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Preconception Vitamin D Associated with Improved Fertility & Pregnancy Outcomes

12/26/2018 3:26:25 PM
Vitamin D receptors are found on all organs involved in the hypothalamic-pituitary-ovarian axis and the uterus. Studies of women receiving in-vitro fertilization (IVF) show that vitamin D improves endometrial receptivity and implantation. Studies in women not undergoing IVF mostly evaluate vitamin D levels in early pregnancy rather than preconception. Two small studies in non-IVF populations have suggested that preconception levels of vitamin D might relate to the risk of pregnancy loss. In a study published in the Lancet in 2018, researchers investigated the association between preconception levels of vitamin D and pregnancy outcomes in women with a history of pregnancy loss and no diagnosis of infertility.
The study was a secondary analysis of data from the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial. Participants were women between the ages of 18 and 40, who had previously experienced 1-2 pregnancy losses. Preconception serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured and classified as sufficient (≥ 75 nmol/L) or insufficient (< 75 nmol/L). The outcomes of interest were clinical pregnancy, pregnancy loss, and live birth.
Preconception vitamin D levels were available for 1191 women, indicating sufficiency in 47% and insufficiency in 53%. The frequency of clinical pregnancies and live births was significantly higher in women with sufficient vitamin D. After adjusting for confounding factors, women with adequate vitamin D had a higher chance of pregnancy (risk ratio [RR] = 1.10; 95% CI, 1.01-1.20) and live birth (RR=1.15; 95% CI, 1.02-1.29). Each increase in serum 25(OH)D concentration of 25 nmol/L was associated with a 22% reduced risk of pregnancy loss (RR=0.88; 95% CI, 0.77-0.99).
A surprising result from this study was that early pregnancy vitamin D concentrations were not associated with pregnancy loss after 8 weeks. Together with the finding that preconception vitamin D status significantly correlated with pregnancy and live births, this study highlights the importance of preconception care and optimization of vitamin D status before pregnancy.
Mumford SL, Garbose RA, Kim K et al. Association of preconception serum 25-hydroxyvitamin D concentrations with livebirth and pregnancy loss: a prospective cohort study. Lancet Diabetes Endocrinol. 2018; 6: 725-732.

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