Introdução: Portadores de fibrose cística têm uma susceptibilidade à deficiência de vitamina D devido à má absorção de nutrientes. Os estudos da prevalência de hipovitaminose D em pacientes com fibrose cística apresentam resultados extremamente variáveis e não há dados a respeito da população não pediátrica no Brasil. Objetivos: Avaliar a prevalência de hipovitaminose D em pacientes não pediátricos portadores de fibrose cística e os fatores associados com as concentrações séricas de 25-hidroxivitamina D. Metodologia: Realizado estudo transversal. A população em estudo foi composta por pacientes maiores que 16 anos acompanhados no Ambulatório de Fibrose Cística do Hospital de Clínicas de Porto Alegre. Foi avaliada a prevalência de deficiência de vitamina D, definida como 25-hidroxivitamina D < 30ng/mL, de acordo com a Cystic Fibrosis Foundation, bem como os fatores clínicos e laboratoriais associados com o valor sérico desta. Foram avaliados o estado nutricional e internações hospitalares. Foi realizada coleta de dados em prontuário, entrevista com os pacientes e colheita de sangue. As análises laboratoriais foram realizadas no Laboratório de Patologia Clínica do Hospital. Foram dosados os valores séricos de proteína C-reativa, cálcio, fosfato, magnésio, albumina, 25-hidroxivitamina D (método: quimiluminescência) e paratormônio (método: imunoensaio para PTH intacto). A função pulmonar foi avaliada por espirometria e escores clínicos e radiológicos. O nível de significância estatística foi estabelecido como P<0,05. Resultados: A prevalência de hipovitaminose D foi de 61,0%, com valores séricos de 25-hidroxivitamina D de 28,42±10,94 ng/mL. Os pacientes com insuficiência pancreática apresentaram uma tendência a ter concentrações mais altas de vitamina D. Dezesseis pacientes apresentavam doença pulmonar grave, com FEV1% do predito inferior a 40%. Após análise multivariada, índice de massa corporal e hospitalizações no último mês permaneceram significativamente associados negativamente aos valores séricos de 25-hidroxivitamina D. Conclusões: A prevalência de hipovitaminose D no presente estudo foi inferior a previamente relatada. A insuficiência de vitamina D continua sendo um problema nos pacientes com fibrose cística, mesmo naqueles recebendo suplementação. / Introduction: Cystic fibrosis patients have a susceptibility to vitamin D deficiency due to nutrient malabsorption. Prevalence studies of hypovitaminosis D in patients with cystic fibrosis have highly variable results and there is no data about the non pediatric population in Brazil. Objectives: To evaluate the prevalence of hypovitaminosis D in non pediactric cystic fibrosis patients and the factors associated with serum 25-hydroxyvitamin D levels. Methods: Cross-sectional study. The study population was composed of patients older than 16 years accompanied in the Cystic Fibrosis Ambulatory of the Hospital de Clínicas de Porto Alegre. We evaluated the prevalence of vitamin D deficiency defined as 25-hydroxyvitamin D < 30 ng/mL, as suggested recently by the Cystic Fibrosis Foundation, and clinical and laboratory factors associated with its serum levels. Nutritional status and hospital admissions were evaluated. Data was collected from medical records and interviews with patient, blood was collected. Laboratory analisys were performed at Clinical Pathology Laboratory of the Hospital. Serum C-reactive protein, calcium, phosphate, magnesium, albumin, 25-hydroxyvitamin D (method: chemiluminescence), and parathyroid hormone levels (method: sandwich immunoassay to intact PTH) were measured. Lung function was evaluated by spirometry and clinical and chest radiographic scores were assessed. Statistical significance level was set at P<0.05. Results: Prevalence of hypovitaminosis D was 61.0 %, with serum 25-hydroxyvitamin D levels of 28,42±10,94 ng/mL. Patients with pancreatic insufficiency had a trend to have higher vitamin D levels. Sixteen patients had severe lung disease with FEV1% predicted below 40%. After multivariable analysis, body mass index and hospitalization in the last month remained significantly associated negatively with serum 25-hydroxivitamin D levels. Conclusions: The prevalence of hypovitaminosis D in the present study was inferior to previously related. Vitamin D insufficiency is still a problem in cystic fibrosis patients, even in those receiving supplementation.

Introdução - A concentração sérica de vitamina D pode variar em indivíduos de diferentes grupos etários e de diversas regiões geográficas e pode ser influenciada pela exposição solar, estação do ano, bem como pelos valores de IMC e paratormônio (PTH). A classificação utilizada para definir concentração sérica adequada de vitamina D refere valores de 25(OH)D acima de 30 ng/mL. Porém, essa classificação pode estar inapropriada para a população brasileira, devido às particularidades climáticas e alimentares. Objetivo - Verificar as concentrações séricas médias de 25(OH)D e PTH e sua relação com IMC, exposição solar e estação do ano e identificar os valores de corte da 25(OH)D associados à elevação do paratormônio (PTH) em adultos e idosos de amostra representativa da população do município de São Paulo. Métodos - Para esta dissertação foi desenvolvido um artigo original. O artigo original descreve o estudo transversal realizado com indivíduos do estudo ISA-Capital, estudo multicêntrico e de base populacional, onde foram investigados 589 indivíduos, de ambos os sexos, dos grupos etários: 20 a 59 (adultos) e 60 e mais (idosos). Foram coletadas amostras de sangue, para dosagens de 25(OH)D e PTH. Os indivíduos que aceitaram participar da coleta de sangue, também responderam um questionário sobre exposição solar. A análise estatística incluiu a curva ROC, testes t de Student, correlação e ANOVA. Os cálculos foram realizados pelo software SPSS versão 17.0. e p 0,05 foi considerado significante. Resultados - No artigo original observou-se idade média de 54,83 (19,21) anos, sendo 61,3 por cento do sexo feminino e 38,7 por cento do sexo masculino. A concentração sérica média de 25(OH)D foi 50,02 (22,69) ng/mL, já entre os grupos foi de 47,48 (23,03) (adultos) e 52,68 (22,06) ng/mL (idosos) havendo diferença significativa entre eles (p=0,005). Observou-se variação sazonal da concentração sérica de 25(OH)D e correlação positiva entre 25(OH)D e IMC (r = 0,114, p = 0,006). O novo valor de corte 55.8 ng/mL, determinado pela análise da curva ROC, encontrou 67,6 por cento dos indivíduos insuficientes de 25(OH)D e entre os grupos 72,1 por cento (adultos) e 62,8 por cento (idosos). Conclusão - Os resultados demonstram a presença de variação sazonal nas concentrações séricas de 25(OH)D no municipio de São Paulo. O ponto de corte proposto para nossa população indicou elevada prevalência de insuficiência de vitamina D. Portanto, se faz necessário políticas públicas de prevenção de insuficiência de vitamina D visando os efeitos benéficos na saúde e qualidade de vida desta população. / Introduction - The serum concentration of vitamin D may vary in individuals of different age groups and geographic regions and may be influenced by sun exposure, season and by BMI and parathyroid hormone (PTH). The classification widely used as a cut-off for appropriate vitamin D status refers serum 25 (OH) D above 30 ng/mL. However, this classification may be inappropriate for the Brazilian population, due to the particular food and the climate of our population. Objective - To determine the mean serum concentrations of 25(OH)D and PTH and correlate them with BMI, sunlight exposure and season and to identify the cutoff values of 25 (OH) D associated with elevation in PTH. Methods For this dissertation, one original article were developed. Original article describe cross-sectional study performed with subjects from the ISA Capital, multicenter population-based. We investigated 589 individuals were of both sexes, age groups: 20-59 (adults) and 60 (elderly). Blood samples for laboratory measurements of 25(OH)D and PTH were collected. Individuals, who agreed to participate in blood collection, also answered a questionnaire on sunlight exposure. Statistical analysis included ROC curve, Student t test, correlation tests, ANOVA. The calculations were performed by the software SPSS version 17.0. and p 0.05 was considered significant. Results - In the original article, the mean age of participants was 54.83 (19.21) years, 61.3 per cent female and 38.7 per cent were male. The mean serum 25 (OH) D was 50.02 (22.69) ng/mL, between the groups was 47.48 (23.03) (adults) and 52.68 (22.06) ng/ mL (elderly) and significant difference between them (p = 0.005). A seasonal variation in serum 25 (OH) D was observed and positive correlation between 25(OH)D and BMI (r = 0.114, p = 0.006). The new cutoff value 55.8 ng / mL, determined by ROC curve analysis found 67.6 per cent of subjects insufficient 25 (OH) D and between groups 72.1 per cent (adults) and 62.8 per cent (elderly). Conclusion - The results demonstrate the presence of seasonal variation in serum 25 (OH) D in the municipality of Sao Paulo. The cutoff point proposed for our population showed a high prevalence of insufficient vitamin D. Therefore, public policy is needed to prevent vitamin D insufficiency in order to beneficial effects on health and quality of life in this population.

Vitamin D is an important immunomodulator. Epidemiological studies have shown that vitamin D deficiency impairs the immune functions and participates in the pathogenesis of infectious and autoimmune diseases. Vitamin D supplementation has shown significant changes on circulating concentrations of inflammatory markers in different clinical conditions. However, the effect of single large-dose of vitamin D3 in immune system in elderly people remains unclear. We carried out a randomized, double-blind, placebo-controlled clinical trial to evaluate the possible benefic effect of single oral dose of 300.000 IU of vitamin D3 on inflammatory markers in elderly post-menopausal women. A total of 40 women aged over 60 years were selected to receive 300.000 IU of cholecalciferol (n = 20) or placebo (n = 20) at baseline. Serum 25-hydroxyvitamin D [25(OH)D] were similar in both group at baseline [16.4 ng/ml (± 3.8) in vitamin D group and 15 ng/ml (± 3.7) in placebo groups, p = 0.23]. Serum levels of IL-6, TNF-α and IL-10 were measured by ELISA at baseline, and 30, 60 and 90 days after intervention. In the vitamin D group, we found a significant median percent decline in levels of IL-6 (30.8%, p = 0.006) and TNF-α (48.6%, p < 0.0001), associated with a significant median percent increase in levels of IL-10 (68.4%, p < 0.0001) after 90 days. We concluded that a single oral dose of 300.000 IU of cholecalciferol, in the short time, is able to improve the cytokines profile in elderly women with vitamin D deficiency. / A vitamina D é um importante imunomodulador. Estudos epidemiológicos têm demonstrado que a deficiência de vitamina D prejudica as funções imunológicas e participa na patogênese de doenças infecciosas e autoimunes. A suplementação de vitamina D tem demonstrado significativas alterações nas concentrações circulantes de marcadores inflamatórios em diferentes condições clínicas. No entanto, o efeito de dose única e elevada de vitamina D3 no sistema imune de pessoas idosas, permanece obscuro. Nós realizamos um ensaio clínico, randomizado, duplo-cego, controlado por placebo para avaliar o possível efeito benéfico de uma dose oral única de 300.000 UI de vitamina D3 em marcadores inflamatórios em mulheres idosas na pós-menopausa. Um total de 40 mulheres com idade superior a 60 anos foram selecionados para receber 300.000 UI de colecalciferol (n = 20) ou placebo (n = 20) no início do estudo. As dosagens de 25-hidroxivitamina D séricas [25(OH)D] foram semelhantes em ambos os grupos no início do estudo [16,4 ng/ml (± 3,8) no grupo vitamina D e 15 ng/ml (± 3,7) no grupo placebo, p = 0,23]. Os níveis séricos de IL-6, TNF-α e IL-10 foram medidos por ELISA no início do estudo e 30, 60 e 90 dias após a intervenção. No grupo da vitamina D, verificou-se uma diminuição significativa na percentagem média dos níveis de IL-6 (30.8 %, p = 0.006) e TNF-α (48.6 %, p < 0.0001), associada com um aumento percentual médio significativo nos níveis de IL-10 (68.4 %, p < 0.0001) após 90 dias. Concluímos que uma dose oral única de 300.000 UI de colecalciferol, em um curto espaço de tempo, é capaz de melhorar o perfil das citocinas em mulheres idosas com deficiência de vitamina D.

Multiple sclerosis (MS) is among the most common neuroinflammatory diseases across the globe and is autoimmune mediated in nature. This progressive, highly debilitating disease often leaves individuals wheelchair bound within 15-25 years of onset. MS is characterized by inflammatory lesions that appear in unpredictable locations around the central nervous system. Lesions can be visualized using magnetic resonance imaging (MRI) technology. As neuroinflammation continues and lesions accumulate, patients can experience a wide array of progressively worsening symptoms including but not limited to motor impairments, sensory disturbances, loss of control of bodily functions, and/or neuropathic pain, depending on the location of lesion formations. There are different types of MS, the most common being relapsing-remitting MS (RRMS) seen in about 85% of cases and characterized by periods of symptom remission followed by flare-ups. A large majority of these patients go on to develop secondary progressive MS (SPMS) where neurological damage and patient decline is progressive and continuous. Primary progressive MS (PPMS) is seen in about 10% of cases and is characterized by progressive and continuous patient decline from the outset of disease. Other rarer forms of MS do exist but will not be discussed further. Research aimed at MS is at an all-time high and the timing could not be better: its global incidence and prevalence is climbing. For decades MS has been thought of as a disease caused by dysfunctional CD4+ T-helper 1 (Th1) cells. It is now known that many different cell types contribute to MS pathophysiology. These other cell types include macrophages and dendritic cells of the innate immune system due to their expression of MHC class II molecules that function to activate CD4+ Th1 cells. More recent research has implicated CD8+ T-cells and B-cells in contributing to disease through direct destruction of neural cells that express MHC class I molecules and through the generation of autoantibodies, respectively. While these discoveries are important and provide hope for future breakthrough treatments, there are still enormous gaps in the medical community’s knowledge of what causes MS. The epidemiologic pattern of MS prevalence has for many decades interested scientists and hinted at a potential cause of this disease. MS tends to affect white individuals with genetic ties to northern Europe, but this relationship may not still hold true, as MS incidence and prevalence may be rising faster in black populations compared to other races/ethnicities, at least in the United States. MS occurs nearly 3 times as often in females than in males, and is strongly associated with Epstein-Barr virus (EBV) infection—especially in those that go on to develop infectious mononucleosis (IM). MS prevalence increases markedly in regions north of 40 degrees North latitude or south of 40 degrees South latitude. MS risk also changes depending on body mass index (BMI) considerations, migration history, and in families with a genetic history of the disease. It is well-accepted that MS has a genetic component, the most important of which is the presence of the HLA-DRB1*1501 allele that codes for certain proteins in MHC class II molecules. However, genetics alone are unable to sufficiently account for MS risk as the concordance rate for identical twins with MS is only 25-30%. These well-established findings imply that some unknown environmental factor(s) must be contributing to MS initiation and progression. All of the environmental factors listed above have a common connecting thread that is logically and empirically verifiable: vitamin D. This fat-soluble vitamin can either be endogenously synthesized in the skin after exposure to ultraviolet B (UVB) light or consumed through the diet, the former being of more importance to humans. Epidemiologic patterns suggest a protective role for vitamin D in MS, where low or deficient levels of vitamin D may be a contributor to increased risk for MS. Populations living at greater latitudes, north or south, have significantly greater prevalence of MS which coincides with the reduction of endogenously produced vitamin D in these regions due to a lesser amount of UVB light (and of lower intensity) experienced year-round. Increases in BMI, especially increased adiposity, correlate with increased risk for MS and with prevalence of vitamin D deficiency. Women tend to naturally have greater adiposity than men, thus increasing their risk for MS. Estrogens and vitamin D have been shown to act synergistically to protect against MS, therefore vitamin D deficiency may increase risk for MS in women. Vitamin D is a known immunomodulatory agent that promotes tolerogenic immune states. Vitamin D also offsets many of the harmful effects caused by EBV, among these including repression of B-cell differentiation into plasma cells, reduced MHC II expression, and promotion of B cell apoptosis. This serves to repress deleterious immunoglobulin secretion by B-cells. Vitamin D is also immunologically beneficial as it promotes regulatory T cell function and their expression of protective cytokines, and through its inhibition of inflammatory Th1 and Th17 cell functions. In total, the immunomodulatory mechanisms of vitamin D are important as the immunological states produced by vitamin D are exactly the opposite of those observed in MS patients and MS animal models. Research in vitamin D is gaining attention as the scientific community is quickly discovering that its true physiologic role extends far beyond its classical function as a calcium regulator. Indeed, rapidly evolving research is revealing roles for vitamin D in cardiovascular function and blood pressure regulation, brain development and neurological function, and even in the prevention of certain cancers. However, this thesis will focus on its most well-known function secondary to calcium regulation: immunomodulation and its anti-inflammatory capabilities. The last portion of this thesis will present information advocating for the increase in minimum dietary intake of vitamin D from its current value of 800 IU/day to 5,000 IU/day. While a more than 5-fold increase may seem drastic, the tolerable upper limit is at least 10,000 IU/day even by the most conservative of estimates—the true upper limit is probably around 20,000 IU/day and may even be 50,000 IU/day. The global prevalence of vitamin D deficiency is so extensive that some authors have even considered it a global pandemic: upwards of 50% of the entire world population may be deficient in this crucial vitamin. Increasing vitamin D supplementation is an extremely low risk way to reduce risk for MS and other diseases.

OBJECTIVE: Vitamin D deficiency is prevalent worldwide. While vitamin D deficiency’s role on caries development has been long suggested, it has yet to be confirmed. The aim of this study was to investigate the association between vitamin D level and coronal and root caries in the U.S. METHODS: This study analyzed National Health and Nutrition Examination Survey 2001-2004 data for individuals 6-65 years old. Vitamin D 25(OH)D serum levels were defined according to the Endocrine Society guideline into: Sufficient >75nmol/L, Insufficient 51-75 nmol/L and Deficient < 50 nmol/L. Descriptive and bivariate analyses were conducted on coronal dental caries (DMFT and dft) by serum 25(OH)D level. Multiple regression models were conducted controlling for confounding. Descriptive, regression models, and survival analysis were conducted to assess the relationship between total vitamin D intake and root caries among men (48-93 years) using the Dental Longitudinal Study (DLS) data. Total vitamin D intake was classified according to the Institute of Medicine definition: <400IU/day, 400-800IU/day and >800IU/day. RESULTS: Children (6-11Y) with insufficient levels of vitamin D (50-75 nmol/L) have marginally higher odds of having dental caries experience in their primary teeth compared to those with sufficient serum levels (OR=1.3, p=0.067). No significant associations were found between DMFT and vitamin D serum level before and after controlling for confounding (P>0.05). Cross-sectional analysis of the DLS baseline data showed that higher total vitamin D intake is associated with higher level of root caries (OR=1.2, P=0.011). Repeated measure regression analysis of multiple cycles of DLS data, however, showed that vitamin D total intake was not significantly associated with the level of root caries. Survival analysis also showed no association (P=0.89). CONCLUSION: The results suggest that there is no significant association between vitamin D levels and coronal or root caries in permanent teeth. In contrast, lower serum vitamin D levels might be associated with higher caries levels in primary teeth. The results of this study, while adding new information, provide inconclusive evidence of the association between vitamin D and dental caries. Further investigation is needed to deepen our understanding of the role of vitamin D on dental caries development. / 2018-09-28T00:00:00Z

No description available.

Exploration of the internal structures of teeth is complex and has the potential to add greatly to existing information about the lifecourse of archaeological individuals, but has yet to realize its full interpretative value as an avenue of bioarchaeological inquiry. This thesis consists of three papers that focus on the potential for internal dental structures to provide important information on chronological age, and physiological alterations linked to vitamin D deficiency. The first paper used SEM, microscopic imaging, and histological investigation of tooth dentin to determine the presence of mineralisation defects, observed as interglobular dentin (IGD) (spaces following incremental lines) in living (with known medical history) and archaeological individuals with clear healed rickets. This paper demonstrated that incremental bands of IGD are indicative of vitamin D deficiency. The second paper expands identification of those with deficiency by quantifying morphological changes in pulp chambers of living and archaeological individuals. Pulp chambers were radiographed, evaluated histologically, and measured. Those with evidence of past vitamin D deficiency displayed constricted or chair shaped pulp horns. This radiographic technique provides a non-destructive tool to identify individuals that experienced childhood vitamin D deficiency. The role vitamin D plays in the development of IGD over the lifecourse requires that accurate age estimates be conducted on older as well as younger adults. The third paper used a new version of pulp/tooth area ratios to provide an accurate estimation of age-at-death in older adults (50+). ImageJ software was used to calculate areas on sectioned teeth and results provided a mean absolute error (MAE) of ±3.9 years in older adults. The results described in this thesis contribute to broader topics of discussion in anthropology, such as investigating health and metabolic disease in human populations, and adds to the ongoing discussion and evaluation of age-at-death techniques used to extend our ability to study the lifecourse of archaeological individuals. / Dissertation / Doctor of Philosophy (PhD) / Teeth record life events and the three papers in this thesis use dental structures to provide methodological foundations to evaluate the occurrence and severity of vitamin D deficiency in early life. The potential long-term consequences of such events are investigated through accurate recognition of older adults. Vitamin D regulates skeletal health by mediating calcium absorption and phosphorous homeostasis and deficiency is recognised as an important health concern. Accurate identification of older adults is also a widely recognised problem in skeletal studies. Age-at-death estimation in older individuals was calculated and the exploration of abnormal pulp chamber shape and mineralisation defects in tooth dentin was done to determine vitamin D status in both younger and older individuals. This research established that internal dental structures enables past episodes of vitamin D deficiency to be recognized in cases where skeletal indicators are not clear and permits increased precision in age-at-death estimations in the older individual.

This research contributes to understandings of the occurrence of and associations between skeletal evidence of vitamin D deficiency and chronic respiratory infections across the life course based on human skeletal material from the Roman period sites of Isola Sacra in Italy (1st - 3rd centuries AD) and Ancaster in the United Kingdom (3rd - 4th centuries AD). Modern clinical data demonstrate a positive association between these two conditions that affects the ways in which they are experienced today, and may extend into the past. Macroscopic, radiographic, and histological evidence for skeletal manifestations of vitamin D deficiency and chronic respiratory infections were considered in the context of archaeological and historical evidence available for the Roman period in order to elucidate patterns in disease occurrence that reflect the unique local biologies of these two assemblages. Differing prevalence values for active and healed lesions caused by both conditions, as well as variation in age at death distributions and the relationship of lesions associated with vitamin D deficiency and chronic respiratory infections with one another and with age at death, provide information on the experience of both conditions and the potential interactions between them. Skeletal lesions caused by both conditions are present in individuals throughout the life course at Ancaster and Isola Sacra, with particular implications for disease experiences during infancy, adolescence, and pregnancy in the Roman period. These results point to a picture of morbidity and mortality at Ancaster that involves longer term survival of and more efficient immune responses to chronic disease processes, with higher levels of skeletal lesions indicating the presence of more "survivors" at this site. The combination of lower frequencies of skeletal lesions and higher mortality at Isola Sacra, on the other hand, suggests that fewer individuals may have survived to the point where they were able to mount a skeletal response to disease. / Dissertation / Doctor of Philosophy (PhD)

O estudo das funções extra-esqueléticas da vitamina D vem ampliando-se nos últimos anos. Na gestação, a preocupação com os níveis de vitamina D maternos ocorre pela necessidade desta vitamina para a formação do esqueleto fetal e pela associação da hipovitaminose D com desfechos adversos materno-fetais. Para o recém-nascido (RN), as complicações incluem o baixo peso ao nascer, o comprometimento do crescimento longitudinal e as infecções respiratórias. Para a gestante, a deficiência de vitamina D vem sendo associada à alteração na homeostase glicêmica e ao aumento da incidência de diabetes gestacional (DG) , à pré-eclâmpsia e à vaginose bacteriana. Entretanto, a evidência científica atual ainda é controversa e não há definição estabelecida sobre o real benefício da suplementação da vitamina D na gestação. O diabetes gestacional, por sua vez, também está associado a desfechos adversos para a gestante e para a prole. Para o feto, há aumento da incidência de prematuridade, macrossomia, distócia de ombro e hipoglicemia neonatal; enquanto para a mãe, há associação com aumento da taxa de cesariana, pré-eclâmpsia e diabetes pós-gestacional. Desta forma, os desfechos adversos da hipovitaminose D e do DG presentes de forma simultânea na gestação podem ser aditivos. Este artigo propõe-se à revisão das repercussões da deficiência da vitamina D e do DG na gestação, para a mãe e para o RN, e discute a potencial repercussão da associação de ambas situações já que a hipovitaminose D pode estar relacionada com aumento da ocorrência de DG. / Extra-skeletal functions of vitamin D have been studied in the last years. During pregnancy, the concern with vitamin D levels is justified by its importance for the fetal skeleton development and by the association of hypovitaminosis D with adverse maternal and fetal outcomes. For the newborn, adverse outcomes include low birth weight, impaired longitudinal growth and respiratory infections. For the women, vitamin D deficiency has been associated with glucose homeostasis impairment and increased incidence of gestational diabetes (GD), preeclampsia and bacterial vaginosis. However, the available scientific data is still controversial and the real benefit of vitamin D supplementation during pregnancy is not defined. Hyperglycemia during pregnancy is also associated with increased rates of perinatal adverse outcomes. For the fetus and the newborn, GD is associated with an increased incidence of prematurity, macrosomia, shoulder dystocia and neonatal hypoglycemia; for the mother, there are increased rates of cesarean delivery, preeclampsia and type 2 diabetes. Therefore, adverse outcomes of hypovitaminosis D and GD present simultaneously during pregnancy could be additive. This manuscript aims to review the impact of vitamin D deficiency and of GD for the women and the newborn, and to discuss the potential association between these two clinical situations since hypovitaminosis D may increase the risk for GD.

O estudo das funções extra-esqueléticas da vitamina D vem ampliando-se nos últimos anos. Na gestação, a preocupação com os níveis de vitamina D maternos ocorre pela necessidade desta vitamina para a formação do esqueleto fetal e pela associação da hipovitaminose D com desfechos adversos materno-fetais. Para o recém-nascido (RN), as complicações incluem o baixo peso ao nascer, o comprometimento do crescimento longitudinal e as infecções respiratórias. Para a gestante, a deficiência de vitamina D vem sendo associada à alteração na homeostase glicêmica e ao aumento da incidência de diabetes gestacional (DG) , à pré-eclâmpsia e à vaginose bacteriana. Entretanto, a evidência científica atual ainda é controversa e não há definição estabelecida sobre o real benefício da suplementação da vitamina D na gestação. O diabetes gestacional, por sua vez, também está associado a desfechos adversos para a gestante e para a prole. Para o feto, há aumento da incidência de prematuridade, macrossomia, distócia de ombro e hipoglicemia neonatal; enquanto para a mãe, há associação com aumento da taxa de cesariana, pré-eclâmpsia e diabetes pós-gestacional. Desta forma, os desfechos adversos da hipovitaminose D e do DG presentes de forma simultânea na gestação podem ser aditivos. Este artigo propõe-se à revisão das repercussões da deficiência da vitamina D e do DG na gestação, para a mãe e para o RN, e discute a potencial repercussão da associação de ambas situações já que a hipovitaminose D pode estar relacionada com aumento da ocorrência de DG. / Extra-skeletal functions of vitamin D have been studied in the last years. During pregnancy, the concern with vitamin D levels is justified by its importance for the fetal skeleton development and by the association of hypovitaminosis D with adverse maternal and fetal outcomes. For the newborn, adverse outcomes include low birth weight, impaired longitudinal growth and respiratory infections. For the women, vitamin D deficiency has been associated with glucose homeostasis impairment and increased incidence of gestational diabetes (GD), preeclampsia and bacterial vaginosis. However, the available scientific data is still controversial and the real benefit of vitamin D supplementation during pregnancy is not defined. Hyperglycemia during pregnancy is also associated with increased rates of perinatal adverse outcomes. For the fetus and the newborn, GD is associated with an increased incidence of prematurity, macrosomia, shoulder dystocia and neonatal hypoglycemia; for the mother, there are increased rates of cesarean delivery, preeclampsia and type 2 diabetes. Therefore, adverse outcomes of hypovitaminosis D and GD present simultaneously during pregnancy could be additive. This manuscript aims to review the impact of vitamin D deficiency and of GD for the women and the newborn, and to discuss the potential association between these two clinical situations since hypovitaminosis D may increase the risk for GD.