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Is there a relation between stillbirth and low levels of vitamin D in the population?: A bi-national follow-up study of vitamin D fortification
Karolinska Inst, Clin Sci & Educ, Obstet & Gynecol, Sodersjukhuset, Sjukhusbacken 10, S-11883 Stockholm, Sweden.;Soder Sjukhuset, Dept Obstet & Gynecol, Stockholm, Sweden..
THL Finnish Inst Hlth & Welf, Dept Knowledge Brokers, Helsinki, Finland.;Univ Turku, Res Ctr Child Psychiat & Invest Res Flagship, Turku, Finland.;Reg Stockholm, Acad Primary Hlth Care Ctr, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Reproductive Health and Migration.ORCID iD: 0000-0002-2900-2849
2023 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, no 1, article id 359Article in journal (Refereed) Published
Abstract [en]

Background: Stillbirth has been associated with low plasma vitamin D. Both Sweden and Finland have a high proportion of low plasma vitamin D levels (< 50 nmol/L). We aimed to assess the odds of stillbirth in relation to changes in national vitamin D fortification.

Methods: We surveyed all pregnancies in Finland between 1994 and 2021 (n = 1,569,739) and Sweden (n = 2,800,730) with live or stillbirth registered in the Medical Birth Registries. The mean incidences before and after changes in the vitamin D food fortification programs in Finland (2003 and 2009) and Sweden (2018) were compared with cross-tabulation with 95% confidence intervals (CI).

Results: In Finland, the stillbirth rate declined from similar to 4.1/1000 prior to 2003, to 3.4/1000 between 2004 and 2009 (odds ratio [OR] 0.87, 95% CI 0.81-0.93), and to 2.8/1000 after 2010 (OR 0.84, 95% CI 0.78-0.91). In Sweden, the stillbirth rate decreased from 3.9/1000 between 2008 and 2017 to 3.2/1000 after 2018 (OR 0.83, 95% CI 0.78-0.89). When the level of the dose-dependent difference in Finland in a large sample with correct temporal associations decreased, it remained steady in Sweden, and vice versa, indicating that the effect may be due to vitamin D. These are observational findings that may not be causal.

Conclusion: Each increment of vitamin D fortification was associated with a 15% drop in stillbirths on a national level. If true, and if fortification reaches the entire population, it may represent a milestone in preventing stillbirths and reducing health inequalities.

Place, publisher, year, edition, pages
BMC , 2023. Vol. 23, no 1, article id 359
Keywords [en]
Stillbirth, Vitamin D, Fortification, Intrauterine death
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-506976DOI: 10.1186/s12884-023-05673-8ISI: 000991986000001PubMedID: 37198534OAI: oai:DiVA.org:uu-506976DiVA, id: diva2:1778930
Funder
Swedish Research Council, S113106103Available from: 2023-07-03 Created: 2023-07-03 Last updated: 2023-07-03Bibliographically approved

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Essén, Birgitta

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