| Part one Associations of maternal depression with newborn vitamin D concentrations and morphology development ObjectiveTo investigate whether the newborns of mothers with maternal depression(MD)had lower vitamin D levels and smaller fetal morphology than newborns of non-MD(NMD)mothers and identify the potential biological pathways underlying this association.Methods2,552 pregnant women who received prenatal check-ups in Hefei Maternal and Child Health Hospital from January to September 2008 were recruited in Hefei.In this study,to exclude potential confounding factors,stillbirth,birth defects,women with delivery before 32 weeks of gestation(early preterm),pregnancy with assisted reproductive technology,or multiple gestations were excluded from the study.1491 pregnant women whose maternal sociodemographic characteristics,health status,lifestyle and birth outcomes were prospectively collected.Finally,we also obtained1,491 available mother-infant pairs with cord blood and 466 mother-infant pairs with both maternal circulating blood before delivery and cord blood.Chi-square test or Student's t-test analyses were adopted to test the differences in the demographics and clinical characteristics of depressive pregnant women and non-depressive pregnant women.The differences in the prevalence of maternal depression and concentrations ofcord blood 25(OH)D between winter-spring and summer-autumn were analyzed using Student's t-test or the Chi-square test.Stratified by season,we examined the differences in concentrations of cord blood 25(OH)D and infants birth weight,length and head circumference between depressive pregnant women and non-depressive pregnant women using a multiple linear model.The risk of vitamin D deficiency for newborns of MD mothers was assessed using a multiple logistic regression model after adjustment for confounders.We further tested the differences in maternal 25(OH)D concentrations and fetomaternal ratios of 25(OH)D between depressive pregnant women and non-depressive pregnant women using multiple linear regression models.ResultsIn this study,there were 218(14.6%)pregnant women above the clinically significant cutoff for depressive symptoms.Depressive pregnant women had significantly reduced education attainment,family income.Alcohol consumption and husband smoking were significantly higher in depressive pregnant women than non-depressive pregnant women.For infants born in winter-spring,infants of mothers with MD had significantly reduced concentrations of cord blood 25(OH)D(adjustedb =-3.51 nmol/L;95% CI:-6.19,-0.84;P=0.010)and elevated risks of vitamin D deficiency(adjusted OR=1.56;95% CI: 1.01,2.40;P=0.045),compared with the infants of NMD mothers.We then stratified the data by season,a significant inverse relationship between maternal CES-D scores and the concentrations of cord blood25(OH)D among infants born in winter-spring(adjusted b =-0.158;95% CI:-0.259,-0.057;P=0.002).In addition,for infants born in winter-spring,neonatal birth weight(3267 ± 450 g vs 3348 ± 5.8 g,F = 4.64,P <0.05),length(50.2 ±2.4 cm vs 50.6 ± 1.6cm,F = 4.61(P <0.05)and head circumference(34.2 ± 2.1 cm vs 34.6 ± 1.5 cm,F =4.43,P <0.05)were also lower than those of non-depressed pregnant women.However,these significant difference were not observed among infants born in summer-autumn.We did not observe a significant difference between depressive pregnant women and non-depressive pregnant women in maternal circulating 25(OH)D concentrations.However,for infants born in winter-spring,the fetomaternal ratio of 25(OH)D among mother-infant pairs of MD mothers was significantly reduced compared with NMD mothers(0.35 ± 0.13 vs.0.44 ± 0.19,P=0.007).Further analysis showed that the significant inverse linear relationship between maternal CES-D scores and the fetomaternal ratio of 25(OH)D was also observed among mother-infant pairs born in winter-spring(adjusted b=-0.005;95% CI:-0.008,-0.003;P<0.001)but not those born in summer-autumn.ConclusionsMaternal depression may lead to lower VD levels and smaller birth weight,body length,and head circumference for newborns,but this significant effect is observed only in newborns born in winter-spring.The effect of depression on fetal VD levels and morphological development may have seasonal specificity.The effect of depression on fetal VD levels during pregnancy may be due to the ability of the placenta to transport25(OH)D,rather than directly affecting the VD level of the pregnant mother.The effect of depression on the 25(OH)D maternal-fetal ratio during pregnancy was also observed only in neonates born in winter-spring,which also supported the hypothesis that "the effect of depression on fetal morphology development may have seasonal specificity".Part two Effect of vitamin D supplementation on birth morphology development in depressive pregnant women:a preliminary intervention trail ObjectiveTo investigate whether vitamin D3 supplementation with 800 IU / d for depressive pregnant women can significantly increase the concentrations of cord blood 25(OH)D among infants and to verify whether infants of mothers with MD may benefit from vitamin D supplementation.Methods2,507 pregnant women who received first prenatal check-ups in Hefei First People's Hospital from March 2015 to August 2016 were recruited.In this study,to exclude potential confounding factors,stillbirth,birth defects,women with delivery before 32 weeks of gestation(early preterm),pregnancy with assisted reproductive technology,or multiple gestations were excluded from the study.Finally,we obtained 1907 pregnant women who had complete access to complete information.The pregnant women were randomly assigned according to the date of first prenatal check-ups.Single-day date of depressive pregnant women assigned to the intervention group for 800 IU / d vitamin D3 supplementation,The double-day date of depressive pregnant women assigned to non-intervention group.All participants completed depressive mood screening at the first prenatal check-ups.Pregnancy health information was collected after 32 weeks of gestation.Cord blood was collected at birth by study nurses when available and the birth outcome information were collected after delivery.Pregnant women with depressive and vitamin D3 supplementation during pregnancy as a depression intervention group,pregnant women who were depressed during pregnancy but did not have vitamin D3 supplementation as a depressive non-intervention group and pregnantwomen with no depression as normal control group.Finally,the number of depression intervention group,depression non-intervention group and the normal control group were 117,147 and 580,respectively.The demographic characteristics,concentrations of maternal 25(OH)D before and after intervention,cord blood 25(OH)D,and the offspring outcome of the three groups were analyzed by variance analysis,rank sum test and covariance analysis.ResultsThere were significant differences in education attainment,family income,sun exposure,milk intake and Pregnant husband smoking between the three groups.There was no significant difference in the concentrations of 25(OH)D between the depressive intervention group and the depressed non-intervention group before intervention,but the concentrations of 25(OH)D in the two groups were lower than the normal control group,the difference was statistically significant(P<0.001).After intervention,the concentrations of 25(OH)D in the depression intervention group was significantly increased,the mean value was 26.1 nmol / L(95% CI: 21.5 ~ 30.6).and the concentrations of 25(OH)D in depression intervention group was significantly higher than the depressive non-intervention group(P<0.001)and normal control group(P<0.001),the concentrations of 25(OH)D in depressive non-intervention group was significantly lower than normal group(P<0.001),the difference was statistically significant(P=0.031).After confounding factors,the concentrations of cord blood25(OH)D in depression intervention group was significantly higher than the depressive non-intervention group and normal control group(P<0.001).We then stratified the data by season,the difference was still exist.However,for infants born in winter-spring,the concentration of cord blood 25(OH)D in depressive non-intervention group was significantly lower than normal group(P=0.004).However,the significant difference was not observed in summer-autumn(P=0.418).The social demographic variables with statistically significant differences(P<0.1)among the three groups were used as covariates,and covariance analysis was performed on the birth outcome of the three generations.The results showed that the significant difference in birth weight and length were not observed between the three groups,while the head circumference was still statistically significant(P = 0.016).The average head circumference of the neonates in the depression intervention group was larger than the normal control group,the difference was statistically significant(P=0.006).We then stratified the data by season.For infants born in winter-spring,the average head circumference of the neonates in the depression intervention group was still larger than the normal control group(P=0.003).However,the significant difference in birth weight,length and head circumference were not observed among infants born in summer-autumn.ConclusionsSupplementation of 800 IU/d Vitamin D3 during pregnancy could significantly increase the concentrations of 25(OH)D among pregnant women and fetus.Depression pregnant women supplement vitamin D during pregnancy could significantly increase neonatal head circumference,this effect can be observed among infants born in winter-spring,but not observed in summer-autumn.Therefore,the promotion of supplement VD among depression pregnant women on morphological development of the offspring may have the birth season specificity.The results of this study support further clinical trials to identify the clinical value of VD supplemention during pregnancy. |
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