Correlation between 25-hydroxy vitamin D levels and COVID-19 severity in pregnant women: a cross-sectional study
B Seven, O Gunduz, A S Ozgu-Erdinc, Dilek Sahin, O Moraloglu Tekin, H L Keskin
The Journal of Maternal-Fetal & Neonatal Medicine, doi:10.1080/14767058.2021.2005564
Objective: To evaluate the relationship between 25-hydroxy vitamin D (25(OH)D) levels and disease severity in hospitalized COVID-19 positive pregnant women Methods: The COVID-19 (þ) pregnant women (confirmed by PCR test) were classified as asymptomatic, mild symptomatic, and severe disease according to their symptoms and laboratory results. Severe COVID-19 criteria were respiratory symptoms and/or findings. The following laboratory results were considered as poor prognostic factors: the number of lymphocytes <800/ml and/or CRP value >10 times the upper limit of the normal range and/or ferritin value >500 ng/ml and/or D-Dimer value >1000 mg/l. The patients were divided into two groups; asymptomatic or mild symptomatic group (Group 1), and severe disease and/or poor prognostic factor group (Group 2). The 25(OH)D levels were compared between groups. ROC curve analysis was used to analyze the cutoff value for vitamin D to predict the severity of COVID-19. Results: 25(OH)D levels were found to be statistically significantly lower in group 2 (15.5 (10.25) ng/ml in Group 1, 13 (12) ng/ml in Group 2, p ¼ .010). The 25(OH)D level under 14.5 ng/ml was associated with severe COVID-19 and/or poor prognostic factors (p ¼ .010). The risk of severe COVID-19 and/or having poor prognostic factors was 1.87 times higher among pregnant women who had 25(OH)D levels below 14.5 ng/ml. This value was found to have 54.1% sensitivity and 61.3% specificity in predicting severe COVID-19 and/or poor prognostic laboratory findings in pregnant women Conclusion: There is a relationship between vitamin D status and the severity of COVID-19 in pregnant women. During the pandemic period, vitamin D supplementation for pregnant women should gain more importance.
Disclosure statement No potential conflict of interest was reported by the author(s).
References
Alipio, Vitamin D supplementation could possibly improve clinical outcomes of patients infected with Coronavirus
Bilezikian, Bikle, Hewison, Mechanisms in endocrinology: vitamin D and COVID-19, Eur J Endocrinol
Castillo, Costa, Barrios, Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: a pilot randomized clinical study, J Steroid Biochem Mol Biol
Cucinotta, Vanelli, WHO declares COVID-19 a pandemic, Acta Biomed
Cyprian, Lefkou, Varoudi, Immunomodulatory effects of vitamin D in pregnancy and Beyond, Front Immunol
D'avolio, Avataneo, Manca, 25-Hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2, Nutrients
Dey, Singh, Tiwari, Pregnancy outcome in first 50 SARS-Cov-2 positive patients at our center, Gynecol Obstet Reprod Med
Eggemoen, Falk, Knutsen, Vitamin D deficiency and supplementation in pregnancy in a multiethnic population-based cohort, BMC Pregnancy Childbirth
Grant, Lahore, Mcdonnell, Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths, Nutrients
Haussler, Jurutka, Mizwicki, Vitamin D receptor (VDR)-mediated actions of 1a,25(OH)(2) vitamin D 3 : genomic and non-genomic mechanisms, Best Pract Res Clin Endocrinol Metab
Henry, De Oliveira, Benoit, Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a metaanalysis, Clin Chem Lab Med
Holick, Vitamin D deficiency, N Engl J Med
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Jovanovich, Ginde, Holmen, Vitamin D level and risk of community-acquired pneumonia and sepsis, Nutrients
Lokken, Taylor, Huebner, Higher severe acute respiratory syndrome coronavirus 2 infection rate in pregnant patients, Am J Obstet Gynecol
Martineau, Jolliffe, Hooper, Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data, BMJ
Medical, World medical association declaration of Helsinki: ethical principles for medical research involving human subjects, JAMA
Mohan, Cherian, Sharma, Exploring links between vitamin D deficiency and COVID-19, PLOS Pathog
Mor, Cardenas, The immune system in pregnancy: a unique complexity, Am J Reprod Immunol
Ozdemir, Gundemir, Kucuk, Vitamin D deficiency in pregnant women and their infants, J Clin Res Pediatr Endocrinol
Phoswa, Khaliq, Is pregnancy a risk factor of COVID-19?, Eur J Obstet Gynecol Reprod Biol
Pike, Christakos, Biology and mechanisms of action of the vitamin D Hormone, Endocrinol Metab Clin North Am
Radujkovic, Hippchen, Tiwari-Heckler, Vitamin D deficiency and outcome of COVID-19 patients, Nutrients
Singh, Nair, Singh, Pregnancy-specific concerns and psychological impact of COVID-19 on antenatal women, Gynecol Obstet Reprod Med
Soy, Keser, Atagunduz, Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment, Clin Rheumatol
Tabatabaeizadeh, Avan, Bahrami, High dose supplementation of vitamin D affects measures of systemic inflammation: reductions in high sensitivity C-Reactive protein level and neutrophil to lymphocyte ratio (NLR) distribution, J Cell Biochem
Tuten, Acikgoz, Mammadov, Is there a role of 25-Hydroxy vitamin D in the pathogenesis of mild and moderate-to-severe endometriosis?, Gynecol Obstet Reprod Med
Van Schoor, Lips, Worldwide vitamin D status, Best Pract Res Clin Endocrinol Metab
Wang, Nestel, Bourdeau, Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression, J Immunol
Wu, Zhao, Yu, A new coronavirus associated with human respiratory disease in China, Nature
Yes ¸iltepe-Mutlu, Aksu, Bereket, Vitamin D status across age groups in Turkey: results of 108,742 samples from a single laboratory, Jcrpe
Zhao, Meng, Kumar, Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a systemic review and metaanalysis, Int J Infect Dis
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