Vitamin D deficiency in pregnancy: bringing the issues to light

Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30329, USA.
Journal of Nutrition (Impact Factor: 3.88). 03/2007; 137(2):305-6.
Source: PubMed
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    • "There is currently no consensus what the correct reference values for serum Vitamin D in pregnancy are, whether these reference values should be the same for all ethnic populations nor what the physiologic changes during pregnancy are. Immigrants in northern countries, especially when they are dark skinned and/or wear total body covering clothes (e.g. the traditional muslim clothing), are more prone to vitamin D deficiency, particularly in pregnancy (McCullough, 2007; Van der Meer et al., 2006). We studied the prevalence of vitamin D deficiency in maternal and umbilical cord blood in a pregnant population of mixed ethnic origin. "
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    ABSTRACT: Objective: To describe the status of vitamin D levels in maternal and umbilical cord blood in term pregnant woman in a mixed ethnic population in an inner-city European maternity. A single centre prospective cohort descriptive study including all uncomplicated singleton term pregnancies from April 1, 2011 until May 31, 2011. Plasma 25-hydroxy vitamin D level was determined in maternal and umbilical cord blood and data on age, previous obstetric history, ethnicity, nutritional intake and use of vitamin supplements were registered. Complete data were collected in 94 patients. Mean maternal serum vitamin D was 16.6 ng/mL. Using a cut-off of 20 ng/mL, 66% of women were classified as deficient. Deficiency was present in all ethnic groups, but lower levels were noted in North-African, Central-African and Asian women. A strong correlation between maternal and umbilical cord levels was noted (R = 0.91). Number of previous pregnancies and intake of supplements had no influence. The majority of low risk pregnant women showed vitamin D deficiency which was strongly correlated with umbilical cord levels. The prevalence was highest in the immigrant non-European population and was not influenced by intake of vitamin supplements. It can therefore be questioned whether the proposed cut-off values are appropriate.
    03/2013; 5(1):3-5.
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    • "The data collected by the National Health and Nutrition Examination Surveys within North America document a 4-fold increase in the prevalence of vitamin D deficiency over the past 10 –15 years with as much as 36% of the USA population being affected (Nesby-O'Dell et al., 2002; Looker et al., 2008). Embedded within these data are the alarming findings that populations with the greatest physiological needs for vitamin D, such as pregnant women, neonates, children and adolescents are also at highest risk for vitamin D deficiency (McCullough, 2007; Alemzadeh et al., 2008; Kovacs, 2008). "
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    ABSTRACT: The steroid hormone vitamin D is historically recognized for its relevance to bone health and calcium homeostasis. Recent years have witnessed a shift in focus to non-skeletal benefits of vitamin D; in this latter context, an accruing body of literature attests to a relevance of vitamin D to reproductive physiology. This article reviews the existing data about the diverse and previously underappreciated roles for vitamin D in reproductive health. A large body of available literature suggests that vitamin D deficiency may be detrimental to reproductive biology. However, given that our appreciation of vitamin D's role in reproductive physiology is almost entirely shaped by 'associative' studies and that data based on prospective interventional trials are limited, these concepts remain predominantly conjectural. Exact mechanisms whereby vitamin D may participate in the regulation of reproductive physiology remain far from clear. This review underscores a need for appropriately designed intervention trials to address the existing knowledge gaps and to delineate the specific roles of vitamin D signaling in reproductive biology.
    Human Reproduction 07/2012; 27(10):3015-27. DOI:10.1093/humrep/des248 · 4.57 Impact Factor
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    • "Vitamin D in supplements is found as either vitamin D 2 or D 3 . The latter could be three times more effective than vitamin D 2 in raising serum concentrations of vitamin D and maintaining those levels for a longer time; also, its metabolites have superior affinity for vitamin D-binding proteins in plasma (Armas 2004; McCullough 2007). As vitamin D has a short half-life, adequate vitamin D intake is necessary in order to ensure sustained circulating levels. "
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    ABSTRACT: Vitamin D deficiency or insufficiency is thought to be common among pregnant women. Vitamin D supplementation during pregnancy has been suggested as an intervention to protect against adverse gestational outcomes. To examine whether supplements with vitamin D alone or in combination with calcium or other vitamins and minerals given to women during pregnancy can safely improve maternal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011), the International Clinical Trials Registry Platform (ICTRP) (31 October 2011), the Networked Digital Library of Theses and Dissertations (28 October 2011) and also contacted relevant organisations (8 April 2011). Randomised and quasi-randomised trials with randomisation at either individual or cluster level, evaluating the effect of supplementation with vitamin D alone or in combination with other micronutrients for women during pregnancy. Two review authors independently i) assessed the eligibility of studies against the inclusion criteria ii) extracted data from included studies, and iii) assessed the risk of bias of the included studies. Data were checked for accuracy. The search strategy identified 34 potentially eligible references. We included six trials assessing a total of 1023 women, excluded eight studies, and 10 studies are still ongoing. Five trials involving 623 women compared the effects of vitamin D alone versus no supplementation/placebo and one trial with 400 women compared the effects of vitamin D and calcium versus no supplementation.Only one trial with 400 women reported on pre-eclampsia: women who received 1200 IU vitamin D along with 375 mg of elemental calcium per day were as likely to develop pre-eclampsia as women who received no supplementation (average risk ratio (RR) 0.67; 95% confidence interval (CI) 0.33 to 1.35). Data from four trials involving 414 women consistently show that women who received vitamin D supplements had higher concentrations of vitamin D in serum at term than those women who received no intervention or a placebo; however the magnitude of the response was highly heterogenous. Data from three trials involving 463 women suggest that women who receive vitamin D supplements during pregnancy less frequently had a baby with a birthweight below 2500 grams than those women receiving no treatment or placebo; statistical significance was borderline (RR 0.48; 95% CI 0.23 to 1.01).In terms of other conditions, there were no significant differences in adverse side effects including nephritic syndrome (RR 0.17; 95% CI 0.01 to 4.06; one trial, 135 women); stillbirths (RR 0.17; 95% CI 0.01 to 4.06; one trial, 135 women) or neonatal deaths (RR 0.17; 95% CI 0.01 to 4.06; one trial, 135 women) between women who received vitamin D supplements in comparison with women who received no treatment or placebo. No studies reported on preterm birth, maternal death, admission to neonatal intensive care unit/special nursery or Apgar scores. Vitamin D supplementation in a single or continued dose during pregnancy increases serum vitamin D concentrations as measured by 25-hydroxyvitamin D at term. The clinical significance of this finding and the potential use of this intervention as a part of routine antenatal care are yet to be determined as the number of high quality trials and outcomes reported is too limited to draw conclusions on its usefulness and safety. Further rigorous randomised trials are required to evaluate the role of vitamin D supplementation in pregnancy.
    Cochrane database of systematic reviews (Online) 02/2012; 2(2):CD008873. DOI:10.1002/14651858.CD008873.pub2 · 6.03 Impact Factor
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