Research Article: Association of Colecalciferol, Ferritin, and Anemia among Pregnant Women: Result from Cohort Study on Vitamin D Status and Its Impact during Pregnancy and Childhood in Indonesia

Date Published: May 20, 2018

Publisher: Hindawi

Author(s): Raden Tina Dewi Judistiani, Lani Gumilang, Sefita Aryuti Nirmala, Setyorini Irianti, Deni Wirhana, Irman Permana, Liza Sofjan, Hesty Duhita, Lies Ani Tambunan, Jeffry Iman Gurnadi, Umar Seno, Reni Ghrahani, Agnes Rengga Indrati, Yunia Sribudiani, Tetty Yuniati, Budi Setiabudiawan.


Studies had shown that iron-cycling was disturbed by inflammatory process through the role of hepcidin. Pregnancy is characterized by shifts of interleukin. Our objective was to determine if 25(OH) vitamin D (colecalciferol) status was associated with ferritin, anemia, and its changes during pregnancy. Method. A cohort study was done in 4 cities in West Java, Indonesia, beginning in July 2016. Subjects were followed up until third trimester. Examinations included were maternal ferritin, colecalciferol, and haemoglobin level. Result. 191 (95.5%) subjects had low colecalciferol, and 151 (75.5%) among them were at deficient state. Anemia is found in 15 (7.5%) subjects, much lower than previous report. Proportion of anemia increased by trimester among women with colecalciferol deficiency. Ferritin status and prepregnancy body mass index in the first trimester were correlated with anemia (r = 0.147, p = 0.038 and r = −0.56, p = 0.03). Anemia in the second trimester was strongly correlated with anemia in the third trimester (r = 0.676, p < 0.01). Conclusion. Our study showed that the state of colecalciferol was not associated with either ferritin state or anemia, but proportion of anemia tends to increase by trimester in the colecalciferol deficient subjects.

Partial Text

The emerging awareness on hypovitaminosis D as major health problem across countries and regions has driven more researches from observational studies to clinical trials. Hypovitaminosis D, defined by serum 25-hydroxy vitamin D (colecalciferol) level below 25 nmol/L, is most common in South Asia and the Middle East [1]. Other studies classified the state as deficient, insufficient, and normal with respect to the disease of interest and also geographical area [1–8]. Certain characteristics were linked to hypovitaminosis D such as life style, less sunlight exposure, dietary habits, and not having fortified food, all included in the major factors that were significantly associated with lower colecalciferol levels [1]. The first report of colecalciferol status among pregnant women from a study in West Java, Indonesia, year 2016, stated that only 4.4% of 160 pregnant women in their first trimester had normal level of colecalciferol (>30 ng/mL), approximately 70% were insufficient (20–29 ng/mL), and the remaining 25.6% were deficient (<20 ng/mL) [9]. This report was a part of cohort study on vitamin D status and its impact during pregnancy and childhood in Indonesia, with special interest in colecalciferol, nutrition, immunological changes and their association with both maternal and fetal outcomes. The cohort started in July 2016 in Bandung, Cimahi, Sukabumi, and Waled, West Java, Indonesia [9]. We expected to include 300 subjects to fit our budget, with approximately equal number from all cities. Our study protocol had been reviewed and ethical clearance was released from Health Research Ethical Committee of Faculty of Medicine, Universitas Padjadjaran. Between July 2016 and July 2017 a total of 201 pregnant women had been completely followed up until third trimester and included for this report. The others were recruited later that they had not met our minimum observation time. Only one subject had a low Mentzer index (<13) and anemia; she was excluded from analysis. The characteristics of our study subjects were as shown in Table 1. Our study showed that first trimester state of colecalciferol was not associated with ferritin. Subjects with vitamin D deficiency in the first trimester were more prone to develop anemia, with increasing proportion as pregnancy progressed to third trimester. First trimester ferritin state was correlated with anemia in the first trimester.   Source:


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