Biochemical osteomalacia reaffirmed by signs and symptoms and perinatal outcome. A prospective cohort study of women in Sweden

Abstract

Background: Vitamin D deficiency-induced osteomalacia remains underexplored, despite the substantial migration to northern sun-deprived latitudes. In women, osteomalacia may impair smooth and striated muscle function and disrupt the birth canal. This study aimed to investigate the associations and effect estimates of biochemical osteomalacia on perinatal outcomes. Methods: A prospective cohort study was conducted to examine 71 Swedish and 52 Somali women during pregnancy and breastfeeding, addressing the heightened risk of severe vitamin D deficiency among Somali women. The baseline data comprised blood samples, questionnaires and clinical examination. Two years later, outcome variables were collected and comprised diagnostic codes for delivery methods. Women with miscarriage, stillbirth, or relocation from the region were excluded. Biochemical osteomalacia reaffirmed by signs and symptoms was diagnosed based on a non-invasive, non-radiation protocol. Associations between biochemical osteomalacia and delivery outcomes were analyzed using multinomial logistic regression, adjusted for a minimal set of confounders. Results: In the cohort 20 women, 19 Somali and one Swedish, were diagnosed with biochemical osteomalacia. Among women with biochemical osteomalacia, the adjusted odds ratio (aOR) for instrumental-assisted delivery was 4.92 (95 % CI 1.30–18.65) and the aOR for vacuum extractions was 16.16 (95 % CI 1.20–217.55). Conclusions: Biochemical osteomalacia was associated with a higher incidence of emergency instrumental delivery procedures, including an increased likelihood of vacuum-assisted delivery and emergency Caesarean sections. Primary healthcare staff play a vital role in screening for vitamin D deficiency during pregnancy and breastfeeding period, as well as initiating supplementation to mitigate the risk of adverse perinatal outcomes.