By taking all these considerations into account, and under medical counseling and supervision, every woman may modulate their VD levels for acquiring sufficiency and avoiding possible toxicity that could lead to hypercalcemia. Evans K.N., Bulmer J.N., Kilby M.D., Hewison M. Vitamin D and placental-decidual function. We only found one interventional study about VD and birth weight. Unauthorized use of these marks is strictly prohibited. 19.79. Lau S.L., Gunton J.E., Athayde N.P., Byth K., Cheung N.W. In a partially randomized assay on pregnant women, the intervention with one single oral dose of 1500 g VD3 (equal to 60,000 IU) or two doses of 3000 g each (equal to 120,000 IU) in the 2nd and 3rd trimesters resulted in higher birth weight and length in comparison to newborns of mothers treated with usual care [210]. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes. Cross N.A., Hillman L.S., Allen S.H., Krause G.F., Vieira N.E. Avila E., Garcia-Becerra R., Rodriguez-Rasgado J.A., Diaz L., Ordaz-Rosado D., Zugel U., Steinmeyer A., Barrera D., Halhali A., Larrea F., et al. Indeed, obese subjects normally have lower basal 25OHD serum concentrations than lean individuals [221], which is possibly explained by the fact that VD is readily stored in adipose tissue due to its fat-soluble nature. In: StatPearls [Internet]. C 1,25-Dihydroxyvitamin D 3 (Calcitriol) Calcitriol is the active form of vitamin D, and it is essential for calcium absorption and bone mineralization. UVB radiation from sunlight initiates vitamin D (VD) biosynthesis in the skin by bioconverting 7-dehydrocholesterol to previtamin D3, which is thermally isomerized to VD3. 1alpha(OH)D3 One-alpha-hydroxy-cholecalciferol--an active vitamin D analog. Interestingly, Robinson and colleagues [129] found that a 10 ng/mL increase in 25OHD levels yields a 63% decrease in the risk of severe PE, strongly suggesting that pregnant women should have VD sufficiency in order to lower the risk for PE development. Weisman Y., Vargas A., Duckett G., Reiter E., Root A.W. The other process mediated by this type of regulation is osteogenesis. However, this hypothesis has been confronted in the last years, given the important transporting and interacting mechanisms existing between the megalin/cubilin complex and DBP/25OHD, together with the observed disparity between the expected amounts of free hormone available for passive diffusion and the levels required to efficiently occupy intracellular target receptors. Maternal vitamin D status in pregnancy and risk of lower respiratory tract infections, wheezing, and asthma in offspring. Powe C.E., Karumanchi S.A., Thadhani R. Vitamin D-binding protein and vitamin D in blacks and whites. In addition, non-genomic calcitriol-dependent biological effects can also take place in cells, involving second messengers generated by membrane-initiated signaling pathways [7,8]. 2019 Jan;55(1):104-106. Tuan R.S., Moore C.J., Brittingham J.W., Kirwin J.J., Akins R.E., Wong M. In vitro study of placental trophoblast calcium uptake using JEG-3 human choriocarcinoma cells. Rubin L.P., Yeung B., Vouros P., Vilner L.M., Reddy G.S. Mannion C.A., Gray-Donald K., Koski K.G. Summary Calcipotriol is a topical synthetic vitamin D2 derivative used in the treatment of plaque psoriasis. The relationship between maternal and fetal vitamin D, insulin resistance, and fetal growth. Vitamin D is excreted into breast milk in small amounts. Pryke A.M., Duggan C., White C.P., Posen S., Mason R.S. Levine B.S., Song M. Pharmacokinetics and efficacy of pulse oral. Cut-offs in vitamin D status according to the Endocrine Society [110]. We believe, that at this moment, the ideal scheme for VD supplementation will depend on particular endogenous and exogenous factors, on the available formulations of VD (i.e., in Mexico only tablets with 400 IU are available), and on the personal VD metabolism, which should be monitored periodically by serum 25OHD analyses. Increased synthesis of calcitriol is linked to higher CYP27B1 activity in maternal kidney, placental trophoblasts and decidua [69,70,71]. In particular, calcitriol induces endometrial decidualization and estradiol and progesterone synthesis, but also regulates the expression of human chorionic gonadotropin and placental lactogen expression [94,95,96,97]. In: StatPearls [Internet]. Please enable it to take advantage of the complete set of features! Many studies have shown an array of adverse health outcomes in the offspring of obese women; for example, lower maternal VD status may be linked to programmed differences in offspring fat mass [224,226]. Maternal vitamin D status and calcium intake interact to affect fetal skeletal growth in utero in pregnant adolescents. Genetic variants in CYP2R1, CYP24A1, and VDR modify the efficacy of vitamin D3 supplementation for increasing serum 25-hydroxyvitamin D levels in a randomized controlled trial. Vitamin D receptor (VDR)-mediated actions of 1alpha,25(OH)(2)vitamin D(3): Genomic and non-genomic mechanisms. Senti J., Thiele D.K., Anderson C.M. If iPTH decrease < target range for CKD stage hold calcitriol therapy until iPTH increases to . Other metabolites as VD2, VD3, 1,25(OH)2D2 and 1,25(OH)2D3 may also be detected and discriminated. Report of the National high blood pressure Education Program Working Group on high blood pressure in pregnancy. Similarly, in a birth cohort study, women with 25OHD levels between 8.5 and 48 nmol/L were more likely to give birth to SGA offspring (OR 1.57, 95% CI 1.032.39) [206]. It is noteworthy mentioning that megalin/cubilin-mediated 25OHD/DBP endocytosis may also take place in the placenta, since these receptors are expressed in this tissue [82,83,84] and placental calcitriol production has been proved [69,75], suggesting that circulating 25OHD is accessible to placental CYP27B1 by active transport. The classic risk factors known for GDM include maternal overweight status or obesity, prior history of GDM, family history of DM2, antecedent of macrosomic infant, and increased maternal age [165]. There is little consensus about the physiological mechanisms governing calcitriol and glucose metabolism connections. Dietary analysis of total VD3 intake was a significant predictor of infant birth weight adjusted for gestation [207], whereas milk or VD intake during pregnancy were significant independent predictors of birth weight [208]. There are also other approved indications. Gestational diabetes and pregnancy outcomesA systematic review of the world health organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. Sergeev I.N., Rhoten W.B. Ross A.C., Manson J.E., Abrams S.A., Aloia J.F., Brannon P.M., Clinton S.K., Durazo-Arvizu R.A., Gallagher J.C., Gallo R.L., Jones G., et al. [230], which considered a cut-off of 75 nmol/L, only 34.2% of women reached sufficiency with the highest dose, which is very low. Mayer C., Joseph K.S. American Diabetes Association Gestational diabetes mellitus. Careers, Unable to load your collection due to an error. Bodnar L.M., Simhan H.N., Catov J.M., Roberts J.M., Platt R.W., Diesel J.C., Klebanoff M.A. B Anal. After three months of intervention, treated women presented significantly higher 25OHD levels and lower HOMA-IR than women with GDM in the control group. Calcitriol has a duration of action of 35 days. Bikle D.D. Given that 25OHD2 binds to DBP with lower affinity than 25OHD3, the kidney would preferentially use the latter metabolite, while cells in the immune system might profit of a greater pool of 25OHD2 for antimicrobial peptide induction [81]. Soheilykhah S., Mojibian M., Rashidi M., Rahimi-Saghand S., Jafari F. Maternal vitamin D status in gestational diabetes mellitus. Technol. In this review, we address the different mechanisms of action involved in the antineoplastic effects of calcitriol. Diaz L., Arranz C., Avila E., Halhali A., Vilchis F., Larrea F. Expression and activity of 25-hydroxyvitamin D-1 alpha-hydroxylase are restricted in cultures of human syncytiotrophoblast cells from preeclamptic pregnancies. Effects of a single post-partum injection of a high dose of vitamin D on glucose tolerance and insulin resistance in mothers with first-time gestational diabetes mellitus. Actually, a great debate has been taking place regarding which form of 25OHD is the more suitable for activation, the free or the DBP-bound form. Maternal vitamin D status and adverse pregnancy outcomes: A systematic review and meta-analysis. Notably, adequate sun exposure, a VD-rich diet and physical activity should always be considered as the first recommendation, while supplementation with cholecalciferol may be advised for persistent VD deficient women. Maternal serum 25-hydroxyvitamin D levels at 11(+0) -13(+6) weeks in pregnant women with diabetes mellitus and in those with macrosomic neonates. Baker A.M., Haeri S., Camargo C.A., Jr., Stuebe A.M., Boggess K.A. This is discussed further in Section 6. Assessment and interpretation of circulating 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in the clinical environment. Generation of inositol phosphates, diacylglycerol and calcium fluxes in myoblasts treated with 1,25-dihydroxyvitamin D3. [231], the observed proportion of 93% in the supplemented group might be misleading, since this number includes women with serum 25OHD levels > 25 nmol/L. Calcipotriol, also known as calcipotriene, is a synthetic derivative of calcitriol, a form of vitamin D. [medical citation needed] It is used in the treatment of psoriasis. Maternal vitamin D status in pregnancy is associated with adiposity in the offspring: Findings from the Southampton Womens Survey. Table 2 shows the criteria for VD status as proposed by the Endocrine Society. Liu N., Kaplan A.T., Low J., Nguyen L., Liu G.Y., Equils O., Hewison M. Vitamin D induces innate antibacterial responses in human trophoblasts via an intracrine pathway. Herein, we resume the more recent randomized clinical trials on VD supplementation in pregnancy. Bodnar L.M., Catov J.M., Zmuda J.M., Cooper M.E., Parrott M.S., Roberts J.M., Marazita M.L., Simhan H.N. In general, the known VDRE-containing genes can be grouped in very diverse biological networks including bone and mineral metabolism (i.e., osteopontin [18]); cell life and death (comprising proliferation, differentiation, migration and apoptosis, i.e., p21 [19]), metabolism and cardiovascular health (i.e., cystathionine -synthase [20], renin [21] and VEGF [22]), immune function (i.e., cathelicidin hCTD, LL-37 [23,24]) and detoxification (i.e., CYP3A4, CYP24A1 [25]). Quesada J.M., Martin-Malo A., Santiago J., Hervas F., Martinez M.E., Castillo D., Barrio V., Aljama P. Effect of calcitriol on insulin secretion in uraemia. Calcitriol can affect growth in children. The relationship between VD, especially 25OHD serum levels, and the risk of PE development has been extensively analyzed in the medical literature. Hashemipour S., Lalooha F., Zahir Mirdamadi S., Ziaee A., Dabaghi Ghaleh T. Effect of vitamin D administration in vitamin D-deficient pregnant women on maternal and neonatal serum calcium and vitamin d concentrations: A randomised clinical trial. Ren S., Nguyen L., Wu S., Encinas C., Adams J.S., Hewison M. Alternative splicing of vitamin D-24-hydroxylase: A novel mechanism for the regulation of extrarenal 1,25-dihydroxyvitamin D synthesis. Asemi Z., Hashemi T., Karamali M., Samimi M., Esmaillzadeh A. In order to take the adequate decision about VD supplementation, every clinical individual situation must be analyzed and placed in the correct balance of risk and benefit before prescribing VD supplementation. It is different from calcitriol in that it has not been hydroxylated at position 25, but this conversion takes place rapidly in the liver following oral or parenteral administration of alfacalcidol in humans [131]. However, when controversies about clinical decisions are involved, scientists must avoid creating medical barriers about the use of preventive strategies in medicine. Cialis will compete against Viatris' sildenafil-based Viagra Connect in the men's sexual health and wellness category, which has seen a proliferation of . Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates. Hyppnen E., Cavadino A., Williams D., Fraser A., Vereczkey A., Fraser W.D., Bnhidy F., Lawlor D., Czeizel A.E. These complications are associated with substantially higher rates of perinatal morbidity and mortality, including cerebral palsy, neonatal polycythemia, hyperbilirubinemia, and hypoglycemia [197]. The https:// ensures that you are connecting to the Evidence for maternal and fetal differences in vitamin D metabolism. Diogenes M.E., Bezerra F.F., Rezende E.P., Taveira M.F., Pinhal I., Donangelo C.M. -, Zhou L, Taylor-Miller T, Zacharin M, Efron D. Extreme hypercalcaemia due to accidental vitamin D intoxication. Specifically, they found that maternal 25OHD levels 50 nmol/L reduce in 40% the risk of severe PE development in comparison to women with 25OHD < 30 nmol/L. Dawson-Hughes B., Heaney R.P., Holick M.F., Lips P., Meunier P.J., Vieth R. Estimates of optimal vitamin D status. Mozaffari-Khosravi H., Hosseinzadeh-Shamsi-Anar M., Salami M.A., Hadinedoushan H., Mozayan M.R. Vitamin D status and recurrent preterm birth: A nested case-control study in high-risk women. Kriebitzsch C., Verlinden L., Eelen G., van Schoor N.M., Swart K., Lips P., Meyer M.B., Pike J.W., Boonen S., Carlberg C., et al. Seki K., Makimura N., Mitsui C., Hirata J., Nagata I. Calcium-regulating hormones and osteocalcin levels during pregnancy: A longitudinal study. Savvidou M.D., Akolekar R., Samaha R.B., Masconi A.P., Nicolaides K.H. Noyola-Martinez N., Diaz L., Avila E., Halhali A., Larrea F., Barrera D. Calcitriol downregulates TNF-alpha and IL-6 expression in cultured placental cells from preeclamptic women. Thompson P.D., Jurutka P.W., Whitfield G.K., Myskowski S.M., Eichhorst K.R., Dominguez C.E., Haussler C.A., Haussler M.R. Vitamin D metabolism, mechanism of action, and clinical applications. Vitamin D3 is a steroid that is ingested in the diet or synthesized in the skin in the presence of ultraviolet light. Kalra P., Das V., Agarwal A., Kumar M., Ramesh V., Bhatia E., Gupta S., Singh S., Saxena P., Bhatia V. Effect of vitamin D supplementation during pregnancy on neonatal mineral homeostasis and anthropometry of the newborn and infant. Maternal plasma 25-hydroxyvitamin D levels, angiogenic factors, and preeclampsia. Noyola-Martinez N., Diaz L., Zaga-Clavellina V., Avila E., Halhali A., Larrea F., Barrera D. Regulation of CYP27B1 and CYP24A1 gene expression by recombinant pro-inflammatory cytokines in cultured human trophoblasts. Zhang J., Merialdi M., Platt L.D., Kramer M.S. This vitamin is widely distributed. The hormonal form and most active metabolite of vitamin D is calcitriol. It is noteworthy mentioning that epidemiological studies have shown controversial results about the benefits of prescribing VD supplements to prevent adverse pregnancy outcomes associated with maternal deficiency. Inside the cell, DBP is degraded and 25OHD is released and hydroxylated by CYP27B1. To our knowledge, there is only one published double-blind randomized controlled clinical trial which supplemented VD3 on pregnant women with GDM [186]. Nevertheless, this metabolite is not the active form of VD, and therefore needs further activation by a second hydroxylation step catalyzed by the enzyme 25OHD-1--hydroxylase (CYP27B1) in order to generate 1,25-(OH)2D3 (calcitriol), which is the hormonal form and most active VD metabolite. Given that the human placenta expresses CYP27B1, which catalyzes the local synthesis of calcitriol, the supplementation with VD during pregnancy might be an accessible and safe way to reduce the incidence of some adverse events associated with mother and baby morbidity-mortality, such as PE, GDM, PROM and infections; while, at the same time, both the mother and the child will profit from the physiological benefits of calcitriol. However, there are recent evidences that include other VD-dependent mechanisms: (a) diminished inflammatory state in obesity and enhanced expression of genes involved in glucose and lipid metabolism like peroxisome proliferator-activated receptor gamma (PPAR) or its coactivator (PGC1) in peripheral blood mononuclear cells [192]; (b) weight reduction and muscle insulin receptor substrate 1 (IRS-1) upregulation [193]; (c) upregulation of adipocyte glucose transporter 4 (GLUT4) protein and its translocation to the cell surface [194]; and d) returning to normal liver activity of glucose metabolic enzymes hexokinase, fructose 1,6-bisphosphatase and glucose 6-phosphatase [195]. Effect of calcium plus vitamin D supplementation during pregnancy in brazilian adolescent mothers: A randomized, placebo-controlled trial. Diaz L., Noyola-Martinez N., Barrera D., Hernandez G., Avila E., Halhali A., Larrea F. Calcitriol inhibits TNF-alpha-induced inflammatory cytokines in human trophoblasts. Wang Z., Kanguru L., Hussein J., Fitzmaurice A., Ritchie K. Incidence of adverse outcomes associated with gestational diabetes mellitus in low- and middle-income countries. Osteopathy and resistance to vitamin D toxicity in mice null for vitamin D binding protein. Other hormonal factors affecting placental VD-metabolism are IGF-I and the natural occurring calciotropic hormones calcitonin and PTH [12,51]. HHS Vulnerability Disclosure, Help IGF-I stimulates biotransformation of 25OHD into calcitriol [51], while both calcitonin and PTH regulate the placental VD-hydroxylases in the same manner as calcitriol and cAMP, inducing CYP24A1 while repressing CYP27B1 gene expression, thereby favoring VD catabolism [12]. Interestingly, in a model of chronic renal failure by Blum and colleagues [76], nephrectomized rats had lower calcitriol levels in comparison with normal rats, but during pregnancy the nephrectomized group reached similar levels to those observed in pregnant controls, despite kidney absence, which emphasized the important contribution of the placenta [76]. [3] in rats infused with 3H-25OHD/DBP and where megalin activity was blocked. Its mechanism of action includes bacterial membrane disruption and activation of toll-like receptors and macrophage and neutrophil chemotaxis [156]. We believe that the controversy may be explained because the biological phenomena can be affected not only by serum concentrations, but also by many factors, such as racial, climatological, or genetic reasons; nutritional status; lifestyle; physical activity; or health status during pregnancy. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Biomed. Calcitriol down-regulates human ether a go-go 1 potassium channel expression in cervical cancer cells. Agarwal R., Virmani D., Jaipal M.L., Gupta S., Gupta N., Sankar M.J., Bhatia S., Agarwal A., Devgan V., Deorari A., et al. Calcitonin opposes the actions of the parathyroid hormone, which is a hormone that increases your blood calcium levels. Randomized controlled trial (RCT) of vitamin D supplementation in pregnancy in a population with endemic vitamin D deficiency. Abboud M., Puglisi D.A., Davies B.N., Rybchyn M., Whitehead N.P., Brock K.E., Cole L., Gordon-Thomson C., Fraser D.R., Mason R.S. Disclosure: David E Komatsu declares no relevant financial relationships with ineligible companies. Association between vitamin D insufficiency and the risk for gestational diabetes mellitus in pregnant chinese women. In this tissue, CYP24A1 gene expression is also potently induced by calcitriol [12]. Liu M., Lee M.H., Cohen M., Bommakanti M., Freedman L.P. Transcriptional activation of the Cdk inhibitor p21 by vitamin D3 leads to the induced differentiation of the myelomonocytic cell line U937. Interestingly, a multicenter study with 2030 pregnant women of an American cohort from 1959 to 1966 showed that higher maternal circulating 25OHD levels were associated with a significantly lower risk of placental vascular pathology (hemorrhage, infarcts, microinfarcts, decidual atheromas or thrombosis of cord vessels) in pregnant women carrying male fetuses [124]. and transmitted securely. Denney J.M., Culhane J.F. However, this article has been criticized by other authors [248]. The spectrum of VD status has been established considering the known risk for adverse consequences [101]. Powe C.E., Evans M.K., Wenger J., Zonderman A.B., Berg A.H., Nalls M., Tamez H., Zhang D., Bhan I., Karumanchi S.A., et al. Interestingly, this action was also found in vitro and in vivo in mammalian cells (Bettoun et al., 2002). Chest pain (angina). In Table 4, studies that evaluated serum 25OHD levels and the risk for GDM are shown. The inhibitory effect of 1,25-dihydroxyvitamin D3 on the secretion of platelet-activating factor acetylhydrolase by human decidual macrophages. Moller U.K., Streym S., Mosekilde L., Heickendorff L., Flyvbjerg A., Frystyk J., Jensen L.T., Rejnmark L. Changes in calcitropic hormones, bone markers and insulin-like growth factor I (IGF-I) during pregnancy and postpartum: A controlled cohort study. Controlled trials of vitamin D, causality and type 2 statistical error. Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. Kumar R., Cohen W.R., Silva P., Epstein F.H. Approved as a pharmacy medicine, Sanofi will launch Cialis Together in the second half of the year. FGF23 also potently inhibits CYP27B1 in response to elevated phosphate levels [30]. Gyetko M.R., Hsu C.H., Wilkinson C.C., Patel S., Young E. Monocyte 1 alpha-hydroxylase regulation: Induction by inflammatory cytokines and suppression by dexamethasone and uremia toxin. Regarding DBP, two longitudinal studies indicate that this protein increases 25% to 56% during pregnancy [59,67], but the mechanisms leading to this increment are still unknown. Brand Names Rocaltrol, Vectical Generic Name Calcitriol DrugBank Accession Number DB00136 Background In the context of cancer, calcitriol regulates the cell cycle, induces apoptosis, promotes cell differentiation and acts as anti-inflammatory factor within the tumor microenvironment. However, this mechanism could not completely explain the higher activity of CYP27B1 in placenta because, as previously described, this tissue has its own mechanisms governing VD metabolism. Calcitriol is administered orally, topically, and by intravenous injection. Early-pregnancy maternal vitamin D status and maternal hyperglycaemia. sharing sensitive information, make sure youre on a federal Bolland M.J., Grey A., Gamble G.D., Reid I.R. Your thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. Shahbazi M., Jeddi-Tehrani M., Zareie M., Salek-Moghaddam A., Akhondi M.M., Bahmanpoor M., Sadeghi M.R., Zarnani A.H. Epigenetic silencing of CYP24 in tumor-derived endothelial cells contributes to selective growth inhibition by calcitriol. Indeed, the classic VDR and the membrane-associated rapid response steroid-binding protein (MARRS) found in the cell membrane may bind calcitriol and initiate the activation of numerous pathways involving protein kinase C (PKC) [9], mitogen-activated protein kinase (MAPK) [10], protein kinase A (PKA) [11,12], phosphatidyl inositol phosphate [13] and Ca2+ and chloride channels [8,14]. 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