A total of 134 participants were recruited after taking their consent over the study period, out of which 22 participants were excluded( Hepatitis B, Hypothyroidism, HIV, Breast Malignancy, Chronic Mental illness). A total of 112 ( Mother venous blood and neonate Cord blood) samples pair was collected at the time of delivery from obstetrics and gynecology department and sent to department of biochemistry for analysis. A total of 15 samples were lost during transportation and storage. At the end 97 samples were estimated for vitamin D levels of both mother and neonate pair. Figure 2 depicts the steps of data collection in the study.
Table 1 : Socio-demographic and dietary distribution(N=97)
Patient Profile
|
|
Age
|
25.98(±4.12)
|
Dietary Intake
|
|
Vegetarian
|
30(30.9)
|
Non-Vegetarian
|
55(56.7)
|
Eggetarian
|
12(12.4)
|
Calcium and Vitamin D Intake
|
|
Regular
|
58(59.8)
|
Irregular/Not taken
|
39(41.2)
|
Extra Vitamin D Intake
|
|
Yes
|
33(34)
|
No
|
64(66)
|
Height of Mother
|
156.18(±5.447)
|
Period of Gestation
|
38.29(±2.34)
|
Fitzpatrick Scale
|
|
Type-III
|
17(17.5)
|
Type-IV
|
42(43.3)
|
Type-V
|
38(39.2)
|
Table 1 shows socio-demographic the mean age was 25.98 years(±4.12) of the participants. Participants followed non-vegetarian diet(30.9), vegetarian diet(30.9) and eggetarian(12.4). Tablet Calcium and Vitamin D (500mg + 250IU) of daily dose from second trimester till the time of delivery was taken regularly by 59.8% of the women. Extra dose of Vitamin D supplementation (apart from 250IU with calcium ) were consumed by 34% of the participants. Most of the participants belonged to Type IV(43.3) and Type V (39.2) of the Fitzpatrick Scale. All the continuous variables were examined for normalcy with q-q plot and all the neonatal anthropometry followed normal distribution (birth weight, length, head circumference and chest circumference).Whereas, Vitamin D levels both in mother and the one collected from cord blood did not follow a normal distribution. There were no distinctive outliers to impact the study outcome.
Table 2 : Distribution of Neonatal anthropometry (N=97)
Neonate anthropometry
|
Mean(SD)/n(%)
|
Birth Weight(gms)
|
2748(±469.28)
|
Length(CMS)
|
47.73(±5.3)
|
Head Circumference(CMS)
|
33.27(±2.37)
|
Chest Circumference(CMS)
|
32.39(±2.7)
|
Birth Weight
|
|
<2500gms
|
25(25.8)
|
≥2500gms
|
72(74.2)
|
Birth Length
|
|
<50Cms
|
70(72.2)
|
≥50Cms
|
27(27.8)
|
Head Circumference
|
|
<33.9Cms
|
53(54.6)
|
≥33.9Cms
|
45(45.4)
|
Table 2 depicts, the average birth weight of the baby was found to be 2748gms(±469.28), the average length of the baby was found to be 47.73Cms(±5.3), head circumference was found to be 33.27Cms (±2.37) and chest circumference was 32.39Cms(±2.7). Most of the neonates were born adequate birth weight (74.2) but adequate neonate length(27.8) and head circumference(45.4) were found to be few in numbers.
As depicted in figure 3 and figure 4, Vitamin D deficiency in mothers was 87.6%, Insufficiency was found to be in 5.2% of the mothers and sufficiency was found to be in 7.2%.Vitamin D deficient neonates were found to be 50.5%, insufficiency was found to be in 44.3% of the neonates and only 5.2% had sufficient amount of Vitamin D levels.
Figure 5 is the depiction of Vitamin D in Cord blood and Vitamin D in Maternal blood which shows positive correlation with r=0.875 and a significance of p<0.05.
Table 3 : Vitamin D as a predictor of Neonatal Anthropometry
|
Birth Weight
|
|
|
Constant
|
Exponential (B)
|
p-value
|
95% CI
|
|
LB
|
UB
|
Model-1a
|
Maternal Venous Vitamin D
|
-.009
|
.991
|
.849
|
.907
|
1.084
|
Calcium and Vitamin D Intake
|
2.48
|
12.00
|
.002*
|
2.504
|
57.504
|
Period of Gestation(<37weeks)
|
-2.989
|
.050
|
.000*
|
.011
|
.224
|
|
Birth length
|
Model-2b
|
Maternal Venous Vitamin D
|
.196
|
1.216
|
.001*
|
1.085
|
1.364
|
Intake Of Extra Vitamin D( Yes)
|
2.445
|
11.527
|
0.01*
|
2.792
|
47.59
|
|
Birth Head circumference
|
Model-3c
|
Maternal Venous Vitamin D
|
.156
|
1.168
|
.004*
|
1.052
|
1.297
|
Intake of Extra Vitamin D (Yes)
|
.978
|
2.658
|
.049*
|
1.003
|
7.045
|
a - Adjusted for Maternal Age, Period of Gestation, intake of extra vitamin D, calcium with vitamin D intake
and Vitamin D in Maternal Venous blood
b- Adjusted for Intake Of Extra Vitamin D, Vitamin D And Calcium Intake, Height of mother, Age.
c- Adjusted for Intake Of Extra Vitamin D, Vitamin D And Calcium Intake, Maternal Venous Blood Vitamin D, Height of mother, Age.
A logistic regression was performed to ascertain the effects of Maternal age, period of gestation, Maternal vitamin D levels, intake of Extra vitamin D, calcium with vitamin D intake during antenatal period on the likelihood of birth weight of babies. The logistic regression Model-1 was statistically significant, X2 (5, N = 97) = 18.357, p = .000. It explained 51.10% (Nagelkerke R2) of the variance in birth weight and correctly classified 84.5% of cases. Antenatal supplements of calcium along with vitamin D (Taken) and period of gestation(<37 weeks) were significant predictors of birth weight. Whereas, Maternal age, Maternal vitamin D status, were not associated with birth weight. Model 2 depicts the effects of Maternal age, height of the mother, intake of Extra vitamin D, calcium with Vitamin D supplements and maternal vitamin D levels. The model was statistically significant, X2 (5, N = 97) =48.181, p = .000. The model explained 54.5% (Nagelkerke R2) of the variance in neonatal length at birth and correctly classified 82.5% of cases. Vitamin D levels in mothers(p<0.05, OR=1.216, 95%CI[1.085,1.364), Maternal supplements of Extra Vitamin D (p<0.05, OR=11.527, 95%CI [2.792, 47.59]) were found to be significant predictors of birth length. However, Maternal age, height of the mother, Calcium and vitamin D intake were not associated with neonatal birth length. Model 3 depicts the effect of Maternal age, height of the mother, intake of Extra vitamin D, calcium with Vitamin D supplements and maternal vitamin D levels during antenatal period on the likelihood of birth head circumference of babies. model was statistically significant, X2 (5, N = 97) =26.640, p = .000. The model explained 32.10% (Nagelkerke R2) of the variance in head circumference at birth of the babies and correctly classified 71.1% of cases. Vitamin D levels of mothers(p<0.05, OR=8.47, 95%CI [2.504, 57.504]) and extra supplementation of vitamin D during antenatal period (p<0.05, OR=2.658, 95%(1.003,7.045). Maternal age, height of the mother, antenatal supplements of calcium along with vitamin D were not significantly predicting the head circumference. All the model summary can be depicted in table 3.