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Pregnancy Timeline by SemestersFetal liver is producing blood cellsHead may position into pelvisBrain convolutions beginFull TermWhite fat begins to be madeWhite fat begins to be madeHead may position into pelvisImmune system beginningImmune system beginningPeriod of rapid brain growthBrain convolutions beginLungs begin to produce surfactantSensory brain waves begin to activateSensory brain waves begin to activateInner Ear Bones HardenBone marrow starts making blood cellsBone marrow starts making blood cellsBrown fat surrounds lymphatic systemFetal sexual organs visibleFinger and toe prints appearFinger and toe prints appearHeartbeat can be detectedHeartbeat can be detectedBasic Brain Structure in PlaceThe Appearance of SomitesFirst Detectable Brain WavesA Four Chambered HeartBeginning Cerebral HemispheresFemale Reproductive SystemEnd of Embryonic PeriodEnd of Embryonic PeriodFirst Thin Layer of Skin AppearsThird TrimesterSecond TrimesterFirst TrimesterFertilizationDevelopmental Timeline
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Home | Pregnancy Timeline | News Alerts |News Archive Oct 31, 2013

 

Researchers used a sample of over 700 cases of preterm birth and 2,600 full-term births
collected by the Collaborative Perinatal Project, which was conducted in 12
U.S. medical centers from 1959 to 1965.
"It is critical to repeat this study in a modern sample,"
said Dr. Bodnar







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Low vitamin D in pregnancy associated with preterm birth in African-American and Puerto Rican mothers

African-American and Puerto Rican women who have low levels of vitamin D during pregnancy are more likely to go into labor early and give birth to preterm babies, research led by the University of Pittsburgh Graduate School of Public Health reveals.

The study, the largest to date to look at the association between vitamin D and preterm birth, is now available online in the American Journal of Epidemiology.

"Vitamin D is unique in that while we get it from our diets, our primary source is our body making it from sunlight," said lead author Lisa Bodnar, Ph.D., M.P.H., R.D., associate professor in Pitt Public Health's Department of Epidemiology. "Previous studies using conservative definitions for vitamin D deficiency have found that nearly half of black women and about 5 percent of white women in the United States have vitamin D concentrations that are too low."


Among non-white mothers, the incidence of spontaneous, preterm birth – naturally going into labor two or more weeks before the 37 weeks of pregnancy considered full-term – decreased by as much as 30 percent as vitamin D levels in the blood increased.

Dr. Bodnar and her co-authors, whose work was funded by the National Institutes of Health, did not find a similar relationship between maternal vitamin D levels and preterm birth in white women.


"We were concerned that finding this association only in non-white women meant that other factors we did not measure accounted for the link between low vitamin D levels and spontaneous preterm birth in black and Puerto Rican mothers," said Dr. Bodnar. She and her co-authors used methods to account for the expected influence of discrimination and socioeconomic position, as well as fish intake and physical activity. "Even after applying these methods, vitamin D deficiency remained associated with spontaneous preterm birth."

"Preterm birth is the most important problem in modern obstetrics," said senior author Hyagriv N. Simhan, M.D., M.S., chief of the division of maternal-fetal medicine and medical director of obstetrical services at Magee-Womens Hospital of UPMC.


"In 2010, over 1 million infants born preterm at less than 37 weeks gestation died worldwide. Preterm infants who survive are at risk of chronic lung disease, deafness, blindness or other visual impairment, and learning and cognitive disability."

Hyagriv N. Simhan, M.D., M.S., chief of the division of maternal-fetal medicine and medical director of obstetrical services at Magee-Womens Hospital of UPMC and senior author


A novel part of the study was the availability of information from placental

examinations. The researchers found that vitamin D deficiency was most strongly related to preterm births with damage to the placenta caused by inflammation.

"This finding may give us insight into the biology connecting low vitamin D and preterm birth," Dr. Simhan said. "It holds great promise and will motivate significant preterm birth research."


The researchers used a sample of over 700 cases of preterm birth and 2,600 full-term births collected by the Collaborative Perinatal Project, which was conducted in 12 U.S. medical centers from 1959 to 1965.

The blood samples collected by the project were well-preserved and able to be tested for vitamin D levels 40 years later.


"It is critical to repeat this study in a modern sample," said Dr. Bodnar, noting that pregnant women today smoke less, have less sun-exposure and receive more vitamin D in their foods than the mid-century cohort. "Further, it is especially important to understand how vitamin D influences preterm birth among black mothers. Vitamin D supplementation could be an easy way to reduce the high rates of preterm birth in this group."

Abstract
The objective of this study was to determine the association between maternal 25-hydroxyvitamin D (25(OH)D) and the risk of spontaneous preterm birth (sPTB) before 35 weeks’ gestation. A random subcohort from the US Collaborative Perinatal Project (1959–1965) was sampled (n = 2,629) and augmented with all remaining cases of sPTB before 35 weeks’ gestation for a total of 767 cases. Banked serum samples collected at 26 weeks’ gestation or earlier were assayed for 25(OH)D. Constructs for vascular histology and inflammatory histology were developed from placental pathology examinations. There was no relationship between 25(OH)D and sPTB among white women. Among nonwhite mothers, serum 25(OH)D levels of 30–<50, 50–<75, and ≥75 nmol/L were associated with reductions of 1.0–1.6 cases of sPTB per 100 live births and 20%–30% reductions in risk of sPTB compared with 25(OH)D levels less than 30 nmol/L after adjustment for prepregnancy body mass index (weight (kg)/height (m)2), season, and other confounders. This association was driven by inflammation-mediated cases of sPTB and sPTB cases without placental lesions. A sensitivity analysis for unmeasured confounding by exercise, fish intake, and skin color suggested some bias away from the null in the conventional results, but conclusions were generally supported. The vitamin D–sPTB relationship should be examined in modern cohorts with detailed data on skin pigmentation and other covariates.

Co-authors on this research include Alison D. Gernand, Ph.D., Janet M. Catov, Ph.D., and W. Tony Parks, M.D., all of the University of Pittsburgh; Mark A. Klebanoff, M.D., of the Ohio State University; and Robert W. Platt, Ph.D., of McGill University.

This work was supported by NIH grant HD 056999.

About the University of Pittsburgh Graduate School of Public Health
The University of Pittsburgh Graduate School of Public Health, founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health problems. For more information about Pitt Public Health, visit the school's Web site at http://www.publichealth.pitt.edu.

About Magee-Womens Hospital of UPMC
Magee-Womens Hospital of UPMC is a full-service women's hospital and includes a range of services for women and men: diagnostic imaging including CT and MRI, a Heart Center, bariatric surgery, orthopaedics, digestive disorders, comprehensive breast and gynecologic cancer services, pulmonology, thoracic surgery, minimally invasive abdominal surgery, vascular surgery, and a full-service emergency department. http://www.upmc.com/media

Original press release: http://www.eurekalert.org/pub_releases/2013-10/uops-lvd103013.php