Relationship Between Vitamin D During Perinatal Development and Health

Jovana Kaludjerovic, MSc; Reinhold Vieth, PhD

Disclosures

J Midwifery Womens Health. 2010;55(6):550-560. 

In This Article

Vitamin D Effects on Heart Disease

Findings from the National Health and Nutrition Examination Survey (1988–1994) revealed that serum 25(OH)D concentrations are inversely associated with cardiovascular disease, hypertension, myocardial infarction, congestive heart failure, and stroke in a large sample representative of the US adult population.[47] Exposure to low concentrations of 25(OH)D during early development may alter function in later life because during perinatal life, the mammalian heart undergoes tremendous growth and development. Emerging epidemiologic evidence (Table 1) suggests that both maternal and neonatal vitamin D deficiency may be associated with heart disease later in life, but the mechanism remains unknown. One hypothesis is that vitamin D deficiency substantially lowers intestinal calcium absorption (50–60%), which triggers parathyroid hormone release.[48] Parathyroid hormone, in addition to its actions on calcium reabsorption and vitamin D production, stimulates insulin resistance, inflammation, and the renin–angiotensin aldosterone system. Over time, these three metabolic modifications upregulate the atherosclerotic process, which can lead to heart disease (Figure 2).[48]

A study conducted in rodents examined how maternal vitamin D deprivation affected metabolic and contractile development of the neonatal heart.[49] Pups exposed to low levels of vitamin D (<200 IU/day) during perinatal life exhibited a reduction in protein (myofibrillar) accumulation and cardiac growth, which may seriously compromise cardiac functional capacity. In humans, there was no association between maternal 25(OH)D levels and cardiac measures in offspring at 9 years of age.[29] However, changes in cardiac measures typically manifest in later life, suggesting that human studies need to be followed more long-term to determine the true association between vitamin D and heart disease.

During pregnancy, vitamin D may also affect heart development by modulating kidney function. In humans, nephron synthesis is complete at 36 weeks of gestation. Perturbations in nephrogenesis during the early stages of development may have long-term implications for renal health and hypertension. A study by Maka et al.[50] revealed that rat pups born to vitamin D–deficient mothers had a 20% increase in nephron endowment and a reduction in renal corpuscle size. These changes suggest that vitamin D does modulate nephrogenesis. However, without examining tubule resorption or kidney perfusion, the long-term implications of these changes for hypertension or heart health are unknown.

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