016(1). doi:10.1002/14651858.CD008873.pub3
Aguilar-Cordero M, Lasserrot-Cuadrado A, Mur-Villar N,León-Ríos X, Rivero-Blanco T, Perez-Castillo IM. VitaminD, preeclampsia and prematurity: A systematic reviewand meta-analysis of observational and interventionalstudies. Midwifery. 2020;87:102707. doi: 10.1016/j.midw.2020.102707
Fogacci S, Fogacci F, Banach M, Michos ED, Hernandez AV,Lip G, et al. Vitamin D supplementation and incident preeclampsia:A systematic review and meta-analysis of randomizedclinical trials. Clinical Nutrition. 2020;39(6):1742-52. doi: 10.1016/j.clnu.2019.08.015
Rostami M, Tehrani FR, Simbar M, Bidhendi Yarandi R,Minooee S, Hollis BW, et al. Effectiveness of prenatalvitamin D deficiency screening and treatment program:a stratified randomized field trial. The Journal of ClinicalEndocrinology & Metabolism. 2018;103(8):2936-48. doi:10.1210/jc.2018-00109
Ali AM, Alobaid A, Malhis TN, Khattab AF. Effect of vitaminD3 supplementation in pregnancy on risk of preeclampsia–Randomized controlled trial. Clinical Nutrition.2019;38(2):557-63. 10.1016/j.clnu.2018.02.023
Zhang M, Michos ED, Wang G, Wang X, Mueller NT. Associationsof cord blood vitamin D and preeclampsia withoffspring blood pressure in childhood and adolescence.JAMA network open. 2020;3(10):e2019046-e. doi:10.1001/jamanetworkopen.2020.19046
Alimohamadi S, Esna-Ashari F, Rooy RSB. Relationship ofvitamin D serum level with intrauterine growth retardationin pregnant women. Int J Women’s Heal Reprod Sci.2020;8:221-6. doi: 10.15296/ijwhr.2020.35
Fang K, He Y, Mu M, Liu K. Maternal vitamin D deficiencyduring pregnancy and low birth weight: a systematicreview and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2021;34(7):1167-73. doi:10.1080/14767058.2019.1623780
Wang L, Zhang C, Song Y, Zhang Z. Serum vitamin D deficiencyand risk of gestational diabetes mellitus: a metaanalysis.Archives of Medical Science. 2020;16(1). doi:10.5114/aoms.2020.94433
Zhang Y, Gong Y, Xue H, Xiong J, Cheng G. Vitamin D andgestational diabetes mellitus: a systematic review basedon data free of Hawthorne effect. BJOG: An InternationalJournal of Obstetrics & Gynaecology. 2018;125(7):784-93.doi: 10.1111/1471-0528.15060
Milajerdi A, Abbasi F, Mousavi SM, Esmaillzadeh A. Maternalvitamin D status and risk of gestational diabetes mellitus:A systematic review and meta-analysis of prospectivecohort studies. Clinical Nutrition 2021; 40 (5): 2576-86. doi:10.1016/j.clnu.2021.03.037
Wang M, Chen Z, Hu Y, Wang Y, Wu Y, Lian F, et al. The effectsof vitamin D supplementation on glycemic control andmaternal-neonatal outcomes in women with establishedgestational diabetes mellitus: a systematic review andmeta-analysis. Clinical Nutrition 2021; 40 (5): 3148-57.doi: 10.1016/j.clnu.2020.12.016
Wagner C, Baggerly C, McDonnell S, Baggerly K, French CB,Baggerly L, et al. Post-hoc analysis of vitamin D status andreduced risk of preterm birth in two vitamin D pregnancycohorts compared with South Carolina March of Dimes2009-2011 rates. J Steroid Biochem Mol Biol 2016; 155:245-51. doi: 10.1016/j.jsbmb.2015.10.022
Thorne‐Lyman AL, Fawzi WW. Vitamin A and carotenoidsduring pregnancy and maternal, neonatal and infant healthoutcomes: a systematic review and meta‐analysis.PaediatrPerinat Epidemiol 2012; 26: 36-54. doi: 10.1111/j.1365-3016.2012.01284.x
Amegah AK, Klevor MK, Wagner CL. Maternal vitaminD insufficiency and risk of adverse pregnancy and birthoutcomes: a systematic review and meta-analysis of longitudinalstudies. PLoS One 2017; 12 (3): e0173605. doi:10.1371/journal.pone.0173605
Zhou SS, Tao YH, Huang K, Zhu BB, Tao FB. Vitamin Dand risk of preterm birth: Up‐to‐date meta‐analysis ofrandomized controlled trials and observational studies.J Obstet Gynaecol 2017; 43 (2): 247-56. doi: 10.1111/jog.13239
Lian RH, Qi PA, Yuan T, Yan PJ, et al. Systematic review andmeta-analysis of vitamin D deficiency in different pregnancyon preterm birth: Deficiency in middLe pregnancymight be at risk. Medicine 2021; 100 (24). doi: 0.1097/MD.0000000000026303
Wagner CL, Hollis BW, Kotsa K, Fakhoury H, Karras SN.Vitamin D administration during pregnancy as preventionfor pregnancy, neonatal and postnatal complications. RevEndocr Metb Disord 2017; 18 (3): 307-22. doi: 10.1007/s11154-017-9414-3
Hollis BW, Wagner CL. New insights into the vitamin Drequirements during pregnancy. Bone Research 2017; 5(1):1-16. doi: 10.1038/boneres.2017.30
Hewison M. Vitamin D and the immune system: new perspectiveson an old theme. Rheum Dis Clin 2012; 38 (1):125-39. doi: 10.1016/j.rdc.2012.03.012
Schulz EV, Cruze L, Wei W, Gehris J, Wagner CL. Maternalvitamin D sufficiency and reduced placental gene expressionin angiogenic biomarkers related to comorbidities ofpregnancy. J Steroid Biochem Mol Biol 2017; 173:273-9.doi: 10.1016/j.jsbmb.2017.02.003
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, WetterslevJ, Simonetti RG, et al. Vitamin D supplementation forprevention of mortality in adults. Cochrane 2014 (1). doi:10.1002/14651858.CD007470.pub3
Bialy L, Fenton T, Shulhan-Kilroy J, Johnson DW, McNeilDA, Hartling L. Vitamin D supplementation to improvepregnancy and perinatal outcomes: an overview of 42 systematicreviews. BMJ 2020; 10 (1): e032626. doi: 10.1136/bmjopen-2019-032626