Vitamina D y embarazo

Vitamin D, pregnancy, breastfeeding, and postpartum MS relapses

Abstract Objective: To determine whether low levels of 25-hydroxyvitamin D (25[OH]D) contribute to the increased risk of postpartum multiple sclerosis (MS) relapses. Design: Prospective cohort study. Setting: Outpatients identified through membership records of Kaiser Permanente Northern California or Stanford University outpatient neurology clinics. Patients: Twenty-eight pregnant women with MS. Interventions: We prospectively followed up patients through the postpartum year and assessed exposures and symptoms through structured interviews. Total serum 25(OH)D levels were measured using the DiaSorin Liaison Assay during the third trimester and 2, 4, and 6 months after giving birth. The data were analyzed using longitudinal multivariable methods. Main Outcome Measures: Levels of 25(OH)D and relapse rate. Results: Fourteen (50%) women breastfed exclusively, and 12 women (43%) relapsed within 6 months after giving birth. During pregnancy, the average 25(OH)D levels were 25.4 ng/mL (range, 13.7-42.6) and were affected only by season (P = .009). In contrast, in the postpartum period, 25(OH)D levels were significantly affected by breastfeeding and relapse status. Levels of 25(OH)D remained low in the exclusive breastfeeding group, yet rose significantly in the nonexclusive breastfeeding group regardless of season (P = .007, unadjusted; P = .02, adjusted for season). By 4 and 6 months after childbirth, 25(OH)D levels were, on average, 5 ng/mL lower in the women who breastfed exclusively compared with the nonbreastfeeding group (P = .001). Conclusions: Pregnancy and exclusive breastfeeding are strongly associated with low 25(OH)D levels in women with MS. However, these lower vitamin D levels were not associated with an increased risk of postpartum MS relapses. These data suggest that low vitamin D in isolation is not an important risk factor for postpartum MS relapses. Annette Langer-Gould, MD, PhD; Stella Huang, MS, DO; Stephen K. Van Den Eeden, PhD; Rohit Gupta, BS; Amethyst D. Leimpeter, MS; Kathleen B. Albers, MPH; Ron Horst, PhD; Bruce Hollis, PhD; Lawrence Steinman, MD; Lorene M. Nelson, PhD Author Affiliations: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Dr Langer-Gould); Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California (Drs Langer-Gould, Huang, Steinman, and Nelson and Mr Gupta); Division of Research, Kaiser Permanente Northern California, Oakland (Drs Van Den Eeden and Leimpeter and Ms Albers); Heartland Assays Inc, Ames, Iowa (Dr Horst); and Medical University of South Carolina, Charleston (Dr Hollis). Dr Huang is now with Loyola University Medical Center, Maywood, Illinois. Source: Arch Neurol. 2011;68(3):310-313. doi:10.1001/archneurol.2010.291 © 2011 American Medical Association. (15/03/11)