Prevalence and Correlates of Low Serum Vitamin D Levels Among Women With Recurrent Pregnancy Loss at the Kenyatta National Hospital: a Cross Sectional Study

Abstract

Introduction: Recurrent1Pregnancy1Loss (RPL) affects1approximately 1% of couples and is defined by WCRPL as the loss of two or more pregnancies after spontaneous conception or following ART excluding molar and ectopic pregnancies. In nearly 50% of the cases, the cause is unknown. However, there are many associated factors leading to RPL which include nutritional factors such as Vitamin D deficiency, antiphospholipid syndrome, genetic and uterine anomalies, endocrine disorders, and infections among others. Deficiency in Vitamin D emerged as an important factor in RPL as shown in recent studies and a significant majority of pregnant women have low levels1of1Vitamin D. There1is1an observed deficiency of Vitamin D in the Kenyan population and its implication in RPL has not been determined. In addition, the prevalence of RPL in Kenya has not been documented despite having an increasing number of patients with RPL attending ANC in major referral hospitals such as KNH. Broad Objective: To1determine1the1prevalence1and1correlates of low serum levels of Vitamin D in women1with1history of recurrent pregnancy1loss at the Kenyatta1National1Hospital. Methodology: This was a comparative cross-sectional study with 124 study participants. The serum levels of Vitamin D of 62 women with a history of RPL were compared with 62 women who delivered 2 or more viable fetus at the Kenyatta National Hospital. Simple random sampling technique was used to obtain participants. Women who gave a written informed consent and fit the inclusion criteria were recruited for the study. Structured questionnaires were used to collect data and any missing sociodemographic information was obtained from the patient’s file. Serum Vitamin D levels were assayed at Pathologists Lancet Kenya. Data management and analysis: Statistical analysis was performed using R software. The mean levels of vitamin D for each group were calculated and comparison done T-test. A correlation of the socio demographic and clinical characteristics and low vitamin D levels was analyzed, and binary logistic regression model performed, controlling for possible confounders. A p value of 0.05 was statistically1significant. xiv Results: Women with RPL had low serum Vitamin D levels with a prevalence of 50.8% compared to women without RPL at 35% (p=0.17). The mean age of women in comparative group was higher compared to women with RPL (32.2 vs 31.3) and BMI was significantly higher among participants with RPL (28.8±4.6) compared to those without RPL (26.4±4.7) before and after adjusting for confounding (P<0.01) Marital status, education level, alcohol consumption, cigarette smoking, and having a history of chronic medical conditions such as diabetes and hypertension were not associated with RPL. Conclusion: Women with RPL had low serum Vitamin D levels compared to women who had normal viable pregnancies. Recommendations: Assessment of serum Vitamin D levels in women with a history of RPL as a component of their preconception care and consider including it in protocol. These will help in further categorizing of patients in need of supplementation hence improve on pregnancy outcomes.