Maternal Serum Concentrations of Vitamin D Early in Pregnancy and Preterm Birth: A Case-Control Study in Southern Sweden

Abstract

Abstract Purpose The purpose of this case-control study was to investigate the associations between maternal serum concentrations of vitamin D early in pregnancy and the occurrence of preterm birth. Methods The study included 269 women (cases) whose children were born preterm (< 37 gestational weeks [gw]) and 332 women (controls) whose children were born term (≥ 37 gw). Among the cases, 59 were extreme preterm (< 28 gw), 74 severe preterm (28‒32 gw), and 136 late preterm (33‒36 gw). All women gave birth in Scania, the most Southern County of Sweden. Concentrations of 25-hydroxyvitamin D3 (vitamin D) in maternal serum collected early in pregnancy were analyzed using liquid chromatography-tandem-mass-spectrometry (LC/MS/MS). The serum concentrations of vitamin D were trichotomized based on the distributions among the controls (≤ 44.9; 45.0‒68.8; and ≥ 68.9 nmol/L) as well as dichotomized at a predefined cut-off (< 50 and ≥ 50 nmol/L). Logistic regression was used to estimate the associations between vitamin D and preterm births, partly when all cases were included in the analyses, and partly when the three different case groups were included separately. The category with the highest vitamin D concentration was used as a reference in the regression analyzes. The analyses were performed without as well as with adjustments for potential confounders. Results When the category with the lowest vitamin D concentrations were compared with the reference category in the analyses where the vitamin D concentrations were trichotomized, no statistically significant associations were observed. However, among the extreme preterm an adjusted odds ratio of 1.93 (95% confidence interval 0.83‒4.48) was observed. The patterns were similar when 50 nmol/L was used as the cut-off. Conclusion Although all comparisons gave adjusted odds ratios in the direction that low maternal vitamin D concentrations early in pregnancy increase the risk of preterm birth, none of these were statistically significant. Accordingly, the present study gives no to very weak support for an association.