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Global problems
P2-469 Maternal vitamin D status and delivery by cesarean
  1. T Scholl,
  2. X Chen,
  3. M Schleuter,
  4. T P Stein
  1. University Medicine and Dentistry New Jersey, Stratford, New Jersey, USA

Abstract

Introduction Factors which increase risk of delivery by cesarean include older maternal age, obesity, nulliparity, minority status and a prior history of cesarean delivery. In all probability less well defined factors exist at least one of which may be nutritional—maternal vitamin D deficiency and insufficiency during pregnancy. We examined the association of circulating levels of vitamin D to risk of cesarean delivery using prospective data.

Method Circulating maternal 25-hydroxyvitamin D and intact parathyroid hormone at entry to care (13.8±0.17 weeks - mean, SEM) were assayed by HPLC (25 hydroxyvitamin D) and radioimmunoassay (parathyroid hormone) in a cohort of 1153 low income and minority gravidae from Camden, NJ.

Results The prevalence of vitamin D deficiency (19.8%) and insufficiency (50.5%) at entry was high and accompanied by increasing concentrations of parathyroid hormone, a functional indicator of vitamin D status. Risk for primary cesarean, for secondary cesarean, as well as for all deliveries by cesarean was increased approximately twofold for vitamin D deficient women (<37.5 nmol/l) except for primary cesarean delivery where risk also was increased 1.5-fold with levels suggestive of insufficiency (37.5–80 nmol/l). Vitamin D deficiency was linked to indications for cesarean including a twofold increased risk of cesarean section for prolonged labour and cesarean section for fetal distress.

Conclusions Poor maternal vitamin D status was linked to approximately a twofold increased risk of as well as to specific indications for cesarean delivery.

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