J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website http://www.jcgo.org

Original Article

Volume 7, Number 2, June 2018, pages 43-51

Maternal Vitamin D Level and Rate of Primary Cesarean Section

**Table 1.** Demographic Characteristics of Patients in Both Groups
Maternal status	Total (N = 381)	VD level	P-value
Age, mean ± SD	26.91 ± 5.66	26.92 ± 5.86	26.91 ± 5.34	0.984
BMI				0.0137
≤ 18.5 (underweight)	1 (0.3%)	1 (0.5%)	0 (0.0%)
18.5 - 25 (normal)	25 (7.0%)	21 (9.8%)	4 (2.8%)
> 25 (overweight)	331 (92.7%)	193 (89.8%)	138 (97.2%)
Race				1.000
White	377 (99.0%)	229 (98.7%)	148 (99.3%)
Black	4 (1.0%)	3 (1.3%)	1 (0.7%)
Season of delivery				0.0003
Autumn	191 (50.1%)	134 (57.8%)	57 (38.3%)
Winter	186 (48.8%)	97 (41.8%)	89 (59.7%)
Spring	0 (0.0%)	0 (0.0%)	0 (0.0%)
Summer	4 (1.0%)	1 (0.4%)	3 (2.0%)
Educational status				0.0567
Illiterate	8 (2.1%)	8 (3.4%)	0 (0.0%)
School	219 (57.5%)	130 (56.0%)	89 (59.7%)
University	154 (40.4%)	94 (40.5%)	60 (40.3%)
Sunscreen use				0.008
No	272 (71.4%)	177 (76.3%)	95 (63.8%)
Yes	109 (28.6%)	55 (23.7%)	54 (36.2%)
Alcohol				0.522
No	379 (99.5%)	230 (99.1%)	149 (100.0%)
Yes	2 (0.5%)	2 (0.9%)	0 (0.0%)
Parity				0.008
Nulliparous	125 (32.8%)	88 (37.9%)	37 (24.8%)
Multiparous	256 (67.2%)	144 (62.1%)	112 (75.2%)
Gestational age at delivery, mean ± SD	38.63 ± 1.06	38.68 ± 1.20	38.55 ± 0.83	0.218
Current pregnancy complications				0.005
No	302 (79.3%)	173 (74.6%)	129 (86.6%)
Yes	79 (20.7%)	59 (25.4%)	20 (13.4%)
Pregnancy-induced hypertension				0.161
No	376 (98.7%)	227 (97.8%)	149 (100.0%)
Yes	5 (1.3%)	5 (2.2%)	0 (0.0%)
Gestational diabetes				0.699
No	361 (94.8%)	219 (94.4%)	142 (95.3%)
Yes	20 (5.2%)	13 (5.6%)	7 (4.7%)
Preterm labor				0.008
No	331 (86.9%)	193 (83.2%)	138 (92.6%)
Yes	50 (13.1%)	39 (16.8%)	11 (7.4%)
Preeclampsia				1.000
No	380 (99.7%)	231 (99.6%)	149 (100.0%)
Yes	1 (0.3%)	1 (0.4%)	0 (0.0%)
Previous pregnancy complications				0.003
No	362 (95.3%)	214 (92.6%)	148 (99.3 %)
Yes	18 (4.7%)	17 (7.4%)	1 (0.7%)
Postpartum hemorrhage				1.000
No	379 (99.7%)	230 (99.6%)	149 (100.0%)
Yes	1 (0.3%)	1 (0.4%)	0 (0.0%)
Gestational diabetes				1.000
No	377 (99.2%)	229 (99.1%)	148 (99.3%)
Yes	3 (0.8%)	2 (0.9%)	1 (0.7%)
Preterm delivery				0.004
No	369 (97.1%)	220 (95.2%)	149 (100.0%)
Yes	11 (2.9%)	11 (4.8%)	0 (0.0%)
Pregnancy-induced hypertension				0.283
No	377 (99.2%)	228 (98.7%)	149 (100.0%)
Yes	3 (0.8%)	3 (1.3%)	0 (0.0%)
Preeclampsia				1.000
No	379 (99.7%)	230 (99.6%)	149 (100.0%)
Yes	1 (0.3%)	1 (0.4%)	0 (0.0%)
New born gender				0.438
Male	191 (50.1%)	120 (51.7%)	71 (47.7%)
Female	190 (49.9%)	112 (48.3%)	78 (52.3%)

Table 1. Demographic Characteristics of Patients in Both Groups

Maternal status

Total (N = 381)

VD level

P-value

≤ 30 ng/mL (N = 232)

> 30 ng/mL (N = 149)

Age, mean ± SD

26.91 ± 5.66

26.92 ± 5.86

26.91 ± 5.34

0.984

BMI

0.0137

≤ 18.5 (underweight)

1 (0.3%)

1 (0.5%)

0 (0.0%)

18.5 - 25 (normal)

25 (7.0%)

21 (9.8%)

4 (2.8%)

> 25 (overweight)

331 (92.7%)

193 (89.8%)

138 (97.2%)

Race

1.000

White

377 (99.0%)

229 (98.7%)

148 (99.3%)

Black

4 (1.0%)

3 (1.3%)

1 (0.7%)

Season of delivery

0.0003

Autumn

191 (50.1%)

134 (57.8%)

57 (38.3%)

Winter

186 (48.8%)

97 (41.8%)

89 (59.7%)

Spring

0 (0.0%)

Summer

4 (1.0%)

1 (0.4%)

3 (2.0%)

Educational status

0.0567

Illiterate

8 (2.1%)

8 (3.4%)

0 (0.0%)

School

219 (57.5%)

130 (56.0%)

89 (59.7%)

University

154 (40.4%)

94 (40.5%)

60 (40.3%)

Sunscreen use

0.008

272 (71.4%)

177 (76.3%)

95 (63.8%)

Yes

109 (28.6%)

55 (23.7%)

54 (36.2%)

Alcohol

0.522

379 (99.5%)

230 (99.1%)

149 (100.0%)

Yes

2 (0.5%)

2 (0.9%)

0 (0.0%)

Parity

0.008

Nulliparous

125 (32.8%)

88 (37.9%)

37 (24.8%)

Multiparous

256 (67.2%)

144 (62.1%)

112 (75.2%)

Gestational age at delivery, mean ± SD

38.63 ± 1.06

38.68 ± 1.20

38.55 ± 0.83

0.218

Current pregnancy complications

0.005

302 (79.3%)

173 (74.6%)

129 (86.6%)

Yes

79 (20.7%)

59 (25.4%)

20 (13.4%)

Pregnancy-induced hypertension

0.161

376 (98.7%)

227 (97.8%)

149 (100.0%)

Yes

5 (1.3%)

5 (2.2%)

0 (0.0%)

Gestational diabetes

0.699

361 (94.8%)

219 (94.4%)

142 (95.3%)

Yes

20 (5.2%)

13 (5.6%)

7 (4.7%)

Preterm labor

0.008

331 (86.9%)

193 (83.2%)

138 (92.6%)

Yes

50 (13.1%)

39 (16.8%)

11 (7.4%)

Preeclampsia

1.000

380 (99.7%)

231 (99.6%)

149 (100.0%)

Yes

1 (0.3%)

1 (0.4%)

0 (0.0%)

Previous pregnancy complications

0.003

362 (95.3%)

214 (92.6%)

148 (99.3 %)

Yes

18 (4.7%)

17 (7.4%)

1 (0.7%)

Postpartum hemorrhage

1.000

379 (99.7%)

230 (99.6%)

149 (100.0%)

Yes

1 (0.3%)

1 (0.4%)

0 (0.0%)

Gestational diabetes

1.000

377 (99.2%)

229 (99.1%)

148 (99.3%)

Yes

3 (0.8%)

2 (0.9%)

1 (0.7%)

Preterm delivery

0.004

369 (97.1%)

220 (95.2%)

149 (100.0%)

Yes

11 (2.9%)

11 (4.8%)

0 (0.0%)

Pregnancy-induced hypertension

0.283

377 (99.2%)

228 (98.7%)

149 (100.0%)

Yes

3 (0.8%)

3 (1.3%)

0 (0.0%)

Preeclampsia

1.000

379 (99.7%)

230 (99.6%)

149 (100.0%)

Yes

1 (0.3%)

1 (0.4%)

0 (0.0%)

New born gender

0.438

Male

191 (50.1%)

120 (51.7%)

71 (47.7%)

Female

190 (49.9%)

112 (48.3%)

78 (52.3%)

**Table 2.** Correlation Between Calcium Intake, Mode of Delivery, and Vitamin D Intake in Each Group With Respect to Vitamin D Level
	Total (N = 381)	VD level	P-value
Calcium intake				0.075
No	13 (3.4%)	11 (4.7%)	2 (1.3%)
Yes	368 (96.6%)	221 (95.3%)	147 (98.7%)
Mode of delivery				< 0.0001
Normal vaginal delivery	256 (67.2%)	126 (54.3%)	130 (87.2%)
Operative vaginal delivery	11 (2.9%)	11 (4.7%)	0 (0.0%)
Primary C-section	114 (29.9%)	95 (40.9%)	19 (12.8%)
Cause of primary C-section				0.254
Failure to progress	67 (58.8%)	55 (57.9%)	12 (63.2%)
Failure of induction	27 (23.7%)	25 (26.3%)	2 (10.5%)
Failure to descend	20 (17.5%)	15 (15.8%)	5 (26.3%)
Vitamin D intake				< 0.0001
No	122 (32.02%)	117(50.4%)	5(3.4%)
Yes	259 (67.98%)	115(49.6%)	144(96.6%)

Table 2. Correlation Between Calcium Intake, Mode of Delivery, and Vitamin D Intake in Each Group With Respect to Vitamin D Level

Total (N = 381)

VD level

P-value

≤ 30 ng/mL (N = 232)

> 30 ng/mL (N = 149)

Calcium intake

0.075

13 (3.4%)

11 (4.7%)

2 (1.3%)

Yes

368 (96.6%)

221 (95.3%)

147 (98.7%)

Mode of delivery

< 0.0001

Normal vaginal delivery

256 (67.2%)

126 (54.3%)

130 (87.2%)

Operative vaginal delivery

11 (2.9%)

11 (4.7%)

0 (0.0%)

Primary C-section

114 (29.9%)

95 (40.9%)

19 (12.8%)

Cause of primary C-section

0.254

Failure to progress

67 (58.8%)

55 (57.9%)

12 (63.2%)

Failure of induction

27 (23.7%)

25 (26.3%)

2 (10.5%)

Failure to descend

20 (17.5%)

15 (15.8%)

5 (26.3%)

Vitamin D intake

< 0.0001

122 (32.02%)

117(50.4%)

5(3.4%)

Yes

259 (67.98%)

115(49.6%)

144(96.6%)

**Table 3.** Maternal Outcomes and Vitamin D Level
Maternal outcome	Total (N = 381)	VD level	P-value
Atony
No	369 (96.9%)	221 (95.3%)	148 (99.3%)	0.033
Yes	12 (3.1%)	11 (4.7%)	1 (0.7%)
PPH (postpartum hemorrhage)
No	366 (96.1%)	219 (94.4%)	147 (98.7%)	0.040
Yes	15 (3.9%)	13 (5.6%)	2 (1.3%)
Postpartum transfusion
No	380 (99.7%)	231 (99.6%)	149 (100.0%)	1.000
Yes	1 (0.3%)	1 (0.4%)	0 (0.0%)
Pregnancy-induced hypertension
No	377 (99.0%)	228 (98.3%)	149 (100.0%)	0.159
Yes	4 (1.0%)	4 (1.7%)	0 (0.0%)
Preeclampsia
No	380 (99.7%)	231 (99.6%)	149 (100.0%)	1.000
Yes	1 (0.3%)	1 (0.4%)	0 (0.0%)
Gestational diabetes
No	367 (96.3%)	227 (97.8%)	140 (94.0%)	0.049
Yes	14 (3.7%)	5 (2.2%)	9 (6.0%)

Table 3. Maternal Outcomes and Vitamin D Level

Maternal outcome

Total (N = 381)

VD level

P-value

≤ 30 ng/mL (N = 232)

> 30 ng/mL (N = 149)

Atony

369 (96.9%)

221 (95.3%)

148 (99.3%)

0.033

Yes

12 (3.1%)

11 (4.7%)

1 (0.7%)

PPH (postpartum hemorrhage)

366 (96.1%)

219 (94.4%)

147 (98.7%)

0.040

Yes

15 (3.9%)

13 (5.6%)

2 (1.3%)

Postpartum transfusion

380 (99.7%)

231 (99.6%)

149 (100.0%)

1.000

Yes

1 (0.3%)

1 (0.4%)

0 (0.0%)

Pregnancy-induced hypertension

377 (99.0%)

228 (98.3%)

149 (100.0%)

0.159

Yes

4 (1.0%)

4 (1.7%)

0 (0.0%)

Preeclampsia

380 (99.7%)

231 (99.6%)

149 (100.0%)

1.000

Yes

1 (0.3%)

1 (0.4%)

0 (0.0%)

Gestational diabetes

367 (96.3%)

227 (97.8%)

140 (94.0%)

0.049

Yes

14 (3.7%)

5 (2.2%)

9 (6.0%)

**Table 4.** Neonatal Outcomes and Vitamin D Levels
Neonatal outcome	Total (N = 381)	VD level	P-value
Small for gestational age
No	363 (95.3%)	220 (94.8%)	143 (96.0%)	0.607
Yes	18 (4.7%)	12 (5.2%)	6 (4.0%)
Preterm delivery
No	373 (97.9%)	226 (97.4%)	147 (98.7%)	0.490
Yes	8 (2.1%)	6 (2.6%)	2 (1.3%)

Table 4. Neonatal Outcomes and Vitamin D Levels

Neonatal outcome

Total (N = 381)

VD level

P-value

≤ 30 ng/mL (N = 232)

> 30 ng/mL (N = 149)

Small for gestational age

363 (95.3%)

220 (94.8%)

143 (96.0%)

0.607

Yes

18 (4.7%)

12 (5.2%)

6 (4.0%)

Preterm delivery

373 (97.9%)

226 (97.4%)

147 (98.7%)

0.490

Yes

8 (2.1%)

6 (2.6%)

2 (1.3%)

**Table 5.** Vitamin D Supplement Regimen and Maternal Level
Vitamin D supplement and regimen	Vitamin D level, mean ± SD	P-value
No vitamin D intake	11.44 ± 9.02	< 0.0001
Vitamin D 10,000/week	19.28 ± 11.84
Vitamin D 10,000 twice/week	33.02 ± 4.76
Vitamin D 25,000/week	34.67 ± 7.44

Table 5. Vitamin D Supplement Regimen and Maternal Level

Vitamin D supplement and regimen

Vitamin D level, mean ± SD

P-value

No vitamin D intake

11.44 ± 9.02

< 0.0001

Vitamin D 10,000/week

19.28 ± 11.84

Vitamin D 10,000 twice/week

33.02 ± 4.76

Vitamin D 25,000/week

34.67 ± 7.44