Vitamin D Status in Women with Uterine Fibroids: A Cross-sectional Study

Farah Farzaneh; Kiana Sadeghi; Mohammad Chehrazi

doi:10.3889/oamjms.2020.3863

Authors

Farah Farzaneh Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Kiana Sadeghi Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammad Chehrazi Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran

DOI:

https://doi.org/10.3889/oamjms.2020.3863

Keywords:

25-Hydroxyvitamin D3, , Risk factors, Leiomyoma, Cross Sectional studies

Abstract

BACKGROUND: Uterine fibroids (UFs) affect women of reproductive age and lead to major morbidity in premenopausal women. Identifying modifiable risk factors could help develop new UF prevention and treatment strategies.

OBJECTIVES: The purpose of this research was to investigate the relationship between serum Vitamin D3 levels and UF in women seeking gynecological services.

METHODS: This caseâ€“control design was conducted in September 2018 at the outpatient gynecology clinic of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Cases had at least one ultrasound confirmed fibroid lesion with an average volume of 2 cm or greater. The outpatient clinic has enrolled a control group of patients without UF, based on transvaginal ultrasonography or any other gynecologic pathology. Radioimmunoassay techniques were applied to measure serum Vitamin D [25(OH) D3] levels.

RESULTS: A total of 148 patients met inclusion criteria, 71 women were had at least one UF and the remaining 77 participants showed normal, UF-free uterine structure. The mean serum concentration of 25-hydroxyvitamin D3 was lower in UF patients (21.37 Â± 7.49 ng/mL) than without (24.62 Â± 9.21 ng/mL) (p = 0.02). A modified odds ratio derived from a backward logistic regression model for 25-hydroxyvitamin D3 that included positive family history, age, body mass index, bleeding volume, physical activity, sun exposure, and history of abortion was 0.92 (95% CI, 0.88â€“0.98) (P = 0.02).

CONCLUSION: For women with UFs, the serum level of 25-hydroxyvitamin D3 was significantly lower than in controls. Vitamin D3 deficiency is a potential risk factor for UFs to occur.

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References

Flake GP, Andersen J, Dixon D. Etiology and pathogenesis of uterine leiomyomas: A review. Environ Health Perspect. 2003;111(8):1037-54. https://doi.org/10.1289/ehp.5787 PMid:12826476

Okolo S. Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2008;22(4):571-88. PMid:18534913

Laughlin SK, Schroeder JC, Baird DD. New directions in the epidemiology of uterine fibroids. Semin Reprod Med. 2010;28(3):204-17. https://doi.org/10.1055/s-0030-1251477 PMid:20414843

Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F. Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2018;46:3-11. https://doi.org/10.1016/j. bpobgyn.2017.09.004 PMid:29054502

Zepiridis LI, Grimbizis GF, Tarlatzis BC. Infertility and uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2016;34:66-73. https://doi.org/10.1016/j.bpobgyn.2015.12.001 PMid:26856931

Parazzini F, Tozzi L, Bianchi S. Pregnancy outcome and uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2016;34:74-84. https://doi.org/10.1016/j.bpobgyn.2015.11.017 PMid:26723475

Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725-36. PMid:17430732

Baird D. Hypothesis: Vitamin D protects against uterine fibroid development. Ann Epidemiol. 2008;9(18):710. https://doi. org/10.1016/j.annepidem.2008.08.018

Sabry M, Halder SK, Allah AS, Roshdy E, Rajaratnam V, Al-Hendy A. Serum Vitamin D3 level inversely correlates with uterine fibroid volume in different ethnic groups: A cross-sectional observational study. Int J Womens Health. 2013;5:93-100. https://doi.org/10.2147/ijwh.s38800 PMid:23467803

Baird DD, Hill MC, Schectman JM, Hollis BW. Vitamin d and the risk of uterine fibroids. Epidemiology. 2013;24(3):447-53. https://doi.org/10.1097/ede.0b013e31828acca0 PMid:23493030

Paffoni A, Somigliana E, Vigano P, Benaglia L, Cardellicchio L, Pagliardini L, et al. Vitamin D status in women with uterine leiomyomas. J Clin Endocrinol Metab. 2013;98(8):E1374-8. https://doi.org/10.1210/jc.2013-1777 PMid:23824422

Mitro SD, Zota AR. Vitamin D and uterine leiomyoma among a sample of US women: Findings from NHANES, 2001- 2006. Reprod Toxicol. 2015;57:81-6. https://doi.org/10.1016/j. reprotox.2015.05.013 PMid:26047529

Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M, Pajouhi M, et al. Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health. 2004;4(1):38. https://doi.org/10.1186/1471-2458-4-38 PMid:15327695

Maghbooli Z, Hossein-Nezhad A, Shafaei AR, Karimi F, Madani FS, Larijani B. Vitamin D status in mothers and their newborns in Iran. BMC Pregnancy Childbirth. 2007;7(1):1. https://doi.org/10.1186/1471-2393-7-1 PMid:17295904

Hovsepian S, Amini M, Aminorroaya A, Amini P, Iraj B. Prevalence of Vitamin D deficiency among adult population of Isfahan city, Iran. J Health Popul Nutr. 2011;29(2):149-55. https://doi.org/10.3329/jhpn.v29i2.7857 PMid:21608424

Heshmat R, Mohammad K, Majdzadeh S, Forouzanfar M, Bahrami A, Omrani GR. Vitamin D deficiency in Iran: A multi-center study among different urban areas. Iran J Public Health. 2008;37(1):72-8.

Tabrizi R, Moosazadeh M, Akbari M, Dabbaghmanesh MH, Mohamadkhani M, Asemi Z, et al. High prevalence of Vitamin D Deficiency among Iranian population: A systematic review and meta-analysis. Iran J Med Sci. 2018;43(2):125-39. PMid:29749981

Tehrani FR, Simbar M, Abedini M. Reproductive morbidity among Iranian women; issues often inappropriately addressed in health seeking behaviors. BMC Public Health. 2011;11(1):863. https://doi.org/10.1186/1471-2458-11-863 PMid:22078752

Horst RL. Exogenous versus endogenous recovery of 25-hydroxyvitamins D2 and D3 in human samples using high-performance liquid chromatography and the DiaSorin LIAISON total-D assay. J Steroid Biochem Mol Biol. 2010;121(1-2):180-2. https://doi.org/10.1016/j.jsbmb.2010.03.010 PMid:20214981

Wagner D, Hanwell HE, Vieth R. An evaluation of automated methods for measurement of serum 25-hydroxy Vitamin D. Clin Biochem. 2009;42(15):1549-56. PMid:19631201

Ersfeld DL, Rao DS, Body JJ, Sackrison JL Jr., Miller AB, Parikh N, et al. Analytical and clinical validation of the 25 OH vitamin D assay for the LIAISON automated analyzer. Clin Biochem. 2004;37(10):867-74. https://doi.org/10.1016/j.clinbiochem.2004.06.006 PMid:15369717

Ritu G, Gupta A. Vitamin D deficiency in India: Prevalence, causalities and interventions. Nutrients. 2014;6(2):729-75. https://doi.org/10.3390/nu6020729 PMid:24566435.

Mendes MA, da Silva I, Ramires V, Reichert F, Martins R, Ferreira R, et al. Metabolic equivalent of task (METs) thresholds as an indicator of physical activity intensity. PLoS One. 2018;13(7):e0200701. https://doi.org/10.1371/journal.pone.0200701 PMid:30024953.

Humayun Q, Iqbal R, Azam I, Khan AH, Siddiqui AR, Baig- Ansari N. Development and validation of sunlight exposure measurement questionnaire (SEM-Q) for use in adult population residing in Pakistan. BMC Public Health. 2012;12:421. https:// doi.org/10.1186/1471-2458-12-421 PMid:22682277.

Somigliana E, Panina-Bordignon P, Murone S, Di Lucia P, Vercellini P, Vigano P. Vitamin D reserve is higher in women with endometriosis. Hum Reprod. 2007;22(8):2273-8. https:// doi.org/10.1093/humrep/dem142 PMid:17548365

BlÃ¤uer M, Rovio PH, Ylikomi T, Heinonen PK. Vitamin D inhibits myometrial and leiomyoma cell proliferation in vitro. Fertil Steril. 2009;91(5):1919-25. https://doi.org/10.1016/j. fertnstert.2008.02.136 PMid:18423458

Sharan C, Halder SK, Thota C, Jaleel T, Nair S, Al-Hendy A. Vitamin D inhibits proliferation of human uterine leiomyoma cells via catechol-O-methyltransferase. Fertil Steril. 2011;95(1):247- 53. https://doi.org/10.1016/j.fertnstert.2010.07.1041 PMid:20736132

Sozen I, Arici A. Interactions of cytokines, growth factors, and the extracellular matrix in the cellular biology of uterine leiomyomata. Fertil Steril. 2002;78(1):1-12. https://doi. org/10.1016/s0015-0282(02)03154-0 PMid:12095482

Theocharis AD, Skandalis SS, Gialeli C, Karamanos NK. Extracellular matrix structure. Adv Drug Deliv Rev. 2016;97:4- 27. https://doi.org/10.1016/j.addr.2015.11.001 PMid:26562801

Rafique S, Segars JH, Leppert PC. Mechanical signaling and extracellular matrix in uterine fibroids. Semin Reprod Med. 2017;35(6):487-93. https://doi.org/10.1055/s-0037-1607268 PMid:29100236

Korompelis P, Piperi C, Adamopoulos C, Dalagiorgou G, Korkolopoulou P, Sepsa A, et al. Expression of vascular endothelial factor-A, gelatinases (MMP-2, MMP-9) and TIMP-1 in uterine leiomyomas. Clin Chem Lab Med. 2015;53(9):1415-24. https://doi.org/10.1515/cclm-2014-0798 PMid:25470608

Narula S, Harris A, Tsaltas J. A review of the molecular basis for reduced endometrial receptivity in uterine fibroids and polyps. J Endometr Pelvic Pain Disord. 2017;9(4):239-44. https://doi. org/10.5301/jeppd.5000304

Brakta S, Diamond JS, Al-Hendy A, Diamond MP, Halder SK. Role of Vitamin D in uterine fibroid biology. Fertil Steril. 2015;104(3):698-706. https://doi.org/10.1016/j. fertnstert.2015.05.031

PMid:26079694