Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Maternal vitamin D status, prolonged labor, cesarean delivery and instrumental delivery in an era with a low cesarean rate

Abstract

Objective:

To examine the association between maternal 25-hydroxyvitamin D (25(OH)D) and adverse labor and delivery outcomes.

Study Design:

We measured serum 25(OH)D at 26 weeks gestation in a random subsample of vertex, singleton pregnancies in women who labored (n=2798) from the 12-site Collaborative Perinatal Project (1959 to 1966). We used labor and delivery data to classify cases of adverse outcomes.

Result:

Twenty-four percent of women were vitamin D deficient (25(OH)D <30 nmol l−1), and 4.5, 3.3, 1.9 and 7.5% of women had prolonged stage 1 labor, prolonged stage 2 labor, primary cesarean delivery or indicated instrumental delivery, respectively. After adjustment for prepregnancy body mass index, race and study site, 25(OH)D concentrations were not associated with risk of prolonged stage 1 or 2, cesarean delivery or instrumental delivery.

Conclusion:

Maternal vitamin D status at 26 weeks was not associated with risk of prolonged labor or operative delivery in an era with a low cesarean rate.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Looker AC, Johnson CL, Lacher DA, Pfeiffer CM, Schleicher RL, Sempos CT . Vitamin D status: United States, 2001-2006. NCHS Data Brief 2011; 59: 1–8.

    Google Scholar 

  2. Looker AC, Pfeiffer CM, Lacher DA, Schleicher RL, Picciano MF, Yetley EA . Serum 25-hydroxyvitamin D status of the US population: 1988-1994 compared with 2000-2004. Am J Clin Nutr 2008; 88 (6): 1519–1527.

    Article  CAS  Google Scholar 

  3. Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-A review of recent evidence. Autoimmun Rev 2013; 12 (10): 976–989.

    Article  CAS  Google Scholar 

  4. Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O'Beirne M, Rabi DM . Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013; 346: f1169.

    Article  Google Scholar 

  5. Wei SQ, Qi HP, Luo ZC, Fraser WD . Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2013; 26 (9): 889–899.

    Article  CAS  Google Scholar 

  6. MacDorman MF, Menacker F, Declercq E . Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol 2008; 35 (2): 293–307.

    Article  Google Scholar 

  7. Osterman MJ, Martin JA . Changes in cesarean delivery rates by gestational age: United States, 1996-2011. NCHS Data Brief 2013; 124: 1–8.

    Google Scholar 

  8. Laughon SK, Branch DW, Beaver J, Zhang J . Changes in labor patterns over 50 years. Am J Obstet Gynecol 2012; 206 (5): 419 e411–419 e419.

    Article  Google Scholar 

  9. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007; 21 (2): 98–113.

    Article  Google Scholar 

  10. Walsh CA, Robson M, McAuliffe FM . Mode of delivery at term and adverse neonatal outcomes. Obstet Gynecol 2013; 121 (1): 122–128.

    Article  Google Scholar 

  11. Gifford DS, Morton SC, Fiske M, Keesey J, Keeler E, Kahn KL . Lack of progress in labor as a reason for cesarean. Obstet Gynecol 2000; 95 (4): 589–595.

    CAS  PubMed  Google Scholar 

  12. Altman MR, Lydon-Rochelle MT . Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review. Birth 2006; 33 (4): 315–322.

    Article  Google Scholar 

  13. Yakoob MY, Lawn JE, Darmstadt GL, Bhutta ZA . Stillbirths: epidemiology, evidence, and priorities for action. Semin Perinatol 2010; 34 (6): 387–394.

    Article  Google Scholar 

  14. Casey BM, Cox SM . Chorioamnionitis and endometritis. Infect Dis Clin North Am 1997; 11 (1): 203–222.

    Article  CAS  Google Scholar 

  15. Cunningham G, Leveno K, Bloom S, Hauth J, Rouse D, Spong C . Williams Obstetrics 23rd edn McGraw-Hill Companies: New York, 2010.

    Google Scholar 

  16. Vienonen A, Miettinen S, Blauer M, Martikainen PM, Tomas E, Heinonen PK et al. Expression of nuclear receptors and cofactors in human endometrium and myometrium. J Soc Gynecol Investig 2004; 11 (2): 104–112.

    Article  CAS  Google Scholar 

  17. Bischoff HA, Borchers M, Gudat F, Duermueller U, Theiler R, Stahelin HB et al. In situ detection of 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue. Histochem J 2001; 33 (1): 19–24.

    Article  CAS  Google Scholar 

  18. Torres CF, Forbes GB, Decancq GH . Muscle weakness in infants with rickets: distribution, course, and recovery. Pediatr Neurol 1986; 2 (2): 95–98.

    Article  CAS  Google Scholar 

  19. Bischoff HA, Stahelin HB, Urscheler N, Ehrsam R, Vonthein R, Perrig-Chiello P et al. Muscle strength in the elderly: its relation to vitamin D metabolites. Arch Phys Med Rehabil 1999; 80 (1): 54–58.

    Article  CAS  Google Scholar 

  20. Thota C, Laknaur A, Farmer T, Ladson G, Al-Hendy A, Ismail N . Vitamin D regulates contractile profile in human uterine myometrial cells via NFB pathway. Am J Obstet Gynecol 2013; 210 (4): 347.

    PubMed  PubMed Central  Google Scholar 

  21. Scholl TO, Chen X . Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight. Early Hum Dev 2009; 85 (4): 231–234.

    Article  CAS  Google Scholar 

  22. Brunvand L, Shah SS, Bergstrom S, Haug E . Vitamin D deficiency in pregnancy is not associated with obstructed labor. A study among Pakistani women in Karachi. Acta Obstet Gynecol Scand 1998; 77 (3): 303–306.

    Article  CAS  Google Scholar 

  23. Savvidou MD, Makgoba M, Castro PT, Akolekar R, Nicolaides KH . First-trimester maternal serum vitamin D and mode of delivery. Br J Nutr 2012; 108 (11): 1972–1975.

    Article  CAS  Google Scholar 

  24. Fernandez-Alonso AM, Dionis-Sanchez EC, Chedraui P, Gonzalez-Salmeron MD, Perez-Lopez FR . First-trimester maternal serum 25-hydroxyvitamin D(3) status and pregnancy outcome. Int J Gynaecol Obstet 2012; 116 (1): 6–9.

    Article  CAS  Google Scholar 

  25. Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF . Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab 2009; 94 (3): 940–945.

    Article  CAS  Google Scholar 

  26. Niswander K . The Collaborative Perinatal Study of the National Institute of Neurological Diseases and Stroke: The Women and their Pregnancies. WB Saunders: Philadelphia, PA, USA, 1972.

    Google Scholar 

  27. Bodnar LM, Klebanoff MA, Gernand AD, Platt RW, Parks WT, Catov JM et al. Maternal Vitamin D status and spontaneous preterm birth by placental histology in the US Collaborative Perinatal Project. Am J Epidemiol 2014; 179 (2): 168–176.

    Article  Google Scholar 

  28. Bodnar LM, Simhan HN, Catov JM, Roberts JM, Platt RW, Diesel JC et al. Maternal vitamin D status and the risk of mild and severe preeclampsia. Epidemiology 2014; 25 (2): 207–214.

    Article  Google Scholar 

  29. Seamans KM, Cashman KD . Existing and potentially novel functional markers of vitamin D status: a systematic review. Am J Clin Nutr 2009; 89 (6): 1997S–2008S.

    Article  CAS  Google Scholar 

  30. Zerwekh JE . The measurement of vitamin D: analytical aspects. Ann Clin Biochem 2004; 41 (Pt 4): 272–281.

    Article  CAS  Google Scholar 

  31. Bodnar LM, Catov JM, Wisner KL, Klebanoff MA . Racial and seasonal differences in 25-hydroxyvitamin D detected in maternal sera frozen for over 40 years. Br J Nutr 2009; 101 (2): 278–284.

    Article  CAS  Google Scholar 

  32. IOM. Dietary Reference Intakes for Calcium and Vitamin D. The National Academies Press: Washington, DC, USA, 2011.

  33. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (7): 1911–1930.

    Article  CAS  Google Scholar 

  34. Greenberg MB, Cheng YW, Hopkins LM, Stotland NE, Bryant AS, Caughey AB . Are there ethnic differences in the length of labor? Am J Obstet Gynecol 2006; 195 (3): 743–748.

    Article  Google Scholar 

  35. Allen VM, Baskett TF, O'Connell CM, McKeen D, Allen AC . Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol 2009; 113 (6): 1248–1258.

    Article  Google Scholar 

  36. Myrianthopoulos NC, French KS . An application of the U.S. Bureau of the Census socioeconomic index to a large, diversified patient population. Soc Sci Med 1968; 2 (3): 283–299.

    Article  CAS  Google Scholar 

  37. Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009; 338: b2393.

    Article  Google Scholar 

  38. Weng HY, Hsueh YH, Messam LL, Hertz-Picciotto I . Methods of covariate selection: directed acyclic graphs and the change-in-estimate procedure. Am J Epidemiol 2009; 169 (10): 1182–1190.

    Article  Google Scholar 

  39. Gernand AD, Simhan HN, Klebanoff MA, Bodnar LM . Maternal serum 25-hydroxyvitamin D and measures of newborn and placental weight in a U.S. multicenter cohort study. J Clin Endocrinol Metab 2013; 98 (1): 398–404.

    Article  CAS  Google Scholar 

  40. Dror DK, King JC, Durand DJ, Allen LH . Association of modifiable and nonmodifiable factors with vitamin D status in pregnant women and neonates in Oakland, CA. J Am Diet Assoc 2011; 111 (1): 111–116.

    Article  CAS  Google Scholar 

  41. Simpson RU, Thomas GA, Arnold AJ . Identification of 1,25-dihydroxyvitamin D3 receptors and activities in muscle. J Biol Chem 1985; 260 (15): 8882–8891.

    CAS  PubMed  Google Scholar 

  42. Moran DS, McClung JP, Kohen T, Lieberman HR . Vitamin D and physical performance. Sports Med 2013; 43 (7): 601–611.

    Article  Google Scholar 

  43. Mithal A, Bonjour JP, Boonen S, Burckhardt P, Degens H, El Hajj Fuleihan G et al. Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int 2013; 24 (5): 1555–1566.

    Article  CAS  Google Scholar 

  44. Hazell TJ, DeGuire JR, Weiler HA . Vitamin D: an overview of its role in skeletal muscle physiology in children and adolescents. Nutr Rev 2012; 70 (9): 520–533.

    Article  Google Scholar 

  45. Wyon MA, Koutedakis Y, Wolman R, Nevill AM, Allen N . The influence of winter vitamin D supplementation on muscle function and injury occurrence in elite ballet dancers: a controlled study. J Sci Med Sport 2013; 17 (1): 8–12.

    Article  Google Scholar 

  46. Thacker SB, Banta HD . Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860-1980. Obstet Gynecol Surv 1983; 38 (6): 322–338.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by NIH grant HD056999 (PI: BLM). We thank Jill Diesel for her assistance with data management. Dr Gernand’s research is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under BIRCWH award number K12HD055882, “Career Development Program in Women’s Health Research at Penn State.” The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L M Bodnar.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gernand, A., Klebanoff, M., Simhan, H. et al. Maternal vitamin D status, prolonged labor, cesarean delivery and instrumental delivery in an era with a low cesarean rate. J Perinatol 35, 23–28 (2015). https://doi.org/10.1038/jp.2014.139

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2014.139

This article is cited by

Search

Quick links