Vitamin D and parathyroid hormone in the umbilical cord blood - Correlation with light and dark maternal skin color

During pregnancy, vitamin D deficiency is associated with negative health consequences for mother and child. Furthermore, dark skin color is associated with lower vitamin D levels. We investigated 25-hydroxy-vitamin D (25(OH)D) and parathyroid hormone (PTH) levels in mothers and in cord blood of their newborns depending on maternal skin color. We recruited 202 mother and child pairs at the University Hospital Zurich and measured 25(OH)D and PTH concentrations in maternal and postpartum umbilical cord blood. Skin type was self-reported based on the Fitzpatrick Scale (type I to V). Uni- and multivariate methods were used to compare the maternal and neonatal 25(OH)D and PTH levels by skin type (light: I-III vs. dark: IV-V). As many as 54.5% of all mothers and 41.1% of the neonates were 25(OH)D deficient. This was higher in the neonates of dark-skinned (55.9%) than in the neonates of light-skinned mothers (38.1%; p = .06). The correlation of 25(OH)D in the maternal with umbilical cord blood was high (light: r = 0.85, dark: r = 0.87), with higher concentrations of 25(OH) vitamin D in the umbilical cord than in maternal blood. Regression analysis revealed that country of origin and maternal 25(OH)D concentration were the only statistically significant determinants for umbilical cord blood 25(OH)D. We observed no correlation of maternal with umbilical cord PTH concentrations; median PTH concentrations in the umbilical cord (5.6 pg/ml) were significantly lower than in maternal blood (25.7 pg/ml). The recommendation of vitamin D supplementation in newborns in their first 3 years of life should be particularly emphasized to dark-skinned mothers

Retrospective Study on the Association between Maternal Macronutrient Intake and Urogenital Infections during Pregnancy in a Swiss Cohort

Aims: Urogenital infections during pregnancy have been linked to adverse pregnancy outcomes. The objective of this study was to test the hypothesis that macronutrient intake and relative macronutrient contribution to diet is related to the risk of developing urogenital infections during pregnancy. Study Design: This is a retrospective single center cohort study. Place and Duration of Study: Outpatient Clinic of Obstetrics at the University Hospital Zurich, Switzerland; between January 2009 and December 2010. Methodology: We included 774 pregnant women of ages ranging from 16 to 47 years with data on urogenital infections and diet history. A diet history of these pregnant women based on food intake during the last seven days was collected in a nutritional counselling program. Diet information of these same women was matched with vaginal/urinary/cervical specimens collected within 90 days (range) prior to the nutrition assessment. The pathogens analyzed included Gram-negative rods, Gram-positive rods, Gram-positive cocci (including group B Streptococcus), Gardnerella vaginalis, Chlamydia trachomatis, and Candida spp. The covariates were maternal age, body mass index (BMI), origin, and parity. Crude and adjusted odds ratios (ORs) were determined by logistic regression. Results: Among the 774 pregnant women, 47.7% had some kind of infection. High fat intake was positively associated with Gardnerella vaginalis (adjusted OR=3.6; 95% confidence interval (CI)=1.3–10; p=0.01). No association was seen between macronutrients or their distribution and other pathogens. However, significant associations were found between infections and covariates. Conclusions: Findings suggested that increased dietary fat intake is associated with vaginal infections, thereby predisposing women to adverse pregnancy outcomes. This signified the importance of appropriate diet during pregnancy

Memory CD8+ T Cells Balance Pro- and Anti-inflammatory Activity by Reprogramming Cellular Acetate Handling at Sites of Infection.

Serum acetate increases upon systemic infection. Acutely, assimilation of acetate expands the capacity of memory CD8+ T cells to produce IFN-γ. Whether acetate modulates memory CD8+ T cell metabolism and function during pathogen re-encounter remains unexplored. Here we show that at sites of infection, high acetate concentrations are being reached, yet memory CD8+ T cells shut down the acetate assimilating enzymes ACSS1 and ACSS2. Acetate, being thus largely excluded from incorporation into cellular metabolic pathways, now had different effects, namely (1) directly activating glutaminase, thereby augmenting glutaminolysis, cellular respiration, and survival, and (2) suppressing TCR-triggered calcium flux, and consequently cell activation and effector cell function. In vivo, high acetate abundance at sites of infection improved pathogen clearance while reducing immunopathology. This indicates that, during different stages of the immune response, the same metabolite-acetate-induces distinct immunometabolic programs within the same cell type

Auswirkungen der Vitamin-D-Versorgung in der Schwangerschaft auf die Gesundheit der Mutter

Hintergrund Durch die Anwesenheit der 1α-Hydroxylase, dem Enzym, das 25(OH) Vitamin D3 in das biologisch aktive 1,25(OH) Vitamin D3 umwandelt, auf den Plazentazellen liegt die Vermutung nahe, dass Vitamin D einen Einfluss auf die Schwangerschaftsentwicklung hat. Ziel Im Beitrag werden die Auswirkungen eines Vitamin-D-Mangels auf die Gesundheit der Mutter beleuchtet. Ergebnisse Schwer wiegende Erkrankungen in der Schwangerschaft wie Gestationsdiabetes und Präeklampsie wurden in epidemiologischen Studien mit einem Vitamin-D-Mangel assoziiert, wobei auch widersprüchliche Resultate beschrieben sind. Weiter wurden Infertilität, bakterielle Vaginose, beeinträchtigte Muskelfunktion, die zu mangelnden Kontraktionen führt, sowie die postpartale Depression und Osteoporose im Zusammenhang mit Vitamin-D-Mangel untersucht. Diskussion Große randomisierte Supplementierungsstudien fehlen bisher, weshalb der therapeutische Nutzen von Vitamin D weiterhin nicht vollständig geklärt ist. Background The presence of 1α-hydroxylase, the enzyme converting 25(OH) vitamin D3 into the biologically active form 1,25(OH) vitamin D3, on placental cells indicates the importance of vitamin D for the onset and development of a healthy pregnancy. Aim In this article the potential consequences of vitamin D deficiency on maternal health are presented and discussed. Results Gestational diabetes and preeclampsie, two severe diseases that can occur in pregnancy, have been associated with vitamin D deficiency in epidemiological studies but also some controversial results have been reported. Additionally the association of vitamin D deficiency with infertility, bacterial vaginosis, impaired muscle function leading to increased cesarean section rates, as well as postpartum depression and osteoporosis has been investigated. Discussion Large supplementation trials are currently still lacking in almost all aspects and therefore final conclusions on the therapeutic benefits of vitamin D cannot be drawn yet

Metabolische Vorsorge in der Schwangerschaft

Zusammenfassung: Hintergrund: Über die Ernährung werden wichtige Stoffwechselvorgänge in der Schwangerschaft beeinflusst. Ziel: Übersicht über die wichtigsten Mikro- und Makronährstoffe in der Schwangerschaft. Ergebnis und Diskussion: Die metabolische Vorsorge in der Schwangerschaft betrifft v.a. die Mikronährstoffe Folsäure, Eisen, VitaminB12, VitaminD, Kalzium und Jod. Bei den Makronährstoffen spielt ein Überschuss an Glukose als Ursache für den Gestationsdiabetes eine wichtige Rolle. Die langkettigen, mehrfach ungesättigten Fettsäuren sind für die Gehirnentwicklung des Fetus und bei der Frühgeborenenrate von besonderer Relevanz

Metabolische Vorsorge in der Schwangerschaft

Hintergrund Über die Ernährung werden wichtige Stoffwechselvorgänge in der Schwangerschaft beeinflusst. Ziel Übersicht über die wichtigsten Mikro- und Makronährstoffe in der Schwangerschaft. Ergebnis und Diskussion Die metabolische Vorsorge in der Schwangerschaft betrifft v. a. die Mikronährstoffe Folsäure, Eisen, Vitamin B12, Vitamin D, Kalzium und Jod. Bei den Makronährstoffen spielt ein Überschuss an Glukose als Ursache für den Gestationsdiabetes eine wichtige Rolle. Die langkettigen, mehrfach ungesättigten Fettsäuren sind für die Gehirnentwicklung des Fetus und bei der Frühgeborenenrate von besonderer Relevanz. = Background The diet can influence important metabolic pathways in the course of pregnancy. Goal Review of the most important micronutrients and macronutrients in pregnancy. Results and discussion For metabolic care during pregnancy the following micronutrients play an important role: folic acid, iron, vitamin B12, vitamin D, calcium and iodine. For the macronutrients, an impaired glucose tolerance is the cause of gestational diabetes and long chain polyunsaturated fatty acids influence neurological development of the fetus as well as being relevant for preterm delivery rates

Vitamin Substitution Beyond Childhood—Requirements and Risks

BACKGROUND Vitamins are vitally important, but they are not always adequately supplied with the diet. In this review, we present the advantages and disadvantages of vitamin supplementation and the indications for it in various life situations. METHODS This review is based on pertinent publications retrieved by a selective search of the literature. RESULTS The German National Nutrition Survey II (Nationale Verzehrsstudie II) showed that most people in Germany consume adequate amounts of vitamins in their diet, with the exception of vitamin D and folate. Supplements are often taken by adults who already consume a balanced diet. Depending on the vitamin, 3-13% of survey respondents took vitamin supplements; the ones most often taken were vitamins C and E. No convincing evidence has yet demonstrated a health benefit from vitamin supplementation in addition to a balanced diet for the primary prevention of nutrition-associated diseases. Vitamin supplementation is indicated in certain specific life situations, e.g., pregnancy, but otherwise unnecessary, unless a deficiency has been diagnosed or the individual is at elevated risk. CONCLUSION Vitamin supplementation is recommended for certain population groups: folic acid for pregnant women, vitamin B12 for vegans and persons with resorption disorders, vitamin D for persons with insufficient endogenous synthesis. In all other cases, it should first be tested whether the individual might be substantially helped by dietary changes alone. In general, the potential adverse effects of vitamin supplementation need to be considered, and its benefits weighed against its risks

Prevalence of vitamin D deficiency and its associations with skin color in pregnant women in the first trimester in a sample from switzerland

Vitamin D deficiency in pregnancy has negative clinical consequences, such as associations with glucose intolerance, and has been shown to be distributed differently in certain ethnic groups. In some countries, a difference in the rate of vitamin D deficiency was detected in pregnant women depending on their skin color. We examined the prevalence of vitamin D deficiency (<20 ng/mL) in women in early pregnancy in Switzerland and evaluated the association of skin color with vitamin D deficiency. In a single-center cohort study, the validated Fitzpatrick scale and objective melanin index were used to determine skin color. Of the 204 pregnant women included, 63% were vitamin D deficient. The mean serum 25-hydroxyvitamin D concentration was 26.1 ng/mL (95% confidence interval (CI) 24.8-27.4) in vitamin D-sufficient women and 10.5 ng/mL (95% CI 9.7-11.5) in women with deficiency. In the most parsimonious model, women with dark skin color were statistically significantly more often vitamin D deficient compared to women with light skin color (OR 2.60; 95% CI 1.08-6.22; adjusted for age, season, vitamin D supplement use, body mass index, smoking, parity). This calls for more intense counseling as one policy option to improve vitamin D status during pregnancy, i.e., use of vitamin D supplements during pregnancy, in particular for women with darker skin color

Maternal mortality in Switzerland 2005–2014

INTRODUCTION Maternal mortality is an important indicator for quality control in obstetrics. To improve clinical care, maternal mortality should be assessed periodically. In this study, we analysed maternal mortality cases between 2005 and 2014 in Switzerland and compared them with those in earlier periods. METHODS The Federal Statistical Office (FSO) provided all death certificates between 2005 and 2014 with an ICD-10 code in the obstetric field (indicated with the letter O). Additionally, we included all death certificates that gave a positive answer about pregnancy or birth within the last 42 days. We also included cases where death occurred within 365 days after delivery. For an analysis of underreporting, cases from the Institute of Forensic Medicine (IRM), Zurich, were included. The cases were classified according to ICD-10 as “direct”, “indirect”, “non-pregnancy-related”, and “late” deaths. The direct maternal mortality rate (MMR), and indirect and combined MMRs were calculated. RESULTS We received 117 cases from the FSO, and one additional case was found in the archives of the IRM. Ninety-six cases were eligible for detailed evaluation. As 787,025 live births were recorded between 2005 and 2014 in Switzerland, the direct MMR was 3.30/100,000 live births (26 cases). It has decreased by 20.5% compared with the MMR in 1995–2004 (4.15/100,000 live births, 32 cases; p = n.s.) and by 40.4% compared with the MMR in 1985–1994 (5.54/100,000 live births, 45 cases; odds ratio [OR] 0.6, p = 0.04, 95% confidence interval [CI] 0.37–0.97). The leading cause for direct maternal mortality in the current study period was haemorrhage (nine cases), followed by amniotic fluid embolisms and preeclampsia (five cases each). The indirect MMR was 3.68/100,000 live births. In this group, 13 women committed suicide and 8 women died of complications of pre-existing cardiac pathologies. Suicide was the leading cause of maternal deaths, had suicides been classified as direct obstetric cases. The combined MMR (direct and indirect) was 6.61/100,000 live births (52 cases) (OR 4.8–8.4). Of 41 non-pregnancy-related cases, almost half (20 cases) died of cancer within the first year after delivery. Lethality after caesarean section was 0.008‰ (2/231,385). CONCLUSIONS The trend of reducing direct maternal mortality as well as lethality after caesarean section continues. Haemorrhage is still the leading cause of direct maternal mortality; the rate is similar to what it was in the early 1990s. Indirect maternal mortality is increasing and specifically suicides need special attention. Precise documentation of all maternal deaths is essential to improve outcomes for future mothers. Keywords: : maternal mortality, Switzerland, direct mortality, indirect mortality, non-pregnancy-related mortalit