jennifer woo, phd, cnm/whnp clinical assistant · pdf filesymptom status pregnancy symptom...
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Item type Presentation
Format Text-based Document
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
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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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Conflicts of Interest
• I have no relevant financial or nonfinancial conflicts of
interest
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• 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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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?
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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)
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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.
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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)
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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)
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
Recruitment:
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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%
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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)
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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
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LOYOLA UNIVERSITY CHICAG0 MARCELLA NIEHOFF SCHOOL OF NURSING
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.
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