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Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency: a before-and-after treatment study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Primary Hlth Care Ctr Jakobsgardarna, Jaxtorget 7A,Box 100 33, S-78110 Borlange, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
2016 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 353Article in journal (Refereed) Published
Abstract [en]

Background: Muscular weakness and severe vitamin D deficiency is prevalent in Somali (veiled) pregnant women, Sweden. The study aims here were to explore adherence to prescribed supplemental vitamin D in new mothers with vitamin D deficiency and its effects on grip strength and upper leg performance in Somali (target group TG) and Swedish women (reference group RG) from spring through winter.

Methods: A before-and after study was designed. A cross-sectional sample of women in antenatal care with serum 25-OHD <= 50 nmol/L were prescribed one or two tablets daily (800 or 1600 IU vitamin D3 with calcium) for 10 months. Reminders were made by Somali nurses (TG) or Swedish doctors (RG). Baseline and 10 month measurements of plasma nmol/L 25-OHD, maximal grip strength held for 10 s (Newton, N) and ability to squat (yes; no) were done. Total tablet intake (n) was calculated. Outcome variables were changes from baseline in grip strength and ability to squat. Predicting variables for change in grip strength and ability to squat were calculated using linear and binary regression in final models. Undetectable 25-OHD values (< 10 nmol/L) were replaced with '9' in statistic calculations.

Results: Seventy-one women (46 TG, 1/3 with undetectable baseline 25-OHD; 25 RG) participated. At the 10-month follow up, 17% TG and 8% RG women reported having refrained from supplement. Mean 25-OHD increased 16 to 49 nmol/L (TG) and 39 nmol/L to 67 nmol/L (RG), (both p < 0.001). Grip strength had improved from 153 to 188 N (TG) (p < 0.001) and from 257 to 297 N (RG) (p = 0.003) and inability to squat had decreased in TG (35 to 9, p < 0. 001). Intake of number of tablets predicted increased grip strength (B 0.067, 95% CI 0.008-0.127, p = 0.027). One tablet daily (> 300 in total) predicted improved ability to squat (OR 16; 95% CI 1.8-144.6).

Conclusions: Adherence to supplemental vitamin D and calcium should be encouraged as an even moderate intake was associated to improved grip strength and upper leg performance, which was particularly useful for the women with severe 25-OHD deficiency and poor physical performance at baseline.

Place, publisher, year, edition, pages
2016. Vol. 16, article id 353
Keywords [en]
Adherence, Multicultural care, Vitamin D, Physical performance, Grip strength, Pregnancy, Somalia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-309795DOI: 10.1186/s12884-016-1117-3ISI: 000387608700001PubMedID: 27846821OAI: oai:DiVA.org:uu-309795DiVA, id: diva2:1058777
Available from: 2016-12-21 Created: 2016-12-07 Last updated: 2019-09-05Bibliographically approved
In thesis
1. Vitamin D, muscle strength, prolonged labour, Caesarean sections and lifestyle: Clinical and intervention studies in pregnant Somali and Swedish women and new mothers
Open this publication in new window or tab >>Vitamin D, muscle strength, prolonged labour, Caesarean sections and lifestyle: Clinical and intervention studies in pregnant Somali and Swedish women and new mothers
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Long-term severe vitamin D deficiency may cause osteomalacia with muscle weakness, pain, soft bones, cramps and eventually death. In a pilot study, I found many Somali women to be vitamin D deficient and very weak. This raised my interest and resulted in the research questions regarding if and how this weakness was linked to vitamin D deficiency, if it could be treated with simple lifestyle advice and supplementation, and if pronounced deficiency could cause serious birth outcomes due to prolonged labour?

Study I showed that 90% of pregnant Somali women (n = 52) and new mothers from primary antenatal care suffered from vitamin D deficiency with pronounced muscular weakness and signs of skeletal degradation, compared with 10% of the Swedish women (n = 71). Handgrip strength was predicted by vitamin D levels.

Study II showed that vitamin D supplementation among those with insufficient levels at baseline reversed deficiency and skeletal degradation. Furthermore, increased strength in hands and legs was predicted by the amount of supplement intake.

Study III aimed to investigate the vitamin D levels and the birth outcomes of cesarean sections and assisted birth for prolonged labour. A directed acyclic graph was established to adjust for covariates. A causal effect of critically low (unmeasurable) vitamin D levels on the outcomes of caesarean sections, emergency caesarean sections and assisted birth for prolonged labour was found with the increased odds of four, nine and six times to one for the birth outcomes, respectively.

Lifestyle associated with vitamin D may concern many due to risk of low sun exposure, for example, when working long office hours, engaging in excessive computer gaming, using sunscreen, wearing veiled clothes, or when having special diets like vegan food.

It is important to monitor individuals in primary- and antenatal care with muscle weakness and risk factors for vitamin D deficiency, especially in the high-risk group of Somali pregnant women and new mothers.         

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 68
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1594
Keywords
: caesarean section, dystocia, immigrant, muscle strength, obstetric labour complications, osteomalacia, physical performance, Somalia, vitamin D, vitamin D deficiency
National Category
Medical and Health Sciences
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-392475 (URN)978-91-513-0741-1 (ISBN)
Public defence
2019-10-25, A1:111a, BMC, Husargatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-10-03 Created: 2019-09-04 Last updated: 2019-10-23

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