Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort

There is currently little information on changes in vitamin D status during pregnancy and its predictors. The aim was to study the determinants of change in vitamin D status during pregnancy and of vitamin D deficiency (<30 nmol/L) in early pregnancy. Blood was drawn in the first (T1) and third trimester (T3). Serum 25-hydroxyvitamin D (25(OH)D) (N = 1985) was analysed by liquid chromatography tandem-mass spectrometry. Season-corrected 25(OH)D was calculated by fitting cosine functions to the data. Mean (standard deviation) 25(OH)D was 64.5(24.5) nmol/L at T1 and 74.6(34.4) at T3. Mean age was 31.3(4.9) years, mean body mass index (BMI) was 24.5(4.2) kg/m2 and 74% of the women were born in Sweden. Vitamin D deficiency was common among women born in Africa (51%) and Asia (46%) and prevalent in 10% of the whole cohort. Determinants of vitamin D deficiency at T1 were of non-North European origin, and had less sun exposure, lower vitamin D intake and lower age. Season-corrected 25(OH)D increased by 11(23) nmol/L from T1 to T3. The determinants of season-corrected change in 25(OH)D were origin, sun-seeking behaviour, clothing style, dietary vitamin D intake, vitamin D supplementation and recent travel <35° N. In conclusion, season-corrected 25(OH)D concentration increased during pregnancy and depended partly on lifestyle factors. The overall prevalence of vitamin D deficiency was low but common among women born in Africa and Asia. Among them, the determinants of both vitamin D deficiency and change in season-corrected vitamin D status were fewer, indicating a smaller effect of sun exposure

Trajectory of vitamin D status during pregnancy in relation to neonatal birth size and fetal survival: a prospective cohort study

Background: We investigated the associations between vitamin D status in early and late pregnancy with neonatal small for gestational age (SGA), low birth weight (LBW) and preterm delivery. Furthermore, associations between vitamin D status and pregnancy loss were studied. Methods: Serum 25-hydroxyvitamin D (25OHD) was sampled in gestational week ≤ 16 (trimester 1 (T1), N = 2046) and > 31 (trimester 3 (T3), N = 1816) and analysed using liquid chromatography tandem mass spectrometry. Pregnant women were recruited at antenatal clinics in south-west Sweden at latitude 57–58°N. Gestational and neonatal data were retrieved from medical records. Multiple gestations and terminated pregnancies were excluded from the analyses. SGA was defined as weight and/or length at birth < 2 SD of the population mean and LBW as < 2500 g. Preterm delivery was defined as delivery < 37 + 0 gestational weeks and pregnancy loss as spontaneous abortion or intrauterine fetal death. Associations between neonatal outcomes and 25OHD at T1, T3 and change in 25OHD (T3-T1) were studied using logistic regression. Results: T1 25OHD was negatively associated with pregnancy loss and 1 nmol/L increase in 25OHD was associated with 1% lower odds of pregnancy loss (OR 0.99, p = 0.046). T3 25OHD ≥ 100 nmol/L (equal to 40 ng/ml) was associated with lower odds of SGA (OR 0.3, p = 0.031) and LBW (OR 0.2, p = 0.046), compared to vitamin D deficiency (25OHD < 30 nmol/L, or 12 ng/ml). Women with a ≥ 30 nmol/L increment in 25OHD from T1 to T3 had the lowest odds of SGA, LBW and preterm delivery. Conclusions: Vitamin D deficiency in late pregnancy was associated with higher odds of SGA and LBW. Lower 25OHD in early pregnancy was only associated with pregnancy loss. Vitamin D status trajectory from early to late pregnancy was inversely associated with SGA, LBW and preterm delivery with the lowest odds among women with the highest increment in 25OHD. Thus, both higher vitamin D status in late pregnancy and gestational vitamin D status trajectory can be suspected to play a role in healthy pregnancy

Preeclampsia and Blood Pressure Trajectory during Pregnancy in Relation to Vitamin D Status

Every tenth pregnancy is affected by hypertension, one of the most common complications and leading causes of maternal death worldwide. Hypertensive disorders in pregnancy include pregnancy-induced hypertension and preeclampsia. The pathophysiology of the development of hypertension in pregnancy is unknown, but studies suggest an association with vitamin D status, measured as 25-hydroxyvitamin D (25(OH)D). The aim of this study was to investigate the association between gestational 25(OH)D concentration and preeclampsia, pregnancy-induced hypertension and blood pressure trajectory. This cohort study included 2000 women. Blood was collected at the first (T1) and third (T3) trimester (mean gestational weeks 10.8 and 33.4). Blood pressure at gestational weeks 10, 25, 32 and 37 as well as symptoms of preeclampsia and pregnancy-induced hypertension were retrieved from medical records. Serum 25(OH)D concentrations (LC-MS/MS) in T1 was not significantly associated with preeclampsia. However, both 25(OH)D in T3 and change in 25(OH)D from T1 to T3 were significantly and negatively associated with preeclampsia. Women with a change in 25(OH)D concentration of ≥30 nmol/L had an odds ratio of 0.22 (p = 0.002) for preeclampsia. T1 25(OH)D was positively related to T1 systolic (β = 0.03, p = 0.022) and T1 diastolic blood pressure (β = 0.02, p = 0.016), and to systolic (β = 0.02, p = 0.02) blood pressure trajectory during pregnancy, in adjusted analyses. There was no association between 25(OH)D and pregnancy-induced hypertension in adjusted analysis. In conclusion, an increase in 25(OH)D concentration during pregnancy of at least 30 nmol/L, regardless of vitamin D status in T1, was associated with a lower odds ratio for preeclampsia. Vitamin D status was significantly and positively associated with T1 blood pressure and gestational systolic blood pressure trajectory but not with pregnancy-induced hypertension

When knowledge is insufficient: Communication difficulties for Somali refugee women meeting the Swedish maternity care.

Att arbeta med nykomna flyktingkvinnor ställer stora krav på barnmorskans kompetens. Språkbarriärer och kulturskillnader kan göra det svårt att nå kvinnan. Flyktingkvinnor och speciellt kvinnor från Afrika söder om Sahara har en högre andel komplicerade graviditeter och sämre perinatalt utfall i jämförelse med svenska kvinnor. Syftet med denna studie var att beskriva och analysera somaliska kvinnors uppfattningar om förebyggande vård och hälsa under graviditet. En pilotintervju med en deltagare och en gruppintervju med fyra deltagare genomfördes. Metoden som användes var fokusgrupp och resultatet analyserades med hermeneutisk ansats. Resultatet presenteras med en huvudtolkning, kommunikationssvårigheter och tre deltolkningar, tystnad, ömsesidig kunskapsbrist och otillräckligt nätverk. Resultatet diskuteras och förslag till förändringar i vården ges utifrån resultatet. Slutsatsen av studien är att kommunikationssvårigheter är ett problem i vården som behöver angripas från flera håll för att nå en jämställd vård. För att nå dessa kvinnor behöver vården inom Mödrahälsovården i Sverige bli mer kulturspecifik och enskilda patientmöten anpassas efter utsatta gruppers behov

Maternity Services in the suburb, the midwife in the meeting with immigrants.

Vård av gravida är en internationell angelägenhet. Barnmorskan har i sitt yrke ansvar för att vara kunskapsförmedlare och stödja kvinnor i livets olika skeden. Att möta invandrarkvinnor med speciella risker och vårdproblem ställer krav på barnmorskans kompetens. Syftet med uppsatsen är att genom en litteraturstudie beskriva invandrarkvinnors problematik i samband med graviditet och barnmorskans möte med denna grupp. Resultatet presenteras i fyra teman; påvisad risk, nutrition, kultur och språk och kommunikation. Studierna belyser vilka risker som finns hos gravida från andra länder och vilka kulturspecifika råd man kan behöva ge angående nutrition. De beskriver även svårigheten som språket kan medföra i kontakten mellan patient och vårdare och kulturens betydelse i mötet. I diskussionen belyses kunskap som finns om invandrarkvinnors ökade risk och de speciella vårdprogram som skulle kunna användas utifrån befintlig kunskap. Konklusionen blir att MHV i Sverige bör förtydliga vilka kvinnor som behöver extra övervakning med fokus på anemi, diabetes, SGA och D-vitaminbrist. Tolk och kulturtolk kan vara ett redskap för att kommunicera och kunna ge individuellt anpassad information

Anemia and iron deficiency in pregnancy, a descriptive study with women from western Sweden.

Bakgrund: Anemi och järnbrist är ett globalt hälsoproblem för gravida kvinnor. De länder som har högst andel ligger i Afrika och Asien. I studier framkommer att även i höginkomstländer har invandrade kvinnor och de med många graviditeter anemi och järnbrist i högre grad än andra. I arbetet som barnmorska inom kunskapsområdet reproduktiv och perinatal hälsa finns flera styrande dokument, som påtalar vikten av att verka för en jämlik vård med kvinnors mänskliga rättigheter som grund. En ojämlik vård kan vara negativt för samhället och individen. Anemi är definierat med lågt Hemoglobin (Hb), järnbrist kan vara en orsak till anemi. Detta kan ge hälsorisker för mor och barn under och efter graviditeten. Det finns nationella medicinska riktlinjer för vård i samband med graviditet, anemi och järnbrist men även lokala riktlinjer i många delar av landet. Syfte: Att undersöka förekomsten av järnbrist och anemi under graviditet och vilka bakgrundsfaktorer som är relaterade till anemi och järnbrist. Det sekundära syftet är att jämföra vård och behandling av kvinnor med anemi utifrån två olika medicinska riktlinjer Metod: Studien har hämtat data från en kohortstudie med rekrytering och insamling av data och blodprover från gravida i västra Sverige Enkätdata och journaldata inhämtades från 2126 kvinnor som deltog i kohortstudien från 2013 till 2014. En kvantitativ metod har använts med uträkningar som redovisats med medelvärden och standardavvikelser. Riskfaktorer för järnbrist och anemi utvärderades med multivariat logistisk regressionsanalys. De två olika medicinska riktlinjerna jämfördes som grupp A och B. Resultat: I hela gruppen hade 3,7 % anemi i första trimestern och 15,8 % hade järnbrist. Riskgrupper för anemi, vid inskrivning på barnmorskemottagning (BMM), var kvinnor födda i Afrika (OR= 6,1) och Asien(OR=3,7) och multiparitet=de som fött barn mer än 2 gånger (OR=2,4). Att vara född i länder utanför Europa hade samband med högre risk för anemi i andra trimestern. Järntillskott var ordinerat till de kvinnor som hade en högre sannolikhet för anemi i första och andra trimestern. I tredje trimestern ökade övervikt, Body Mass Index (BMI) 25–29,9, sannolikheten för anemi jämfört med om kvinnan hade lägre eller högre BMI (OR =2,2). faktorer som gav ökad sannolikhet för järnbrist var om kvinnan var äldre än 28 år (OR 0,5), multiparitet (OR 2,2) och att vara född i Asien (OR 1,6) eller i Afrika (OR 3,5). Det fanns signifikanta skillnader mellan grupp A och B i flera bakgrundsfaktorer och för Hb i andra trimestern. Slutsats; Gravida kvinnor i studien hade anemi och järnbrist i olika frekvens beroende på bakgrundsfaktorer. Sannolikheten för anemi och järnbrist under graviditet var högre hos kvinnor från Afrika och Asien, samt om de var multipara, än hos förstföderskor från Nordeuropa. Analys av Ferritin i tidig graviditet ger en möjlighet till tidig start av järntillskott. Jämförelsen mellan regionala riktlinjer i grupp A och grupp B visar på att en senare ordination av järntillskott kan vara negativt för andelen med anemi i mitten av graviditeten. Riskgrupper har tydliggjorts som kan behöva utökad information och vård under graviditeten.Background: Anemia and iron deficiency (ID) is a health problem for pregnant women, throughout the world. Countries in Africa and Asia have the highest rate of these problems. Research has found that in high income countries, women who are multipara or immigrants have anemia more often than others. The midwife in Sweden has an area of expertise of reproductive and neonatal health. There are documents from the government that states the importance of giving equal care with focus on women’s human rights. If health care is unequal there can be negative effects both individually and for the society. The definition of anemia is by the level of Hemoglobin (Hb). Iron deficiency (ID) can be one reason to anemia. Anemia and ID can sometimes give health problems to mother or child during pregnancy or at the delivery. There are national and more local or regional medical guidelines which regulates how the midwife should give care to pregnant women with anemia or ID. Aim: The aim of this study was to investigate the frequency of anemia and iron deficiency among pregnant women in Sweden and the background factors related to anemia and iron deficiency. The second aim was to compare care and treatment of pregnant women with anemia between two different medical guidelines. Method: This study has collected data from 2126 women in a cohort study made in southwest Sweden. Pregnant women were recruited during 2013 and 2014. Their blood samples and medical files where collected together with data from a questionnaire. Quantitative methods using descriptive methods with means and standard deviations where used. Risk factors for anemia and ID where analysed with multifactor logistic regression. Two different medical guidelines where compared with participants as group A and group B. Result: Within the population, in first trimester, 3, 7% had anemia and 15, 8 % showed ID. Background factors as multiparity (OR=2,4) or country of birth Africa (OR=6,1) or Asia (OR=3,7) were related with higher risk for anemia when constant was nulli-para and Northern 5 Europe, in the beginning of the pregnancy. In second trimester, the factor being born outside Europe was related to higher risk for anemia. Iron supplement was registered among women with a higher probability to anemia in the first and second trimester. In the third trimester was overweight defined by Body Mass Index (BMI) 25-29, 9, one factor that increased the probability for anemia (OR =2,2). Factors related to the probability to get ID, in the first trimester was older than 28 years (OR 0, 5) and multiparity (OR=2, 2) compared with first pregnancy. Compared with women born in Northern Europe the probability to get ID was higher among women born in Asia (OR=1,6) or in Africa (OR=3,5). There were differences between group A and B in background factors and significant difference in Hb in trimester two. Conclusions Pregnant women in this study had anemia and iron deficiency in different frequency according to characteristics. Risk groups had higher probability for anemia and iron deficiency. The probability is higher among women born in Asia or Africa and multipara compared to women from northern Europe expecting their first child. Risk groups for anemia and ID during pregnancy are made clear in this study, they may need extra care during pregnancy. Analysing Ferritin in early pregnancy is positive for early start with iron supplement. Comparison between regional guidelines in group A and B shows that if iron deficiency is discovered late it can be negative for the percentage with anemia in the middle of pregnancy

Characteristics of participants.

<p>Characteristics of participants.</p

Bivariable and multivariable logistic regression analysis of the determinants of preeclampsia.

<p>Bivariable and multivariable logistic regression analysis of the determinants of preeclampsia.</p

Mixed models analysis of determinants of systolic (SBP) and diastolic blood pressure (DBP) trajectory during pregnancy, corrected for baseline BP^a.

<p>Mixed models analysis of determinants of systolic (SBP) and diastolic blood pressure (DBP) trajectory during pregnancy, corrected for baseline BP<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0152198#t003fn002" target="_blank">^a</a>.</p