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

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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.

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Acknowledgements

AL designed and conducted the parent (DAVID) study. EEA developed the research questions for secondary analyses and wrote the first draft of this manuscript. JM analyzed the data. AL, CH and JM assisted in writing. All authors contributed to the present study design, interpretation of data, and approved the final manuscript. The authors have no financial gain related to the outcome of this research, and there are no potential conflicts of interest. We thank the participants in this study for contributing to this research and increasing our knowledge about the experiences of pregnant women. We acknowledge the support of the research team members, Susan Jackman, MS, RN and Morgan McKay, MSW at Cedars-Sinai Medical Center.

Funding

The parent (DAVID) study was partially supported by funding by a CTSA award No. UL1TR000445 from the National Center for Advancing Translational Sciences to AL and the Miriam Jacobs Chair in Maternal–Fetal Medicine (CJH).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Eynav Elgavish Accortt, Amy Lamb & Calvin J. Hobel

  2. Cedars-Sinai Biostatistics Core, Research Institute, Clinical and Translational Science Institute (CTSI), Clinical and Translational Research Center (CTRC), Los Angeles, CA, USA

    James Mirocha

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  1. Eynav Elgavish Accortt
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The authors Eynav Elgavish Accortt, Amy Lamb, James Mirocha, and Calvin J. Hobel declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

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Accortt, E.E., Lamb, A., Mirocha, J. et al. Vitamin D deficiency and depressive symptoms in pregnancy are associated with adverse perinatal outcomes. J Behav Med 41, 680–689 (2018). https://doi.org/10.1007/s10865-018-9924-9

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  • DOI: https://doi.org/10.1007/s10865-018-9924-9

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