ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the foetal skeleton
Eur J Endocrinol April 10, 2015 EJE-14-0826
Rebecca Moon, Nicholas Harvey and Cyrus Cooper cc at mrc.soton.ac.uk
R Moon, MRC Lifecourse Epidemiology Unit, University of Southampton, SOUTHAMPTON, United Kingdom
N Harvey, MRC Lifecourse Epidemiology Unit, University of Southampton, SOUTHAMPTON, United Kingdom
C Cooper, MRC Lifecourse Epidemiology Unit, University of Southampton, SOUTHAMPTON, United Kingdom
Overview Pregnancy and vitamin D has the following summary
|IU||Cumulative Benefit||Blood level||Cofactors||Calcium||$*/month|
|200|| Better bones for mom|
with 600 mg of Calcium
|6 ng/ml increase||Not needed||No effect||$0.10|
|400|| Less Rickets (but not zero with 400 IU)|
3X less adolescent Schizophrenia
Fewer child seizures
|20-30 ng/ml||Not needed||No effect||$0.20|
|2000|| 2X More likely to get pregnant naturally/IVF |
2X Fewer dental problems with pregnancy
8X less diabetes
4X fewer C-sections (>37 ng)
4X less preeclampsia (40 ng vs 10 ng)
5X less child asthma
2X fewer language problems age 5
|42 ng/ml||Desirable||< 750 mg||$1|
|4000|| 2X fewer pregnancy complications |
2X fewer pre-term births
|49 ng/ml|| Should have |
|< 750 mg||$3|
|6000||Probable: larger benefits for above items|
Just enough D for breastfed infant
More maternal and infant weight
|< 750 mg||$4|
The articles in Pregnancy AND Meta-analysis are here:
- Multiple Sclerosis 40 percent more likely if mother had low vitamin D – meta-analysis Jan 2020
- Pregnancies helped by Vitamin D (insulin and birth weight in this case) – 28th meta-analysis Oct 2019
- Preeclampsia 2.7 X less likely if 50,000 IU of Vitamin D every 2 weeks – meta-analysis Sept 2019
- Autism risk increased 30 percent by Cesareans (both low vitamin D) – meta-analysis Sept 2019
- Vitamin D treats Gestational Diabetes, decreases hospitalization and newborn complications – meta-analysis March 2019
- Birth size and weight increased by Vitamin D – meta-analysis Feb 2019
- Pregnancies helped by Vitamin D in many ways – 27th meta-analysis Jan 2019
- Vitamin D supplementation reduced SGA, fetal mortality, infant mortality – JAMA Meta – May 2018
- Gestational Diabetes 39 percent more likely if insufficient Vitamin D – Meta-analysis March 2018
- Preeclampsia reduced 2X by Vitamin D, by 5X if also add Calcium – meta-analysis Oct 2017
- Preeclampsia risk reduced 60 percent if supplement with Vitamin D (they ignored dose size) – meta-analysis Sept 2017
- Small for gestational age is 1.6 X more likely if mother was vitamin D deficient – meta-analysis Aug 2017
- Miscarriage 2 times more likely if low vitamin D – meta-analysis May 2017
- Fewer than half of pregnancies will get even 20 ng of vitamin D with 800 IU daily dose – meta-analysis May 2017
- Low Vitamin D results in adverse pregnancy and birth outcomes – Wagner meta-analysis March 2017
- Bacterial vaginosis in pregnancy increased prematurity risk by 60 percent - meta-analysis 1999
- Preterm birth rate reduced by 43 percent with adequate Vitamin D supplementation – meta-analysis Feb 2017
- Vitamin D during pregnancy reduces risk of childhood asthma by 13 percent – meta-analysis Dec 2016
- Vitamin D helps during pregnancy – meta-analysis Feb 2016
- Preterm birth 30 percent more likely if low vitamin D – meta-analysis May 2016
- Preterm birth extended by 2 weeks with Omega-3 – Meta-analysis Nov 2015
- Gestational Diabetes Mellitus 1.5X more likely if low vitamin D – meta-analysis Oct 2015
- Infant wheezing 40 percent less likely if mother supplemented with vitamin D, vitamin E, or Zinc – meta-analysis Aug 2015
- Birth weight and length increased with high levels of vitamin D – meta-analysis March 2015
- Pregnancy and Vitamin D – meta-analysis April 2015
- More vitamin D needed during pregnancy – meta-analysis Oct 2014
- Preeclampsia rate cut in half by high level of vitamin D – meta-analysis March 2014
- Preeclampsia 2.7X more frequent if low vitamin D – meta-analysis Sept 2013
- 2X more preeclampsia when vitamin D less than 30 ng, etc. - meta-analysis March 2013
- 2X more likely to have preeclampsia if less than 20 ng of vitamin D – Meta-analysis Jan 2013
- Multiple Sclerosis 23 percent more likely if born in April vs. Oct – meta-analysis Nov 2012
- Pregnancy and vitamin D meta-analysis – July 2012
- Low vitamin D increased probability of low birth weight by 60 percent – meta-analysis June 2012
- Gestational diabetes 60 percent more likely below 20 ng of vitamin D – meta-analysis Feb 2012
- Premature or low birth weight resulted in children 3X more likely to be anxious – meta-analysis May 2011
Vitamin D status is increasingly associated with wide ranging clinical outcomes. There is now a wealth of observational studies reporting on its associations with obstetric complications, including preeclampsia, gestational diabetes and mode and timing of delivery. The findings are inconsistent and currently there is a lack of data from high quality intervention studies to confirm a causal role for vitamin D in these outcomes. This is similarly true with regards to fetal development, including measures of fetal size and skeletal mineralisation.
Overall, there is an indication of possible benefits of vitamin D supplementation during pregnancy for
- offspring birthweight,
- calcium concentrations and bone mass, and for
- reduced maternal pre-eclampsia.
However, for none of these outcomes is the current evidence base conclusive, and the available data justify the instatement of high-quality randomised placebo controlled trials in a range of populations and health care settings to establish potential efficacy and safety of vitamin D supplementation to improve particular outcomes.
Received 1 October 2014, Accepted Preprint first posted online on 10 April 2015
Download the PDF from VitaminDWiki
Figure 1: Forest plot of the association between maternal vitamin D status and risk of preeclampsia (observational studies)
Table 1: Meta-analyses of maternal vitamin D status (intake and serum 25-hydroxyvitamin D level) and risk of pre-eclampsia
Table 2: Intervention studies of vitamin D supplementation (alone, and in combination with calcium supplementation) in pregnancy to reduce obstetric complications
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