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Item type Presentation
Format Text-based Document
Title What is the Relationship Between Pregnancy Symptoms,Vitamin D Status, and Quality of Life?
Authors Woo, Jennifer G.
Downloaded 25-May-2018 03:35:23
Link to item http://hdl.handle.net/10755/622199
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
What is the relationship between vitamin D status,
pregnancy symptoms, and quality of life?
Jennifer Woo, PhD, CNM/WHNP
Clinical Assistant Professor
Baylor University
STTI conference
July 28, 2017
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Conflicts of Interest
• I have no relevant financial or nonfinancial conflicts of
interest
• The learner will be able to describe the pregnancy
symptoms most significantly impacting pregnant
women.
• The learner will be able to describe what pregnancy
symptoms were associated with vitamin D deficiency
• Describe the correlation between pregnancy
symptoms and quality of life
Objectives
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Background
• Vitamin D receptors are located throughout the body and
impact multiple body systems (Holick, 2007; Urrutia & Thorp, 2012)
• Therefore, if deficient in vitamin D, it can impact the brain
(mood/sleep), muscles (musculoskeletal pain/pelvic floor
disorders), immune system (infections, inflammation),
metabolism (insulin-resistance) (Pludowski et al., 2013; Hollis & Wagner, 2013; McCarty et al., 2013)
• What impact does vitamin D status have in pregnant
women’s symptoms, and does it impact quality of life?
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Background
• Pregnancy-related physical symptoms at 15-23 weeks
predicted depressive symptoms at 26-39 weeks (Kamysheva et al.,
2009)
• Severity of discomfort of these symptoms can impact
mood and a pregnant woman’s ability to provide self-
care for herself (Nazik & Eryilmaz, 2014; Kamysheva et al., 2010)
• Vitamin D deficiency has been associated with
symptoms such as fatigue, musculoskeletal pain, poor
sleep quality, pelvic floor disorders and depression in a
nonpregnant population (Knutsen et al., 2010, Spedding, 2014; Parker-Autry et al, 2010; McCarty et al, 2013)
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Background
• African American and
Hispanic women are at
greater risk for deficiency (Hossein-Nezhad & Holick, 2013)
• AA and Hispanic women
are also at greater risk for
adverse birth outcomes (Bodnar & Simhan, 2010)
• Vitamin D deficiency has
also been linked to
preterm delivery, GDM,
preeclampsia, and SGA(Ginde, Sullivan, Mansbach, & Camargo, 2010)
NHANES data from 2001-2006
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Impact of vitamin D deficiency in
pregnancy
• risk for preterm
delivery
• incidence of pre-
eclampsia
• risk for gestational
diabetes
• risk of small for
gestational age baby
• risk of perinatal
infections
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Definitions of vitamin D deficiency
Defined either in nmol or ng/ml
To convert between ng/ml to nmol, multiply by 2.5
Institute of Medicine Deficiency < 20 ng/mlSufficiency ≧20 ng/ml
Endocrine Society Sufficiency > 30 ng/mlInsufficiency 21-30 ng/ml; Deficiency ≦ 20 ng/mlSevere deficiency < 12 ng/ml
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Study Aim
• To determine if there is a relationship between vitamin D
status, pregnancy symptoms including sleep disruption
and depressive symptoms, health promoting behaviors,
and quality of life
Hypothesis:Individuals who have deficient levels of vitamin D are
hypothesized to be more likely to have more pregnancy
symptoms, poor sleep quality, more depressive
symptoms, poorer health behaviors and quality of life.
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Study Design
• Descriptive, cross-sectional design
– Benefits: used to explore relationships between
variables of interest; limited research related to
symptoms and vitamin D status in pregnant women
– Limitation: no causal inference; data collected at one
timepoint (24-32 weeks gestation)
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Sample
• Convenience sampling
• Inclusion criteria: ≥ 18 years of age; pregnant between
24.0 to 32.6 weeks gestation;
• Exclusion criteria: significant mental health diagnosis,
pre-gestational diabetes, HIV infection, and/or any
autoimmune disorder
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
MeasurementsBiologic factors Serum vitamin D status
Dietary vitamin D intake
Hemoglobin
Demographic form
Symptom status Pregnancy Symptom Inventory (PSI)
Pittsburgh Sleep Quality Index (PSQI)
Edinburgh Postnatal Depression Scale(EPDS)
Functional status Health Promoting Lifestyles Profile (HPLP)
PSI – limitation component
General Health Perceptions Maternal health perceptions of pregnancy and of health of her baby
Quality of Life Standard Form – 12 (SF-12)
Characteristics of the Individual Demographic form
Characteristics of the environment Multidimensional Scale of PerceivedSocial Support (MSPSS)
Spiritual perspectives scale (SPS)
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Data Collection
• Completed questionnaires at 24-32 weeks gestation
along with a venous blood draw for serum vitamin D
level
• Time to complete: 20 – 40 minutes
• Took place from March 2016 to June 3, 2016
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Recruitment:
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Description of Sample
n=125
• Age 18-43 Mean = 26.8
• Pre-pregnancy BMI 16.8 – 53.0 Mean = 28.4
• African American (49.6%), Hispanic (42.4%), other (8%)
• Married or with partner 61.4%
• Income < $40,000 87.2%
• Primiparas/Multiparas 21.6%/78.4%
• Education of at least HS diploma 53.6%
• Planned pregnancy 34.4%
• Enrolled in centering 46.4%
• No history of depression 88%
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Summary of variables based on
vitamin D groups
Vitamin D < 20 ng/ml
n = 73
Vitamin D ≥ 20 ng/ml
n = 52
Biologic factors:Vitamin D levelDietary vitamin D*Hemoglobin
13.5(SD=3.6)141.3(SD=146.0)
10.9(SD=1.01)
27.75(SD=5.9)149.2(SD=112.7)
11.5(SD=1.0)
Symptom statusPSI (0-126)PSQI (0-21)EPDS (0-30)
36.2(17.4)*7.28(3.6)4.05(4.8)
36.3(18.8)*5.1(2.9)3.62(4.1)
Functional statusHPLP (1-4) 2.56(0.42) 2.64(0.44)
Quality of LifePhysical (>50, better)Mental
*43.43(7.2)52.4(8.6)
*47.74(7.2)51.5(8.6)
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Main pregnancy symptoms
reported
• Most frequently reported:
– Tiredness (84%)
– Urinary
frequency(80.8%)
– Food cravings (79.2%)
– Back pain (79.2%)
– Headache (78.4%)
– Poor sleep (72%)
– Breast pain (68%)
– Sore nipples (68%)
• Most limiting symptom
– *Tiredness (83.8%)
– *Poor sleep (77.2%)
– **Back pain (76.7%)
– *Hip/pelvic pain (71.9%)
– Headache (65.3%)*p < 0.05 ** p < .01
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Univariate analysis
• Noted only sleep quality
and physical quality of life
were significantly
predicted by vitamin D
status
• Sleep quality ODDs ratio
of 2.905
• Physical quality of life
(PCS) ODDs ratio of
5.219
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Multivariable logistic regression with
sleep quality as outcome
• Correlation analysis with
all demographic and
outcome variables with
sleep quality – (hgb, parity, living children ≠ sleep
quality)
• Pregnant women with
deficient vitamin D level
were 3.1 times more
likely to have poor sleep
quality
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Multivariable logistic regression with
physical QOL as outcome
• Correlation analysis with
all demographic and
outcome variables with
physical quality of life
• Pregnant women with
deficient vitamin D level
were 5.8 times more
likely to have poor
physical quality of life
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Discussion
• Vitamin D deficiency significantly predicted poorer sleep
quality despite controlling for significant covariates
• Multiple studies have examined similar patient
population and have seen increased depressive
symptoms and association with vitamin D (Cassidy-Bushrow et al., 2012;
Murphy et al., 2015; Brandenberg et al., 2012; Accortt et al., 2015)
• Studies in nonpregnant population (McCarty et al., 2013; Cakir et al., 2015; Massa et al.,
2015; Huang et al., 2013), VDD = poorer sleep quality, but only one
study examined pregnant women VDD ≠ poorer sleep
quality (Gunduz et al., 2015)
• Increased physical activity and higher vitamin D levels (Brock et al., 2010; Man et al., 2015; Munasinghe et al., 2015)
• No other studies examined vitamin D and QOL
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Nursing Implications
• APNs and RNs play a big role in providing perinatal
education to patients and can increase awareness about
the importance of vitamin D sufficiency
• Emphasize importance of social support and spirituality
and its positive impact on mood
• Understand the impact of pregnancy symptoms on
quality of life of pregnant women; Provide interventions
for education and management of symptoms when
needed
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Future Research
• Validate impact of vitamin D status on sleep quality and
physical QOL
• Continue clinical trials assessing vitamin D
supplementation on depressive symptoms, sleep
improvement, improved pregnancy outcomes.
• Type 2 diabetes on the rise, and diabetics are more
prone to symptoms, and could be exacerbated in
pregnancy
• Understand the relationship between inflammatory
processes and vitamin D with its relationship to
symptoms
LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
References• Aydogmus, S., Kelekci, S., Aydogmus, H., Demir, M., Yilmaz, B., & Sutcu, R. (2015). Association of antepartum vitamin D levels
with postpartum pelvic floor muscle strength and symptoms. International Urogynecology Journal, 26(8), 1179-1184.
• Bodnar, L. M., & Simhan, H. N. (2010). Vitamin D may be a link to black-white disparities in adverse birth outcomes.Obstetrical and Gynecological Survey, 65(4), 273-284.
• Bergstrom, I., Palmer, M., Persson, J., & Blanck, A. (2014). Observational study of vitamin D levels and pain in pregnant immigrant women living in Sweden. Gynecological Endocrinology : The Official Journal of the International Society of Gynecological Endocrinology, 30(1), 74-77.
• Ginde, A. A., Sullivan, A. F., Mansbach, J. M., & Camargo Jr., C. A. (2010). Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the united states. American Journal of Obstetrics and Gynecology, 202(5), 436.e1-436.e8.
• Hollis, B. W., & Wagner, C. L. (2013). Vitamin D and pregnancy: Skeletal effects, nonskeletal effects, and birth outcomes.Calcified Tissue International, 92(2), 128-139. doi:10.1007/s00223-012-9607-4 [doi]
• Hossein-nezhad, A., & Holick, M. F. (2012). Optimize dietary intake of vitamin D: An epigenetic perspective. Current Opinion in Clinical Nutrition and Metabolic Care, 15(6), 567-579. doi:10.1097/MCO.0b013e3283594978 [doi]
• Nazik, E., & Eryilmaz, G. (2014). Incidence of pregnancy-related discomforts and management approaches to relieve them among pregnant women. Journal of Clinical Nursing, 23(11-12), 1736-1750.
• McCarty, D. E., Reddy, A., Keigley, Q., Kim, P. Y., Cohen, S., & Marino, A. A. (2013). Nonspecific pain is a marker for hypovitaminosis D in patients undergoing evaluation for sleep disorders: A pilot study. Nature and Science of Sleep, 5, 37-42.
• Pludowski, P., Holick, M. F., Pilz, S., Wagner, C. L., Hollis, B. W., Grant, W. B., . . . Soni, M. (2013). Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-A review of recent evidence. Autoimmunity Reviews, 12(10), 976-989.
• Spedding, S. (2014). Vitamin D and depression: A systematic review and meta-analysis comparing studies with and without biological flaws. Nutrients, 6(4), 1501-1518.
• Wagner, C. L., Taylor, S. N., Dawodu, A., Johnson, D. D., & Hollis, B. W. (2012). Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients, 4(3), 208-230.
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