Jennifer Woo, PhD, CNM/WHNP Clinical Assistant · PDF fileSymptom status Pregnancy Symptom Inventory ... • Most limiting symptom –Tiredness (83.8%) –Poor sleep ... for education

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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

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


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


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?


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)


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


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


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


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.


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)


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


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)


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


Recruitment:


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%


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)


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


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


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


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


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


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


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


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.

Documents

Jennifer Woo, PhD, CNM/WHNP Clinical Assistant · PDF fileSymptom status Pregnancy Symptom Inventory ... • Most limiting symptom –*Tiredness (83.8%) –*Poor sleep ... for education

Jennifer Woo, PhD, CNM/WHNP Clinical Assistant · PDF fileSymptom status Pregnancy Symptom Inventory ... • Most limiting symptom –Tiredness (83.8%) –Poor sleep ... for education