Relationship between vitamin D status in the first trimester of the
pregnancy and gestational weight gain: A mediation analysis
Abstract
Objective To evaluate the total, and direct effects of vitamin D,
measured by circulating 25-hydroxyvitamin D [25(OH)D] levels, on GWG
after adjustment for confounding variables, and then assess the indirect
effects by demonstrating the role of gestational age at birth as a
mediator in this association. Design A secondary analysis of data
collected in a screening program in pregnancy. Setting and population
Data collected in “Khuzestan Vitamin D Deficiency Screening Program in
Pregnancy” was used for the present study; it was included the data of
900 pregnant women referred to the health centers of Shushtar (Khuzestan
Province, Iran), whose vitamin D status during the third trimester of
pregnancy was available. Methods A mediation analysis was applied to
detect the causal relationship between serum level of 25(OH)D,
covariates (maternal age, parity, and baseline maternal weight),
mediator (gestational age), and outcome (GWG). Main outcome measures The
main outcome measure of the study was gestational weight gain. Results
The adjusted total effect of vitamin D on GWG was estimated 0.0699
(95%CI: 0.0537, 0.0849; P=0.000). Although, an adjusted direct effect
of vitamin D on GWG was not statistically significant, the adjusted
indirect effect of this micronutrient on GWG by considering gestational
age as a mediator was found to be significant [0.059 (95%CI: 0.048,
0.0708; P=0.000)]. Women with severe vitamin D deficiency had the
lowest speed as compared to moderate and normal levels. Conclusion This
study shows that maternal vitamin D status affects the gestational
weight gain by reducing the risk of preterm delivery.