Biopolym. Cell. 2010; 26(2):97-104.
Reviews
Vitamin D – a novel role in pregnancy
- Cedars-Sinai Medical Center,
Burns-Allen Research Institute and the Division of Maternal-Fetal Medicine
8635, West Third St., Ste 160W, Los Angeles, CA, USA, 90048 - David Geffen School of Medicine,
University of California Los Angeles
10833, Le Conte Avenue, Los Angeles, CA, USA, 90095
Abstract
Vitamin D regulates placental development and function. It is a potent regulator of the immune system- stimulating antimicrobial responses while suppressing inflammation. Its deficiency has been linked to increased risk of serious chronic and inflammatory diseases. Vitamin D deficiency during pregnancy increases susceptibility to infection and inflammation, leading, in turn, to outcome like preterm birth or preeclampsia. Pregnant women with darker skin pigmentation are more likely to be vitamin D deficient, particularly when living in regions with low exposure to sunlight. It is possible that during pregnancy, a primary non-infectious inflammatory process is activated by vitamin D deficiency. Combined assessment of vitamin D deficiency and inflammatory markers in early pregnancy or during different stages of pregnancy may facilitate the recognition of the risk of complications.
Keywords: vitamin D, pregnancy, immune response
Full text: (PDF, in English)
References
[1]
Bodnar L. M., Simhan H. N., Powers R. W., Frank M. P., Cooperstein E., Roberts, J. M. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates J. Nutr 2007 137, N 2 P. 447–452.
[2]
Holick M. F. Resurrection of vitamin D deficiency and rickets J. Clin. Invest 2006 116, N 8 P. 2062–2072.
[3]
Hollis B. W., Wagner C. L. Nutritional vitamin D status during pregnancy: reasons for concern CMAJ Canad. Med. Assoc. J 2006 174, N 9 P. 1287–1290.
[4]
Hollis B. W., Wagner C. L. Vitamin D deficiency during pregnancy: an ongoing epidemic Amer. J. Clin. Nutr 2006 84, N 2 P. 273.
[5]
Chapuy M. C., Preziosi P., Maamer M., Arnaud S., Galan P., Hercberg S., Meunier P. J. Prevalence of vitamin D insufficiency in an adult normal population Osteopor. Int 1997 7, N 5 P. 439–443.
[6]
Dawson-Hughes B., Heaney R. P., Holick M. F., Lips P., Meunier P. J., Vieth R. Estimates of optimal vitamin D status Osteopor. Int 2005 16, N 7 P. 713–716.
[7]
Stene L. C., Joner G., and Norwegian Childhood Diabetes Study Group. Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population-based, case-control study Am. J. Clin. Nutr 2003 78, N 6 P. 1128–1134.
[8]
Camargo C. A. Jr., Rifas-Shiman S. L., Litonjua A. A., RichEdwards J. W., Weiss S. T., Gold D. R., Kleinman K., Gillman M. W. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age Am. J. Clin. Nutr 2007 85, N 3 P. 788–795.
[9]
McGrath J. Hypothesis: is low prenatal vitamin D a risk-modifying factor for schizophrenia? Schizophr. Res 1999 40, N 3 P. 173–177.
[10]
McGrath J., Saari K., Hakko H., Jokelainen J., Jones P., Jarvelin M. R., Chant D., Isohanni M. Vitamin D supplementation during the first year of life and risk of schizophrenia: a Finnish birth cohort study Schizophr. Res 2004 67, N 2– 3 P. 237–245.
[11]
Evans K. N., Bulmer J. N., Kilby M. D., Hewison M. Vitamin D and placental-decidual function J. Soc. Gynecol. Invest 2004 11, N 5 P. 263–271.
[12]
Romero R., Espinoza J., Goncalves L. F., Kusanovic J. P., Friel L. A., Nien J. K. Inflammation in preterm and term labour and delivery Semin. Fetal and Neonat. Med 2006 11, N 5 P. 317–326.
[13]
Romero R., Espinoza J., Goncalves L. F., Kusanovic J. P., Friel L., Hassan S. The role of inflammation and infection in preterm birth Semin. Reproduct. Med 2007 25, N 1 P. 21–39.
[14]
Hillier S. L., Witkin S. S., Krohn M. A., Watts D. H., Kiviat N. B., Eschenbach D. A. The relationship of amniotic fluid cytokines and preterm delivery, amniotic fluid infection, histologic chorioamnionitis, and chorioamnion infection Obstet. and Gynecol 1993 81, N 6 P. 941–948.
[15]
Gravett M. G., Novy M. J., Rosenfeld R. G., Reddy A. P., Jacob T., Turner M., McCormack A., Lapidus J. A., Hitti J., Eschenbach D. A., Roberts C. T. Jr., Nagalla S. R. Diagnosis of intra-amniotic infection by proteomic profiling and identification of novel biomarkers JAMA 2004 292, N 4 P. 462–469.
[16]
El-Shazly S., Makhseed M., Azizieh F., Raghupathy R. Increased expression of pro-inflammatory cytokines in placentas of women undergoing spontaneous preterm delivery or premature rupture of membranes Am. J. Reprod. Immun 2004 52, N 1 P. 45–52.
[17]
Blank V., Hirsch E., Challis J. R., Romero R., Lye S. J. Cytokine signaling, inflammation, innate immunity and preterm labour – a workshop report Placenta 2008 29, Suppl 1 P. 102–104.
[18]
Gomez R., Romero R., Edwin S. S., David C. Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection Infect. Dis. Clin. North Amer 1997 11, N 1 P. 135–176.
[19]
Fischer D., Schroer A., Ludders D., Cordes T., Bucker B., Reichrath J., Friedrich M. Metabolism of vitamin D3 in the placental tissue of normal and preeclampsia complicated pregnancies and premature births Clin. Exp. Obstet. Gynecol 2007 34, N 2 P. 80–84.
[20]
Diaz L., Arranz C., Avila E., Halhali A., Vilchis F., Larrea F. Expression and activity of 25-hydroxyvitamin D-1 alpha-hydroxylase are restricted in cultures of human syncytiotrophoblast cells from preeclamptic pregnancies J. Clin. Endocrinol. Metabol 2002 87, N 8 P. 3876–3882.
[21]
Hypponen E. Vitamin D for the prevention of preeclampsia? A hypothesis Nutr. Rev 2005 63, N 7 P. 225–232.
[22]
Zehnder D., Evans K. N., Kilby M. D., Bulmer J. N., Innes B. A., Stewart P. M., Hewison M. The ontogeny of 25-hydroxyvitamin D(3) 1a-hydroxylase expression in human placenta and decidua Am. J. Pathol 2002 161, N 1 P. 105–114.
[23]
Nesby-O'Dell S., Scanlon K. S., Cogswell M. E., Gillespie C., Hollis B. W., Looker A. C., Allen C., Doughertly C., Gunter E. W., Bowman B. A. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third Nat. Health and Nutr. Examination Survey, 1988–1994 Am. J. Clin. Nutr 2002 76, N 1 P. 187–192.
[24]
Hollis B. W., Wagner C. L. Assessment of dietary vitamin D requirements during pregnancy and lactation Amer. J. Clin. Nutr 2004 79, N 5 P. 717–726.
[25]
Arora C. P., Hobel C. J. Vitamin D and IL-6 in pregnancies with subsequent preterm birth. Reprod. Sci. 2010; 17 179A–180A.
[26]
Hobel C. J., Arora C. P., Adeniji A., Arora P., Jackman S. E., Miadel O., Baldiyan L. Circulating levels of vitamin D and IL-6 in pregnancies with IUGR Reprod. Sci. 2008; 15, N 2, suppl 121A–122A.
[27]
Holick M. F. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis Am. J. Clin. Nutr 2004 79, N 3 P. 362–371.
[28]
Clemens T. L., Adams J. S., Henderson S. L., Holick M. F. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3 Lancet 1982 319, N 8263 P. 74–76.
[29]
Centers for Disease Control and Prevention (CDC). Differences in infant mortality between blacks and whites – United States, 1980–1991 MMWR – Morbidity & Mortality Weekly Report 1994 43, N 16 P. 288–289.
[30]
Arora C. P., Adeniji A., Jackman S. E., Forooghi B., Mostadim I., Yadegari P., Hobel C. J. Reduced plasma levels of vitamin D in Caucasian women at term are associated with increased rate of infection Reprod. Sci 2008 15, N 2, suppl 183A.
[31]
Adeniji A., Arora C. P., Baldiyan L., Miadel O., Arora P., Ortega M., Le A., Koenig M., Hobel C. J. Reduced vitamin D levels in African American pregnancies are associated with increased rate of infection Reprod. Sci 2008 15, N 2, suppl 187A.
[32]
Evans K. N., Nguyen L., Chan J., Innes B. A., Bulmer J. N., Kilby M. D., Hewison M. Effects of 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 on cytokine production by human decidual cells Biol. Reprod 2006 75, N 6 P. 816– 822.
[33]
Mathieu C. van, Etten E., Decallonne B., Guilietti A., Gysemans C., Bouillon R., Overbergh L. Vitamin D and 1,25-dihydroxyvitamin D3 as modulators in the immune system J. Steroid Biochem. and Mol. Biol 2004 89–90, N 1–5 P. 449–452.
[34]
Adams J. S., Liu P. T., Chun R., Modlin R. L., Hewison M. Vitamin D in defense of the human immune response Ann. N. Y. Acad. Sci 2007 1117 P. 94–105.
[35]
Liu H., Redline R. W., Han Y. W. Fusobacterium nucleatum induces fetal death in mice via stimulation of TLR4-mediated placental inflammatory response J. Immunol 2007 179, N 4 P. 2501–2508.
[36]
Cantorna M. T., Zhu Y., Froicu M., Wittke A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system Am. J. Clin. Nutr 2004 80, N 6, suppl P. 1717S–1720S.
[37]
Griffin M. D., Xing N., Kumar R. Vitamin D and its analogs as regulators of immune activation and antigen presentation Ann. Rev. Nutr 2003 23 P. 117–145.
[38]
Deluca H. F., Cantorna M. T. Vitamin D: its role and uses in immunology FASEB J 2001 15, N 14 P. 2579–2585.
[39]
Townsend K., Evans K. N., Campbell M. J., Colston K. W., Adams J. S., Hewison M. Biological actions of extra-renal 25-hydroxyvitamin D-1alpha-hydroxylase and implications for chemoprevention and treatment J. Steroid Biochem. and Mol. Biol 2005 97, N 1–2 P. 103–109.
[40]
Hewison M., Zehnder D., Chakraverty R., Adams J. S. Vitamin D and barrier function: a novel role for extra-renal 1 alpha-hydroxylase Mol. and Cell. Endocrinol 2004 215, N 1–2 P. 31–38.
[41]
Kreutz M., Andreesen R., Krause S. W., Szabo A., Ritz E., Reichel H. 1,25-dihydroxyvitamin D3 production and vitamin D3 receptor expression are developmentally regulated during differentiation of human monocytes into macrophages Blood 1993 82, N 4 P. 1300–1307.
[42]
Hewison M., Freeman L., Hughes S. V., Evans K. N., Bland R., Eliopoulos A. G., Kilby M. D., Moss P. A., Chakraverty R. Differential regulation of vitamin D receptor and its ligand in human monocyte-derived dendritic cells J. Immunol 2003 170, N 11 P. 5382–5390.
[43]
Gray T. K., Lester G. E., Lorenc R. S. Evidence for extra-renal 1 alpha-hydroxylation of 25-hydroxyvitamin D3 in pregnancy Science 1979 204, N 4399 P. 1311–1313.
[44]
Weisman Y., Harell A., Edelstein S., David M., Spirer Z., Golander A. 1 alpha, 25-Dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 in vitro synthesis by human decidua and placenta Nature 1979 281, N 5729 P. 317–319.
[45]
Bruns M. E., Bruns D. E. Vitamin D metabolism and function during pregnancy and the neonatal period Ann. Clin. Lab. Sci 1983 13, N 6 P. 521–530.
[46]
Rebut-Bonneton C., Demignon J. Effects of 1,25-dihydroxyvitamin D3 on in vitro lymphocyte reactions: arguments for a role at the maternofetal interface Gynecol. Obstet. Invest 1991 32, N 3 P. 134–138.
[47]
Sacks G., Sargent I., Redman C. An innate view of human pregnancy Immunol. Today 1999 20, N 3 P. 114–118.
[48]
Guleria I., Pollard J. W. The trophoblast is a component of the innate immune system during pregnancy Nat. Med 2000 6, N 5 P. 589–593.
[49]
Zenclussen A. C., Schumacher A., Zenclussen M. L., Wafula P., Volk H. D. Immunology of pregnancy: cellular mechanisms allowing fetal survival within the maternal uterus Expert Rev. Mol. Med 2007 9, N 10 P. 1–14.
[50]
Laskarin G., Kammerer U., Rukavina D., Thomson A. W., Fernandez N., Blois S. M. Antigen-presenting cells and materno-fetal tolerance: an emerging role for dendritic cells Am. J. Reprod. Immunol 2007 58, N 3 P. 255–267.
[51]
Liu P. T., Stenger S., Li H., Wenzel L., Tan B. H., Krutzik S. R., Ochoa M. T., Schauber J., Wu K., Meinken C., Kamen D. L., Wagner M., Bals R., Steinmeyer A., Zugel U., Gallo R. L., Eisenberg D., Hewison M., Hollis B. W., Adams J. S., Bloom B. R., Modlin R. L. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response Science 2006 311, N 5768 P. 1770–1773.
[52]
Adams J. S., Hewison M. Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity Nat. Clin. Pract. Endocrinol. Metabol 2008 4, N 2 P. 80–90.
[53]
Bodnar L. M., Krohn M. A., Simhan H. N. Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy J. Nutr 2009 139, N 6 P. 1157– 1161.
[54]
Fiscella K. Racial disparity in infant and maternal mortality: confluence of infection, and microvascular dysfunction Matern. and Child Health J 2004 8, N 2 :45–54.