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Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers
Primary Care Center Jakobsgårdarna, Jaxtorget 7A, Box 100 33 Borlänge S-781 10, Sweden.
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.
2013 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, article id 237Article in journal (Refereed) Published
Abstract [en]

Background:

Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH) D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born).

Methods:

Women (n = 123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60 degrees N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10-24, 25-49, 50-74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH) D categories. Undetectable values (< 10 nmol/L) were replaced with '9' in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH) D levels, age, height, weight, physical activity, lactation status, parity, and gestational age.

Results:

Somali participants (35%) had 25(OH) D levels of < 10 nmol/L, and 90% had < 25 nmol/L; 10% of Swedish participants had < 25 nmol/L of 25(OH) D, and 54% had < 50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167-246) vs. median 316 N (inter-quartile range 278-359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH) D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH) D levels (B 0.94, p=0.013) together with Somali birth (B -63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).

Conclusions:

Many Somali women had undetectable/severely low 25(OH) D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH) D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly.

Place, publisher, year, edition, pages
2013. Vol. 13, article id 237
Keywords [en]
Vitamin D, 25(OH)D, Ultraviolet B radiation, Grip strength, Clinical observation, Physical performance, Primary care, Somalia, Pregnancy
National Category
General Practice
Identifiers
URN: urn:nbn:se:uu:diva-217631DOI: 10.1186/1471-2393-13-237ISI: 000329252000003OAI: oai:DiVA.org:uu-217631DiVA, id: diva2:694290
Available from: 2014-02-06 Created: 2014-02-04 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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Kalliokoski, PaulLöfvander, Monica

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