1. Department of Obstetrics and Gynecology, College of Medicine, Jouf University, Sakaka, Saudi Arabia. firstname.lastname@example.org
2. Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt.
3. Department of Pathology, College of Medicine, Jouf University, Sakaka, Saudi Arabia. email@example.com
4. Department of Internal Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia. firstname.lastname@example.org
5. Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia. email@example.com
6. Department of Pathology, Biochemistry Division, College of Medicine, Jouf University, Sakaka, Saudi Arabia. firstname.lastname@example.org.
7. Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
Vitamin D (VitD) deficiency during pregnancy has been associated with adverse neonatal outcomes and increased risk of late pregnancy complications. We planned to correlate serum VitD biomarkers; 25-hydroxyvitamin D (25-OH-VitD) and 1,25-dihydroxyvitamin D (1,25-diOH-VitD) levels; and their ratio with the frequency of feto-maternal pregnancy complications. A prospective cross-sectional case-control study was conducted at Aljouf Maternity and Children Hospital, Sakaka, Saudi Arabia, during the period of September 1, 2017 to September 30, 2019. 322 pregnant women were stratified into 2 groups: controls (110 cases) and complicated group (212 cases). The later comprised severe preeclamptic toxemia associated with intrauterine growth restriction (58 cases), gestational diabetes mellitus (GDM; 82 cases), abortion (26 cases), undisturbed ectopic pregnancy (16 cases), premature rupture of membranes (PROM; 14 cases), and, inevitable preterm labour (16 cases). After clinical assessment, peripheral blood samples were collected. Serum biomarkers were measured using specific immunoassays. The direct 1,25-diOH-VitD/25-OH-VitD ratio was calculated. Serum 25-OH-VitD indicated widely spreading VitD deficiency among participants with significantly higher levels in controls vs. GDM subgroup only. 1,25-diOH-VitD levels and the ratio were markedly reduced in the six complicated subgroups vs. controls, with non-significant differences amongst the complicated subgroups. ROC analysis showed very high sensitivity and specificity, to differentiate patients from controls, only for 1,25-diOH-VitD (AUC = 0.965; 0.947 - 0.983, p <0.001) followed by the ratio but not 25-OH-VitD. In conclusions, 25-OH-VitD did not show significant changes except for GDM. 1,25-diOH-VitD levels and the ratio showed strong associations with pregnancy complications. Serum 1,25-di-OH-VitD and its ratio to 25-OH-VitD are more reliable and physiologically relevant biomarkers for VitD status in pregnancy.
Keywords: Serum vitamin D biomarkers, pregnancy outcomes, pregnancy complications, 25-hydroxyvitamin D, 1, 25-dihydroxyvitamin D