Hypovitaminosis D in Pregnancy in the Mediterranean Region: a Systematic Review

Overview

Journal Eur J Clin Nutr

Specialty Nutritional Sciences

Date 2016 Mar 3

PMID 26931671

Citations 40

Authors

S Karras

S A Paschou

E Kandaraki

P Anagnostis

C Annweiler

B C Tarlatzis

B W Hollis

W B Grant

D G Goulis

Affiliations

Soon will be listed here.

Abstract

Despite high levels of sunshine, maternal hypovitaminosis D during pregnancy is prevalent in the Mediterranean region. The aim of this study is to systematically review trials that investigated vitamin D concentrations during pregnancy in this region, in order to determine predictors of hypovitaminosis D and explain this phenomenon. After applying inclusion/exclusion criteria, 15 studies were entered into the systematic review involving 2649 pregnant women and 820 neonates. The main outcome was maternal vitamin D status, assessed by serum 25-hydroxy-vitamin D (25(OH)D) concentrations. Possible predictors of the outcome included maternal age, body mass index (BMI), race, socioeconomic status, skin type, gestational age, sun exposure, calcium and vitamin D intake and supplementation, smoking status, parity and season of delivery. Studies differed widely in vitamin D deficiency criteria, method of measurement and outcomes. The prevalence of vitamin D insufficiency ranges from 9.3 to 41.4%, whereas that of vitamin D deficiency from 22.7 to 90.3%. A positive association with 25(OH)D concentrations exists for light skin color, white race, uncovered dressing pattern, maternal vitamin D supplementation and season of gestation (spring/summer). An inverse association exists for BMI and gestational age, whereas data for smoking and socioeconomic status are controversial. We concluded that vitamin D deficiency in pregnancy seems to be quite common, even in the Mediterranean region. Racial, social and cultural habits, as well as the absence of preventive supplementation/dietary strategies, seem to negate the benefits of sun exposure.

Citing Articles

The Impact of Vitamin D Deficiency on Gestational Diabetes Mellitus Risk: A Retrospective Study.

Dragomir R, Gheoca Mutu D, Sima R, Toader O, Stanculescu R Cureus. 2024; 16(7):e65037.

PMID: 39035594 PMC: 11260427. DOI: 10.7759/cureus.65037.

Effects of vitamin D in pregnancy on maternal and offspring health-related outcomes: An umbrella review of systematic review and meta-analyses.

Chien M, Huang C, Wang J, Shih C, Wu P Nutr Diabetes. 2024; 14(1):35.

PMID: 38816412 PMC: 11139885. DOI: 10.1038/s41387-024-00296-0.

Vitamin D levels and its influencing factors in pregnant women in mainland China: A systematic review and meta-analysis.

Chen B, Ji P, Wang Q, Qin W, Li Z PLoS One. 2024; 19(5):e0297613.

PMID: 38723005 PMC: 11081274. DOI: 10.1371/journal.pone.0297613.

Clinical practice of vitamin D screening and supplementation in pregnancy in Asia-pacific countries: A cross-sectional study.

Lee R, Chng A, Tan K Heliyon. 2023; 9(11):e21186.

PMID: 38034721 PMC: 10684368. DOI: 10.1016/j.heliyon.2023.e21186.

The Degree of Prepregnancy Vitamin D Deficiency Is Not Associated With Gestational Diabetes in Women Undergoing ART.

Liu Y, Hocher J, Chen H, Hu L, Zhang X, Cai S J Endocr Soc. 2023; 7(12):bvad140.

PMID: 38024652 PMC: 10681737. DOI: 10.1210/jendso/bvad140.

References

Pludowski P, Karczmarewicz E, Bayer M, Carter G, Chlebna-Sokol D, Czech-Kowalska J . Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013; 64(4):319-27. DOI: 10.5603/ep.2013.0012. View

Libon F, Cavalier E, Nikkels A . Skin color is relevant to vitamin D synthesis. Dermatology. 2013; 227(3):250-4. DOI: 10.1159/000354750. View

Garcia-Fernandez E, Rico-Cabanas L, Rosgaard N, Estruch R, Bach-Faig A . Mediterranean diet and cardiodiabesity: a review. Nutrients. 2014; 6(9):3474-500. PMC: 4179172. DOI: 10.3390/nu6093474. View

Clifton-Bligh R, McElduff P, McElduff A . Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabet Med. 2008; 25(6):678-84. DOI: 10.1111/j.1464-5491.2008.02422.x. View

Holick M . Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004; 80(6 Suppl):1678S-88S. DOI: 10.1093/ajcn/80.6.1678S. View

Christesen H, Elvander C, Lamont R, Jorgensen J . The impact of vitamin D in pregnancy on extraskeletal health in children: a systematic review. Acta Obstet Gynecol Scand. 2012; 91(12):1368-80. DOI: 10.1111/aogs.12006. View

Holick M, Binkley N, Bischoff-Ferrari H, Gordon C, Hanley D, Heaney R . Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab. 2012; 97(4):1153-8. DOI: 10.1210/jc.2011-2601. View

Jablonski N, Chaplin G . Colloquium paper: human skin pigmentation as an adaptation to UV radiation. Proc Natl Acad Sci U S A. 2010; 107 Suppl 2:8962-8. PMC: 3024016. DOI: 10.1073/pnas.0914628107. View

Karras S, Anagnostis P, Bili E, Naughton D, Petroczi A, Papadopoulou F . Maternal vitamin D status in pregnancy and offspring bone development: the unmet needs of vitamin D era. Osteoporos Int. 2013; 25(3):795-805. DOI: 10.1007/s00198-013-2468-5. View

10.

Wei S, Qi H, Luo Z, Fraser W . Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2013; 26(9):889-99. DOI: 10.3109/14767058.2013.765849. View

11.

Mpalaris V, Anagnostis P, Goulis D, Iakovou I . Complex association between body weight and fracture risk in postmenopausal women. Obes Rev. 2015; 16(3):225-33. DOI: 10.1111/obr.12244. View

12.

Wortsman J, Matsuoka L, Chen T, Lu Z, Holick M . Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000; 72(3):690-3. DOI: 10.1093/ajcn/72.3.690. View

13.

Holick M . Vitamin D: A millenium perspective. J Cell Biochem. 2003; 88(2):296-307. DOI: 10.1002/jcb.10338. View

14.

Haliloglu B, Ilter E, Benli Aksungar F, Celik A, Coksuer H, Gunduz T . Bone turnover and maternal 25(OH) vitamin D3 levels during pregnancy and the postpartum period: should routine vitamin D supplementation be increased in pregnant women?. Eur J Obstet Gynecol Reprod Biol. 2011; 158(1):24-7. DOI: 10.1016/j.ejogrb.2011.04.002. View

15.

Batieha A, Khader Y, Jaddou H, Hyassat D, Batieha Z, Khateeb M . Vitamin D status in Jordan: dress style and gender discrepancies. Ann Nutr Metab. 2011; 58(1):10-8. DOI: 10.1159/000323097. View

16.

Cadario F, Savastio S, Pozzi E, Capelli A, Dondi E, Gatto M . Vitamin D status in cord blood and newborns: ethnic differences. Ital J Pediatr. 2013; 39:35. PMC: 3685533. DOI: 10.1186/1824-7288-39-35. View

17.

Diaz-Gomez N, Mendoza C, Gonzalez-Gonzalez N, Barroso F, Jimenez-Sosa A, Domenech E . Maternal smoking and the vitamin D-parathyroid hormone system during the perinatal period. J Pediatr. 2007; 151(6):618-23. DOI: 10.1016/j.jpeds.2007.05.003. View

18.

Ustuner I, Keskin H, Tas E, Neselioglu S, Sengul O, Avsar A . Maternal serum 25(OH)D levels in the third trimester of pregnancy during the winter season. J Matern Fetal Neonatal Med. 2011; 24(12):1421-6. DOI: 10.3109/14767058.2011.566768. View

19.

Lau S, Gunton J, Athayde N, Byth K, Cheung N . Serum 25-hydroxyvitamin D and glycated haemoglobin levels in women with gestational diabetes mellitus. Med J Aust. 2011; 194(7):334-7. DOI: 10.5694/j.1326-5377.2011.tb03000.x. View

20.

Pludowski P, Grant W, Bhattoa H, Bayer M, Povoroznyuk V, Rudenka E . Vitamin d status in central europe. Int J Endocrinol. 2014; 2014:589587. PMC: 3984788. DOI: 10.1155/2014/589587. View