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  • Title: Vitamin D deficiency in pregnancy is not associated with obstructed labor. A study among Pakistani women in Karachi.
    Author: Brunvand L, Shah SS, Bergström S, Haug E.
    Journal: Acta Obstet Gynecol Scand; 1998 Mar; 77(3):303-6. PubMed ID: 9539276.
    Abstract:
    BACKGROUND: Vitamin D deficiency is widespread among pregnant Pakistanis in Norway. It may cause osteomalacia with destruction of maternal pelvis, and thus be a risk factor for cephalopelvic disproportion. This study was performed to determine whether vitamin D deficiency is common among pregnant Pakistanis in Pakistan, and to test the hypothesis that vitamin D deficiency in nulliparous pregnant women is associated with mechanical dystocia. METHODS: The study was carried out at the Civil Hospital, in a poor area of Karachi, and had a case-referent design. Thirty-seven nulliparous parturients with Cesarean section due to mechanical dystocia served as cases, and 80 nulliparous parturients with uncomplicated vaginal delivery were their referents. All blood samples were drawn before parturition. RESULTS: The mothers with obstructed labor were shorter (on average 150 vs. 155 cm, p= 0.0001) and lighter (on average 58 vs. 60.5 kg, p=0.005) than their referents. Seventy-one percent (83/117) of all the participants had marginal or low vitamin D status defined as serum level of calcidiol (25-OH vitamin D3) below 30 nmol/l. Vitamin D deficiency was, however, not more widespread among the mothers with obstructed labor (20/37 vs. 63/80). Furthermore, there were no significant differences in the serum levels of the carboxyterminal telopeptide of type I collagen, a sensitive biochemical marker of bone resorption, (7.2 vs. 6.6 microg/l), and bone specific alkaline phosphate (18.1 vs. 22.0 U/l) a sensitive marker of bone formation. CONCLUSIONS: Vitamin D deficiency in pregnancy is common in Karachi, but is not associated with mechanical dystocia. Vitamin D deficiency, widespread among pregnant Pakistani women living in Norway, may cause osteomalacia and thus represent a risk factor for cephalopelvic disproportion. The present study investigated the prevalence of vitamin D deficiency among pregnant women in Karachi, Pakistan, in 1994-95 and its association with mechanical dystocia. 37 nulliparous women admitted to the Civil Hospital in a poor area of Karachi for cesarean section due to dystocia served as cases; 80 nulliparous parturients with uncomplicated vaginal delivery were enrolled as their controls. On average, mothers with obstructed labor were significantly shorter (50 vs. 155 cm) and lighter (58 vs. 60.5 kg) than their referents. Overall, 83 women (71%) had marginal or low vitamin D status (serum levels of calcidiol under 30 nmol/l). However, vitamin D deficiency was not more widespread among women with obstructed labor (20/37, or 54%) than controls (63/80, or 83%), even when logistic regression analysis including the risk factors of maternal height and birth weight was performed. In addition, there were no significant differences in serum levels of the carboxy-terminal telopeptide of type I collagen (a sensitive biochemical marker of bone resorption) or bone-specific alkaline phosphate (a marker of bone formation). The shorter height of Pakistani women with obstructed labor suggests that stunted growth in childhood--not vitamin D deficiency in pregnancy--is a major risk factor for cephalopelvic disproportion in low-income areas where vitamin D deficiency in pregnancy is widespread.
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