0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort

Kassandra L. Munger, ScD1; Julia Åivo, MD2; Kira Hongell, MD2; Merja Soilu-Hänninen, MD2; Heljä-Marja Surcel, PhD3; Alberto Ascherio, MD, DrPH1,4
[+] Author Affiliations
1Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
2Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Finland
3National Institute for Health and Welfare, Oulu, Finland
4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA Neurol. 2016;73(5):515-519. doi:10.1001/jamaneurol.2015.4800.
Text Size: A A A
Published online

Importance  Vitamin D has been associated with a decreased risk of multiple sclerosis (MS) in adulthood; however, some, but not all, previous studies have suggested that in utero vitamin D exposure may be a risk factor for MS later in life.

Objective  To examine whether serum 25-hydroxyvitamin D (25[OH]D) levels in early pregnancy are associated with risk of MS in offspring.

Design, Setting, and Participants  Prospective, nested case-control study in the Finnish Maternity Cohort conducted in May 2011. We identified 193 individuals with a diagnosis of MS before December 31, 2009, whose mothers are in the Finnish Maternity Cohort and had an available serum sample from the pregnancy with the affected child. We matched 176 cases with 326 controls on region of birth in Finland, date of maternal serum sample collection, date of mother’s birth, and date of child’s birth.

Main Outcomes and Measures  Maternal serum 25(OH)D levels were measured using a chemiluminescence assay. The risk of MS among offspring and association with maternal 25(OH)D levels were the main outcomes. Conditional logistic regression was used and further adjusted for sex of the child, gestational age at the time of sample collection, and season of sample collection to estimate the relative risks and 95% CIs.

Results  Of the 193 cases in the study, 163 were female. Of the 331 controls in the study, 218 were female. Seventy percent of serum samples were collected during the first trimester of pregnancy. The mean (SD) maternal vitamin D levels were in the insufficient vitamin D range, but higher in maternal control than case samples (15.02 [6.41] ng/mL vs 13.86 [5.49] ng/mL [to convert to nanomoles per liter, multiply by 2.496]). Maternal vitamin D deficiency (25[OH]D levels <12.02 ng/mL) during early pregnancy was associated with a nearly 2-fold increased risk of MS in the offspring (relative risk, 1.90; 95% CI, 1.20-3.01; P = .006) compared with women who did not have deficient 25(OH)D levels. There was no statistically significant association between the risk of MS and increasing serum 25(OH)D levels (P = .12).

Conclusions and Relevance  Insufficient maternal 25(OH)D during pregnancy may increase the risk of MS in offspring.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Multivariate Relative Risk for Multiple Sclerosis in Offspring by Quintiles of Maternal 25-Hydroxyvitamin D Level During Pregnancy

Adjusted for sex, gestational age, and season at time of sample collection. Error bars indicated 95% CIs.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Multivariate Relative Risk for Multiple Sclerosis in Offspring by Maternal 25-Hydroxyvitamin D Level Adequacy During Pregnancy

Adjusted for sex, gestational age, and season at time of sample collection. P = .006 for the relative risk in the <12.02 category vs the 12.02 to <20.03 category.

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

5,911 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Detecting the Likelihood of Pregnancy

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Is This Patient Pregnant?

brightcove.createExperiences();